ACA's Ability to Reduce Healthcare Coverage Disparities Has Mixed Results

The implementation of the Affordable Care Act (ACA) has reduced the number of uninsured Americans and created significant gains in health coverage among racial and ethnic minorities.

However, new research published in Health Affairs finds that the ability of the ACA to reduce racial and ethnic disparities has been limited.

“Several components of the ACA were expected to contribute to coverage gains for all racial and ethnic groups, both among the uninsured whom the act made newly eligible for financial assistance and among those who had been previously eligible for Medicaid or other coverage but who had not enrolled,” wrote the authors.

The Supreme Court ruling that made Medicaid expansion optional for states has disproportionately affected blacks and continued ineligibility of undocumented immigrates for Medicaid and insurance marketplace participation dramatically affects Hispanics.

The researchers used data from the 2014 National Health Interview Survey and identified 2 measures of disparities: absolute disparity, which reflects the gap in the percentage of uninsured between whites and blacks and between whites and Hispanics; and relative disparity, which reflects the ratio of the percentage of uninsured for blacks or Hispanics to the rate of whites.

Between the second and third quarters of 2013 and the same period in 2014 absulte disparities in the uninsurance rate for blacks and Hispanics decreased in both expansion and nonexpansion states. However, Hispanics in expansion states actually saw an increase in the relative disparity while blacks in nonexpansion states saw a significant decline in the relative disparity.

Overall, compared to whites, there remain significant gaps in the uninsurance rate for blacks and Hispanics. As ACA implementation continues, making substantial progress on reducing disparities in uninsurance requires expanding Medicaid in all states, the researches said.

“Targeted education, outreach, and enrollment efforts related to Medicaid and the Marketplaces may also be particularly important for members of racial and ethnical minority groups, who have been shown to have more limited health insurance literacy than their white counterparts,” the authors concluded.