The Affordable Care Act (ACA) was a landmark healthcare law that has cut the health insurance rate in half and improved healthcare disparities since it was signed into law in 2010 by President Barack Obama.
In the last few years, uninsured rates dropped to a historic low of 8%, while racial disparities across healthcare have also vastly improved, according to a new report from the Commonwealth Fund. Several policies helped reduce the uninsured rate over the past few years, particularly the expansion of Medicaid eligibility during the public health emergency throughout the COVID-19 pandemic. However, millions of Americans will soon lose Medicaid coverage once the PHE ends May 11 this year.
According to the Commonwealth Fund, racial disparities before the ACA was fully implemented loomed larger, with Black and Hispanic adults having higher uninsured rates prior to 2013. This was mostly due to lower access to employer-sponsored insurance among people with low incomes, an unregulated and unsubsidized individual insurance market and lack of Medicaid coverage for adults except for very low income parents in most states. The ACA changed those factors by creating a regulated and subsidized insurance marketplace and vastly expanding Medicaid to states that chose to expand it through federal funding.
“Uninsured rates for adults in each of the three racial/ethnic groups fell after the coverage expansions went into effect in 2014, and Black and Hispanic residents reported the largest gains,” the report found. “Uninsured rates for Hispanic adults fell by 15.7 percentage points between 2013 and 2021. The Black adult uninsured rate dropped by 10.9 points, and the white uninsured rate declined by 6.3 points.”
The gains reduced disparities significantly, and the gap between white and Black adults dropped from 9.9 percentage points to 5.3 points, while the gap for Hispanic adults declined from 25.7 to 16.3 points. The largest gains were made the years immediately following full implementation of the provisions of the ACA, from 2013 to 2016, but the second-highest period of improvement was between 2019 and 2021, when more expansions were put in place in reaction to the COVID-19 pandemic. Even as employer-based coverage dropped during the pandemic, the uninsured rate reached historic lows due to the Biden administration’s actions to expand Medicaid eligibility and expand subsidies for insurance on the ACA marketplace.
This was also true for Black and Hispanic adults, according to the report, and many states saw coverage gains from 2019 to 2021 for these demographics.
We found that the percentage of adults in both expansion and nonexpansion states who reported having Medicaid or individual market coverage increased between 2019 and 2021, with Black and Hispanic adults seeing the largest coverage gains,” the report said.
In 14 states, uninsured rates for Black adults fell at least two percentage points during that time period, while Nebraska saw an 11-point drop after expanding Medicaid in 2020. Similarly, after expanding Medicaid in 2019, Virginia saw significant coverage gains among the Black population.
Among the Hispanic population, uninsured rates for Hispanic adults declined at least two points in 19 states, with big coverage gains in Florida and California, which expanded Medicaid after the ACA. Comparatively, white adults saw modest coverage gains in nearly all states, the report noted.
Overall, uninsured rates and racial disparities were lower in states that have expanded Medicaid under the ACA compared to states that have not. States that did not expand Medicaid did still see improvements in coverage due to Medicaid policies during the pandemic. Those benefits are not equal across the country, however. For example, 44% of low-income Black adults live in the 12 states that had not yet expanded Medicaid during the study period.
“While Medicaid expansion has helped produce greater coverage gains and smaller disparities, the impact of the policy has been unevenly distributed because many states, including some of the most populated in the country, have yet to expand their programs,” the Commonwealth Fund found.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."