Affordable Care Act and Disparities in Health Services Utilization among Ethnic Minoritiy Breast Cancer Survivors: Evidence from Longitudinal Medical Expenditure Panel Surveys 2008-2015

Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women, but mortality rates are higher for black women. Scant evidence exists on how heath care reform policies differentially affect the use of health care services among racial/ethnic minority breast cancer survivors in the US. This study draws on rich, nationally representative data, the 2008-2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle, and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance among breast cancer survivors. Gaps in mammography use significantly declined post-ACA for Hispanic breast cancer survivors compared with white and black survivors. The ACA did not significantly impact disparities in physician utilization. Out-of-pocket prescription drug expenditures declined, narrowing the gap for black and Hispanic survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.