Decreasing Disparities in Health Coverage

Implemented in 2010, the ’s major coverage expansion was designed to improve the accessibility and affordability of health insurance. Although the ACA’s coverage expansion should decrease disparities in health care coverage among racial and ethnic minorities, both immigration status and an individual’s state of residency have proved to be the greatest hindrance to reducing disparities.

Specifically, undocumented immigrants and individuals living in states where Medicaid was not expanded saw the in disparities. This study determined the impact of the ACA among racial and ethnic groups in states that expanded Medicaid versus those that did not.

Overall, black adults saw declines in uninsured rates in both expansion and non-expansion states (25.9% to 17.2%) whereas declines in uninsured rates among white adults occurred primarily in states that expanded Medicaid. Among Hispanics adults, however, researchers observed a decline in absolute disparities and an increase in relative disparities. The increase in relative disparities for Hispanics simply means that uninsured rates improved to a disproportionate degree for other ethnic groups. Expansion states saw a lower uninsured rate among all groups compared to non-expansion states.

Several implications emerge when looking at disparities among the various racial and ethnic groups affected by the ACA.

Source: Families USA (All Rights Reserved)

Source: Families USA (All Rights Reserved)

Black adults had a greater decrease in uninsured rates despite some states choosing to opt out of Medicaid expansion. This seems to imply that non-expansion states, largely in the South, have had suboptimal rates of prior enrollment in Medicaid despite previous eligibility. Consumers are less likely to participate in programs that are not well understood or ones that are difficult to navigate. Therefore, in order to improve racial disparities in healthcare coverage reformers must continue to provide focused education, structured outreach, and improved enrollment efforts.

The situation for Hispanics shows a different societal issue. The narrowing of absolute disparity among Hispanics but not the relative disparity may have been impacted by multiple factors. This study failed, however, to identify the resident and immigration status of those surveyed. It is likely that the impact of Medicaid expansion available to Hispanics has been exaggerated.

As undocumented immigrants are ineligible to enroll in subsidized plans through the Marketplace, the persisting lack of coverage in this population will likely lead to costlier, episodic health care that can negatively impact an already strained healthcare system and widen gaps in health disparities. This highlights the importance of policy reform that includes means to provide

There were fewer declines in coverage gaps among whites in non-expansion states. This may speak to ideology and attitudes among those who oppose providing care to the underserved despite the individual and societal benefits. Unfortunately, there may never be an effective policy to squelch the fears of those who oppose the ACA.

commentary by Ellana Stinson

Abstract

Black and Hispanic adults have long experienced higher uninsurance rates than white adults. Under the Affordable Care Act, differences in uninsurance rates have narrowed for both black and Hispanic adults compared to their white counterparts, but Hispanics continue to face large gaps in coverage. PMID: 26378026

McMorrow, S, et al. Health Affairs. 2015; 34 (10): 1774-1778.