Inequalities in hospitalizations for ambulatory care sensitive conditions in New York City before and after the affordable care act

• Published date: 01 December 2023
• Author: Michael K. Gusmano,Daniel Weisz,Victor G. Rodwin
• Date: 01 December 2023
• DOI: http://doi.org/10.1002/wmh3.548

Received: 21 February 2022

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Revised: 5 July 2022

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Accepted: 6 August 2022

DOI: 10.1002/wmh3.548

ORIGINAL ARTICLE

Inequalities in hospitalizations for ambulatory

care sensitive conditions in New York City

before and after the affordable care act

Michael K. Gusmano

1

|Daniel Weisz

2

|Victor G. Rodwin

3

1

Professor and Associate Dean for Academic

Programs, College of Health, Lehigh

University, Bethlehem, Pennsylvania, USA

2

Research Scholar, Department of Research,

The Hastings Center, Garrison,

New York, USA

3

New York University, New York, New

York, USA

Correspondence

Michael K. Gusmano, Professor and

Associate Dean for Academic Programs,

College of Health, Lehigh University,

Bethlehem, PA, USA.

Email: mig321@lehigh.edu

Abstract

The Patient Protection and Affordable Care Act (ACA)

was signed into law by U.S. President Obama in 2010

and fully implemented in 2014. The ACA expandedhealth

insurance by expanding the Medicaid program, creating

health insurance exchanges (now called “marketplaces”)

in which people with incomes between 139% and 400%

of the federal poverty level, could purchase subsidized

insurance coverage, and by regulating health insurance

to eliminate practices such as denying coverage to

people with pre‐existing conditions, or basing premiums

on health status. We investigate the effects of the ACA's

implementation on access to ambulatory health services

in New York City by comparing rates of hospitalizations

for ambulatory care‐sensitive conditions (ACSC) before

and after the full implementation of the law. Although the

ACA was associated with a significant decrease in the

rate of ACSC in NYC, we find that there continue to be

systemic inequalities by gender, race, ethnicity, income,

and insurance status. We argue that the broader social

and economic inequalities at the national and state levels,

including tax and spending policies that have led to

increased income and wealth inequalities, help explain

why we see persistent inequalities in hospitalizations

for ACSC.

KEYWORDS

Affordable Care Act, inequality, New York City

Key Points

•Advocates hoped that the full implementation of the

Affordable Care Act would reduce inequalities in

access to health care.

•We find that, after the implementation of the Afford-

able Care Act in New York City, there are still large

World Med. & Health Policy. 2023;15:324–335.wileyonlinelibrary.com/journal/wmh3324

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