Many Americans, including members of marginalized groups, gained coverage thanks to new flexibilities introduced during the COVID-19 pandemic.
However, with the public health emergency set to expire in short order, those gains could be significantly reduced, according to a new analysis from the Commonwealth Fund. The group dove into federal data and found that 5 million people gained covered between 2020 and early 2022.
This drove the uninsured rate down to a historic low of 8%, according to the report. Between 2013 and 2021, uninsured rates among Hispanic adults decreased by 15.7 percentage points and for Black adults by 10.7 percentage points. For white adults, the uninsured rate decreased by 6.3 points.
These improvements have their roots in the Affordable Care Act's (ACA's) reforms, but enhanced subsidies on the exchanges and a pause on Medicaid determinations were key during the COVID-19 response, according to the report.
"The Affordable Care Act has been a powerful force for racial equity in health and health care over the past decade," the analysts wrote. "The expansion in access to affordable coverage has served as the backbone for this progress, helping to remove financial barriers and increase access to primary care clinics and other providers where people can get the care they need to stay healthy."
"This access has become even more critical during the COVID-19 pandemic," they said.
In addition to decreasing the uninsured rate overall, these reforms have been critical in narrowing the gap in coverage between whites and people of color. Between 2013 and 2021, the gap between white adults and Black adults decreased from 9.9 percentage points to 5.3 percentage points.
The gap between Hispanic and white adults decreased from 25.7 points to 16.3 points, according to the report.
Medicaid has played a key role in boosting access to coverage, according to the report, and uninsured rates across all groups are far lower in states that expanded the program under the ACA. So for policymakers planning for the end of the public health emergency, look to Medicaid first, the researchers said.
For one, there are still 11 states that have not expanded the program, even though additional financial incentives were made available during the pandemic, according to the report. Congress could establish a federal fallback option that would catch at least some of the people who do not qualify for Medicaid in those states, for example, according to the report.
The Medicaid redetermination process, which is set to kick off again April 1, will also be crucial. A recent Urban Institute analysis projects that 18 million people could lose coverage during this process. People of color are disproportionately represented in Medicaid, Commonwealth Fund said.
"While the federal omnibus bill phases down the federal matching funds and gives the federal government leverage to stop disenrollment in states that don’t follow federal guidelines, the phase-down is rapid, ending in nine months," the researchers wrote. "This gives states an incentive to move quickly."