• Adam W Gaffney, Laura Hawks, David Bor, Alexander C White, Steffie Woolhandler, Danny McCormick, and David U Himmelstein.
• Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA. Electronic address: agaffney@challiance.org.
• Chest. 2021 Jun 1; 159 (6): 2173-2182.

BackgroundRacial and ethnic as well as economic disparities in access to care among persons with asthma and COPD have been described, but long-term access trends are unclear.Research QuestionHave health coverage and access to care and medications among adults with airways disease improved, and have disparities narrowed?Study Design And MethodsUsing the 1997 through 2018 National Health Interview Survey, we examined time trends in health coverage and the affordability of medical care and prescription drugs for adults with asthma and COPD, overall and by income and by race and ethnicity. We performed multivariate linear probability regressions comparing coverage and access in 2018 with that in 1997.ResultsOur sample included 76,843 adults with asthma and 30,548 adults with COPD. Among adults with asthma, lack of insurance rose in the first decade of the twenty-first century, peaking with the Great Recession, but fell after implementation of the Affordable Care Act (ACA). From 1997 through 2018, the uninsured rate among adults with asthma decreased from 19.4% to 9.6% (adjusted 9.27 percentage points; 95% CI, 7.1%-11.5%). However, the proportions delaying or foregoing medical care because of cost or going without medications did not improve. Racial and ethnic as well as economic disparities present in 1997 persisted over the study period. Trends and disparities among those with COPD were similar, although the proportion going without needed medications worsened, rising by an adjusted 7.8 percentage points.InterpretationCoverage losses among persons with airways disease in the first decade of the twenty-first century were reversed by the ACA, but neither care affordability nor disparities improved. Further reform is needed to close these gaps.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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