June 15, 2017
Obamacare Working to Reduce Racial and Ethnic Disparities in Health Insurance Coverage
The Affordable Care Act (ACA) was designed to increase health insurance coverage in the U.S. and has largely succeeded in doing so. An open question is whether and how the implementation of the law has affected health disparities. In particular, the United States experiences large and enduring racial and economic disparities not only in health insurance coverage but in income, wealth, and health. SRC's Helen Levy, with co-authors Thomas Buchmueller, Zachary Levinson, and Barbara Wolfe used data from the American Community Survey (ACS) to study racial patterns in coverage and to track changes in coverage by race and ethnicity over the period when many of the major provisions of the act were implemented, from 2013 to 2014.
They also looked at the sources of coverage, studying nonelderly adults who were uninsured, covered by Medicaid, and covered by private health insurance. This is important because sources of coverage differ by race with Whites more likely to hold private insurance and Blacks and Hispanics more likely to hold public insurance. Interestingly, even before the ACA went into effect, race differences in income explained most of the gap in insurance coverage between Black and White Americans, and to a lesser extent between White and Hispanic US citizens. On the other hand, even at similar levels of income, noncitizen Hispanics were much less likely to hold health insurance.
The researchers found that Obamacare reduced racial and ethnic disparities in health insurance coverage. Large disparities in coverage continue, however. Coverage increased the most in states that expanded Medicaid. The researchers suggest that further increases in coverage will require Medicaid expansion by more states.
Buchmueller, T.C., Levinson, Z.M., Levy, H.G., Wolfe, B.L. (2016). Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage. American Journal of Public Health. DOI: 10.2105/AJPH.2016.303155