The Affordable Care Act (ACA) reduced racial disparities in health insurance coverage in California, according to new research (PDF) from the University of California, Los Angeles (UCLA) Center for Health Policy Research.
In 2013—the year before people began receiving coverage through the exchanges—there were clear racial disparities in coverage. The uninsured rate was 10.3% among non-Latino whites, but 13.6% and 13.8%, respectively, among its Asian and black populations. But by 2016, these rates were all between 5.6% and 5.8%.
While the uninsured rates for these groups drifted apart a bit in 2017, the differences between them were not statistically significant, the paper said.
All racial and ethnic groups saw a 40% decline in the uninsured rate. However, some disparities still exist. In 2016, the uninsured rate among Latinos was 12.3%—a marked improvement from 2013, when the rate was 21.4%, but notably higher than other groups that year.
“Part of the reason the uninsured rate has stayed high for Latinos is that many are ineligible for Medicaid or for subsidies,” explained Tara Becker, Ph.D., a researcher at UCLA who authored the analysis.
Policies that expand access to coverage through Medicaid, another public program, or marketplace subsidies “to a wider variety of people would help to improve coverage rates,” she added.
But policies that reduce eligibility for coverage or subsidies would likely undo California’s progress.
For example, changes to Medicaid eligibility, such as work requirements or changing the income level cutoff, “would disproportionately hit Latinos and African-Americans,” who are more likely to be covered through the program, Becker said. Moreover, such policies would “leave them with few other options for getting coverage.”
Becker encouraged policymakers to consider how any piece of healthcare legislation will impact racial and ethnic disparities.
"There are policies that we can propose that do, in fact, help us to narrow the gap across racial and ethnic groups. But we also see that there are limitations to that,” she said.