How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care

How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care

Five years after the implementation of the Affordable Care Act, African-American adults in states that expanded Medicaid eligibility are now less likely to be uninsured or to forgo care due to cost than white adults in non-expansion states, a data brief from the Commonwealth Fund finds. According to the report, How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (20 pages, PDF), the uninsurance rate for African-American adults in Medicaid expansion states fell significantly over the five-year period, from 21.5 percent in 2013 to 10.1 percent in 2018, while the rate for white adults in non-expansion states declined only from 16.9 percent to 12.3 percent. But while uninsurance rates and access to care have improved for Latinx, African-American, and white adults even in non-expansion states, the report found that progress in insuring all Americans has stalled since 2016 and that Latinx suffer larger disparities in part because undocumented immigrants cannot qualify for marketplace coverage, receive subsidies, or enroll in Medicaid — disparities that could be exacerbated by the Trump administration's new "public charge" rule. To close such disparities, the report's authors call for an expansion of Medicaid without restriction in the fifteen states that have not done so, filling the "coverage gap" for individuals with incomes too high to qualify for Medicaid but too low for subsidies, and the adoption of targeted, state-specific Medicaid expansion beyond the ACA.