Study Finds the ACA Decreased Socioeconomic Disparities in Healthcare Access

Among wealthy countries, the United States maintains the most substantial socioeconomic disparities in access to healthcare; however, these disparities were reduced when the Affordable Care Act (ACA) was implemented, according to a new study in Health Affairs.

The study utilized national data from the 2011 to 2015 Behavioral Risk Factor Surveillance System to examine the changes in health insurance coverage associated with the ACA among varying socioeconomic levels and assessed based on an individuals’ income, education, employment status, and home ownership status.

The study found that among states that had expanded Medicaid by mid-2015 the coverage gap had decreased by 46% between residents of poor households (income of less than $25,000) and higher-income households (incomes more than $75,000). In nonexpansion states, the coverage gap also decreased but to a lesser degree (23%).

“Not only did access disparities fall in greater absolute terms in expansion states compared to nonexpansion states, but disparities were also smaller in expansion states in the first place,” the researchers noted. “States’ opting out of the ACA Medicaid expansion thus compounded preexisting access barriers for their poorer residents, leading to a geographic divergence in access for poor Americans.”

Despite the narrowed gaps that resulted from the implementation of the ACA, many Americans with incomes under $25,000 remained without coverage, with 35% uninsured in nonexpansion states and 21% in expansion states in 2015. This suggests the need for additional policies to further reduce the access disparities.

“President Trump and Republicans in Congress have promised to repeal and replace the ACA, with plans to reduce federal subsidies for Medicaid expansion and for low-income (but not Medicaid-eligible) insurance plans purchased on the exchanges,” the researchers noted. “Such an approach is likely to widen gaps in health care access between lower-income and better-off Americans, reversing gains observed under the ACA.”

More research is necessary to establish what access gains will contribute to improved health outcomes in order to demonstrate how the health disparities will alter as the policy environment changes.