Major ACA provisions improved minority access to health care

Health care access disparities experienced by blacks and Hispanics, compared to whites, narrowed after the major provisions of the Patient Protection and Affordable Care Act (ACA) were implemented. According to the Commonwealth Fund, states that chose to expand their Medicaid programs were more likely to see greater declines in this disparity.

Improved insurance rates.

As of 2013, states that chose to expand their Medicaid programs already had lower rates of uninsured working-age citizens than states that had not expanded by 2015. Although rates in both groups of states dropped after many of the ACA’s provisions were implemented, expansion states saw lower rates of in all three ethnic groups. From 2013 to 2015, rates in expansion states changed as follows:

  • 36 percent to 22 percent for Hispanic adults;
  • 20 percent to 11 percent for black adults; and
  • 13 percent to 7 percent for white adults.

For non-expansion states, the rates went from:

  • 47 percent to 36 percent for Hispanic adults;
  • 28 percent to 19 percent for black adults; and
  • 17 percent to 12 percent for white adults.

Access improvements.

The Commonwealth Fund analysis also revealed that the racial disparity improved for two additional measures: having a regular health care provider and skipping needed health care. The disparity in the share of adults lacking a usual source of care narrowed between blacks and whites from eight to five percentage points, while the disparity between Hispanics and whites went from 24 to 21 percentage points. The black-white disparity for going without health care due to costs concerns was reduced by two percentage points, while the Hispanic-white disparity narrowed by three points.
Although 5.5 million more black and Hispanic adults reported having insurance between 2013 and 2015, these groups are more likely to encounter difficulty in accessing their needed care. They are also more likely to skip needed care due to cost concerns. The Commonwealth Fund report noted that the states of Florida, Georgia, North Carolina, and Texas have chosen not to expand Medicaid eligibility, and that these states have high populations of blacks and/or Hispanics. The Commonwealth Fund believes that Medicaid expansion in these states would further reduce the care disparities.

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