Alliance Senior Policy Advisor Okey K. Enyia, DrPH, MPH Discusses his Research on Equity and Access to Care

This post was authored by Okey Enyia, DrPH, MPH.

I’m honored and humbled to share that I have successfully defended my doctoral dissertation – a first-of-its-kind study examining the Affordable Care Act and its impact on access to care for Black men – from the George Washington University School of Public Health. Why did I pursue a doctorate in public health? 

1) I wanted to take a research-based approach to exploring my practical experiences as a conscious Black man in society.

2) I endeavored to employ critical consciousness to drive self-liberation for Black and Brown people worldwide. 

One of the things I loved about the doctorate in public health (health policy concentration) was that it allowed me to work at the nexus of theory and praxis in a variety of contexts. Consequently, I am now a subject matter expert in four distinct yet interrelated fields: 1) men’s health, 2) public health, 3) health care utilization, and 4) health policy.

My dissertation was titled “Examining the Affordable Care Act and its Impact on Access to Care for Black men and White men: Implications for Policy and Practice.” 

Contextually, Black men experience poor health outcomes across a spectrum of chronic medical conditions and comorbidities that ultimately lead to lower quality of life and premature death. Lack of access to medical care is one of many factors that contribute to these poor outcomes. My study examined the impact of the Patient Protection and Affordable Care Act of 2010 (ACA) on Black men’s access to care compared to White men ages 18-64 and proposed strategies to help address any inequities. The ACA undergirded this study because it included several provisions that were specifically meant to help address racial and ethnic health disparities and improve health outcomes.

This study took a longitudinal approach by examining access to care among non-Hispanic Black men and non-Hispanic White men ages 18-64 from 2011-2019. Using a publicly available secondary data source, the Medical Expenditure Panel Survey (MEPS), a descriptive and multivariate analysis was conducted to examine the relationship between race, sociodemographic characteristics, and two indicators of health care access (insurance status and usual source of care). The analysis found that the ACA decreased the proportions of non-Hispanic Black men and non-Hispanic White men who were uninsured after 2014 by nearly 50%; however, racial disparities persisted. 

Other key findings are as follows: 

1) race was a significant predictor of being uninsured, with non-Hispanic Black men having 30% greater odds than non-Hispanic White men of being uninsured, and 

2) non-Hispanic Black men had 25% lower odds than non-Hispanic White men of having a usual source of care. 

Other factors significantly associated with a greater likelihood of being uninsured were being part-time and intermittently employed and living in a Southern state. Factors significantly associated with a greater likelihood of not having a usual source of care were education (i.e., completing a high school or a college degree) full-time, part-time, or intermittent employment, and region (living in the South or the West).

While the ACA achieved one of its goals of increasing health insurance coverage for men of both racial groups examined in this study, the racial gap between non-Hispanic Black men and non-Hispanic White men did not close for the two outcomes of interest – being uninsured or having a usual source of care post-ACA. These findings have implications for policy and practice to improve health care access. 

My specific policy recommendations proposed include: 

1) develop pathways to coverage for states that have yet to adopt Medicaid expansion, and 

2) use a multilevel approach to expand the proportion of men with a usual source of care that includes:

a) disseminating educational messages to improve men’s awareness of the value of having a regular source of care and 

b) facilitating health care delivery and payment reforms that incentivize health care institutions to increase the number of Black men who are meaningfully engaged with a regular source of care.

My future research includes but is not limited to: 

1) taking a mixed methods approach (i.e. quantitative and qualitative) to data collection, analysis and interpretation across race and gender; 

2) specifically examining African immigrant or foreign-born men to potentially yield further insights to support culturally-tailored interventions for men of African descent; 

3) control for health status and chronic medical conditions; 

4) build out the artificial intelligence health equity space in the context of men’s health; and 

5) operationalize a Policy Advocacy in Action Framework for men whereby any interested stakeholders can directly influence policy through civic engagement and advocacy at all levels of government.

My study lays the groundwork and has the potential to revolutionize the policy landscape for Black men because it proposes nuanced policy recommendations and practical steps that seek to make an indelible impact on the domestic and global health care ecosystems. 

As a scholar-activist and policy-maker, I look forward to serving in government, higher education, consulting, public speaking, and entrepreneurship as I shift into the next phase of my career.

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