In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon

  • John Heintzman
  • Steffani R. Bailey
  • Jennifer DeVoe
  • Stuart Cowburn
  • Tanya Kapka
  • Truc-Vi Duong
  • Miguel Marino



Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and non-Hispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Cross-sectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status.


Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014.


Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014.


Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort.


Health insurance Hispanic/Latino Americans Affordable Care Act Community health centers 



We acknowledge the patients, staff, and clinicians of the OCHIN Practice-Based Research Network.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board of Oregon Health and Science University (OHSU) approved this study.


The study received funding from the Agency for Healthcare Quality and Research (AHRQ) Grant No. K08 HS021 522, National Institute on Drug Abuse Grant No. K23DA037453, and AHRQ No. R01HS024270: (PACE).

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

This analysis was performed with deidentified patient data, so was deemed exempt from individual informed consent procedures by the Institutional Review Board at OHSU. Community clinics in our network have consented to the use of their data in this manner.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2016

Authors and Affiliations

  • John Heintzman
    • 1
  • Steffani R. Bailey
    • 1
  • Jennifer DeVoe
    • 1
    • 2
  • Stuart Cowburn
    • 2
  • Tanya Kapka
    • 3
  • Truc-Vi Duong
    • 4
  • Miguel Marino
    • 1
    • 5
  1. 1.Department of Family MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.OCHIN, IncPortlandUSA
  3. 3.Virginia Garcia Memorial Health CenterBeavertonUSA
  4. 4.Oakland University William Beaumont School of MedicineRochesterUSA
  5. 5.Division of Biostatistics, Department of Public Health and Preventive MedicineOregon Health and Science UniversityPortlandUSA

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