KFF: ACA significantly narrowed disparities in coverage for people of color—but those trends may be reversing

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Racial disparities have decreased in states with adopted Medicaid expansion, study finds. (CC BY 2.0/by jonrawlinson)

The implementation of the Affordable Care Act (ACA) has significantly narrowed the disparities in coverage experienced by people of color, but those gains may be slowing, according to a new report.

A new brief from the Kaiser Family Foundation looks at the disparity in health coverage by race and ethnicity between 2013 and 2017 using American Community Survey data. In 2013, 16.8% of the nonelderly population lacked insurance, with the scales tipping higher for people of color, KFF found.

After the ACA coverage expansion in 2014, the Hispanic population experienced the largest coverage gain, followed by Asians, American Indians and Alaskan Natives (AIAN) and blacks, compared to whites. 

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Although coverage improved almost every year since the start of the ACA, 2016 to 2017 marked the first time that uninsured rates actually increased for whites and blacks.The uninsured rate overall among the total nonelderly population increased from 10% to 10.2%, according to the report. Specifically, uninsured rates among whites went up 0.2 percentage points and rates among blacks went up 0.5 percentage points.

Overall, in 2017 AIANs had the highest risk of being uninsured at 22%, followed by Hispanics at 9% and whites at 7%. 

RELATED: California's racial disparities in coverage declined post-ACA, study finds

Beginning in 2014, the ACA offered new coverage options for low- and moderate-income individuals in need of healthcare coverage, particularly through Medicaid expansion that allows the program to cover adults who earn up to 138% of the federal poverty level.

Many states still have not adopted the Medicaid expansion option, however. Nonelderly Blacks are more likely than whites to fall into a coverage gap because more live in states, particularly in the South, that have not implemented the Medicaid expansion, according to the study. In addition, the gap in coverage for Asians and Hispanics can be attributed, at least in part, to eligibility restrictions under immigration laws, according to the study. 

Changes under the Trump administration may be playing a role in these downturn in coverage, according to the study. Though the White House scaled back funding for outreach significantly and has expanded access to alternative insurance options, enrollment for 2019 was down by just 4%.

Coverage accessibility will increase if additional states adopt Medicaid expansion, helping to break down disparities, KFF's researchers concluded. However, federal and state policy changes, should they continue on a similar course, could further reverse coverage gains, they said.

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