- After the United States implemented the Affordable Care Act, racial and ethnic disparities in access to both insurance coverage and healthcare services for adults narrowed, according to a new study from the Commonwealth Fund.
- Disparities in rates of insurance coverage between white adults and black and Hispanic adults narrowed more in states that expanded Medicaid than in states that did not. In fact, black adults in expansion states are now more likely to be insured than their white peers in non-expansion states, the study found.
- However, progress in reducing the rates of uninsured people stalled after 2016 for whites (8.2% in 2016 versus 8.6% in 2018) and blacks (13.7% in 2016 and 14.4% in 2018). Uninsured rates did not drop for Hispanics during the same period, but the ethnic group historically has had higher rates of uninsured people than the other two groups.
The percentage of uninsured Americans has dropped dramatically since the ACA was implemented in 2014 — from 20.4% in 2013 to 12.4% in 2018, according to the Commonwealth Fund study.
Black and Hispanic adults — who were more likely to be uninsured than their white peers before the ACA — had the largest gains. From 2013 to 2018, the uninsured rate dropped from 24.4% to 14.4% for blacks and from 40.2% to 24.9% for Hispanics.
This led to a reduction in racial and ethnic disparities in insurance coverage. From 2013 to 2018, the gap between whites and blacks decreased from 9.9 percentage points to 5.8 points, while the gap between whites and Hispanics dropped from 25.7 percentage points to 16.3 percentage points.
From 2013 to 2018, implementation of the law also led to reductions in the percentage of white adults (15.1% to 12.9%) black adults (23% versus 17.6%) and Hispanic adults (27.8% versus 21.2%) who went without needed healthcare services because of cost.
Disparities in adults who skipped these services because of cost also improved. Between 2013 and 2018, the gap between whites and blacks dropped from 8.1 percentage points to 4.7 points, while the white-Hispanic gap dropped from 12.7 points to 8.3 points.
Other studies have shown the benefits of lower rates of uninsured people. For example, researchers from the National Bureau of Economic Research demonstrated how 15,600 deaths would have been avoided between 2014 and 2017 if all states had expanded Medicaid.
That situation is improving. As of January, 37 states have expanded Medicaid, which allows for coverage of up to 138% of the federal poverty level.
With the exception of Louisiana and Arkansas, most of the states that have not expanded Medicaid are in the South. Because large percentages of blacks and Hispanics live in these states, it's become difficult for the United States to further reduce disparities in access to care, the Commonwealth Fund notes in the study.
However the future of the ACA remains in doubt. A federal appeals court ruled last month that a key element of the ACA, the individual mandate, is unconstitutional. The three-judge panel did not rule on whether the rest of the law can stand, sending that question back to the lower court.
After the ruling, blue states, led by California, petitioned the U.S. Supreme Court to take up the case before the November presidential election.