Content area
Full Text
Objectives.Todocument howhealthinsurancecoveragechangedforWhite,Black,and Hispanic adults after the Affordable Care Act (ACA) went into effect.
Methods. We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status.
Results. In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs.
Conclusions. The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so. (Am J Public Health. 2016;106:1416-1421. doi:10.2105/AJPH.2016.303155)
Large disparities in health insurance coverage related to race and ethnicity are a long-standing feature of the US health care system and a cause for concern among policymakers and health care professionals. Several studies have identified these differences in insurance coverage as an important determinant of disparities in access to care.1-5 In addition, a growing literature shows that by reducing exposure to large medical expenses, health insurance leads to better financial outcomes, such as improved credit scoresandareducedriskofbankruptcy.6-9 Thus, policies that reduce disparities in health insurance coverage are likely to have a broader effect on economic inequality.
The Affordable Care Act (ACA) has made new health insurance options available to uninsured individuals in low- and middle-income households, a group in which Blacks and Hispanics are overrepresented. A recent study by McMorrow et al.10 that used data from the National Health Interview Survey found that although the uninsured rate declined overall between 2013 and 2014, it decreased by a larger amount among Black and Hispanic adults than among White adults (8 percentage points vs 4 percentage points). The uninsured...