After Mass. health law, racial gaps in heart care persist

One of the cornerstones of the 2006 Massachusetts health care law was the belief that improving access to care would narrow health gaps among different racial, ethnic, and socioeconomic groups. A new report from Harvard says disparities in the heart treatments provided to black and white patients persisted two years after enactment of the landmark law requiring near-universal insurance coverage.

Dr. Michelle Albert, a cardiologist at Brigham and Women’s Hospital and Harvard Medical School, led a group that analyzed the billing records for more than 62,000 heart patients two years before the law was enacted and more than 61,000 patients two years after. The researchers tracked which patients with blocked blood flow to their hearts received bypass surgery, angioplasty, or stenting. In the last two procedures, a balloon-tipped catheter is threaded up from an artery in the leg to blood vessels leading to the heart. A balloon is inflated to clear blockages and sometimes a mesh metal tube called a stent is left behind to prop these blood vessels open.

Before the health care law was passed, black patients were 43 percent less likely to get these procedures than white patients; Hispanic patients were 17 percent less likely than whites. After the health care law, those differences did not budge. There was a change among Asian patients. Before the law, they were 50 percent more likely to get the procedures than whites and 80 percent more likely than whites after the law. Albert said that should be interpreted with caution because there were only 1,265 Asian patients in the study.

“Clearly our results suggest that the introduction of insurance does not eliminate preexisting disparities,” she said in an interview. “Blacks were just as unlikely to receive coronary artery bypass surgery, [angioplasty, or stenting] as they were prereform.”