Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage

Abstract

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.

The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults

“…Our findings suggest that larger gains in insurance coverage for some minority groups observed among the overall adult population were not driven by differential take-up of Medicaid among newly eligible adults. Estimates from the American Community Survey reported in a recent study that simultaneously stratifies on race, income, and state expansion status also suggest that differences in Medicaid take-up across racial and ethnic groups did not closely resemble changes in the uninsurance rate for individuals of all income levels in all states (Buchmueller et al, 2016).…”

“…Across all states and income groups, young adults experienced larger reductions in uninsurance between 2013 and 2014 than did older adults, and larger gains in insurance coverage have also been documented for Black and Hispanic adults relative to white adults (Buchmueller et al, 2016;Courtemanche, Marton, and Yelowitz, 2016;McMorrow et al, 2015a;McMorrow et al, 2015b).…”

“…Existing reports of demographic patterns in insurance coverage between 2013 and 2014 either do not distinguish between expansion and nonexpansion states (Courtemanche, Marton, and Yelowitz, 2016; or do not stratify on income and pre-ACA eligibility in a way that allows conclusions to be drawn about take-up among the newly eligible (Cohen and Martinez, 2015b;McMorrow et al, 2015a;McMorrow et al, 2015b). This is true even of the estimates reported by Buchmueller et al (2016), which captured changes in the uninsurance rate by race and ethnicity specifically for adults with family income below 138 percent of the FPL. The estimates in that study pooled parents and childless adults together and included Medicaid expansion states that had already expanded Medicaid eligibility to this income range prior to the ACA.…”

Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History

“…A number of studies have examined the effects of the ACA expansions on the general population, finding gains similar to those of our noncancer history subgroup. 15,18,20 One previous study by Parsons et al 27 focused on the coverage effects of the 2010 expansions that allowed young adults up to age 26 to be covered on a parent’s family policy. That study found higher coverage rates among young adults newly diagnosed with cancer compared with a slightly older group who could not be covered under a parent policy.…”

“…14,15 The decrease was evident in all states and sociodemographic groups though more pronounced for adults in states that expanded Medicaid, 16,17 in persons with low socioeconomic status, and in racial and ethnic minorities. 18,19 The decline in uninsured rates nationally comes from a 5.5 percentage point increase in private coverage, and a 2.2 percentage point increase in public (Medicaid) enrollment. 20 …”