KFF Chart of uninsured rates

One of the goals of the Affordable Care Act was to improve the access to and coverage of health care for racial and ethnic groups, and in the time it's been in effect, it has succeeded—although since the inception of the Trump administration, progress on that front has not only stalled, but actually eroded.

A new study from the Commonwealth Fund highlights how effective the ACA has been in improving health care coverage for black and Hispanic adults since its inception, as well as how its success has encountered roadblocks and regressed under the Trump administration. It reviewed three key measures of health care access by race and ethnicity: not having insurance coverage, going without needed health care because of cost, and having a regular source of care.

Since 2014, says the study, the racial gaps in health care coverage fell, particularly in states that expanded Medicaid. The uninsured rate for black adults dropped from 24.4 percent in 2013 to 14.4 percent in 2018, while the rate for Hispanic adults decreased from 40.2 percent to 24.9 percent.

That brought the gap between black and white adult uninsured rates down by 4.1 percentage points, and the difference between Hispanic and white uninsured rates down by 9.4 points.

In 2013, about 23 percent of black adults said they avoided getting care because of the cost in 2018, that had fallen to 17.6 percent in 2018. And among Hispanic adults, cost-related access problems fell from 27.8 percent to 21.2 percent. Most of this improvement actually took place between 2013 and 2016.

In expansion states, the report adds, all three groups had better overall access to care than they did in nonexpansion states, and there were generally smaller differences between whites and the two minority groups. In fact, five years after the ACA went into effect, black adults living in expansion states report coverage rates and access to care measures as good as or better than those reported by white adults in nonexpansion states.

And a disproportionate number—46 percent—of black working-age adults who live in the 15 nonexpansion states saw benefit from the ACA.

But since 2016, it's been a different story, with black adults seeing their uninsured rate rise by 0.7 percentage points, while white adults have seen a half-point increase. This has largely halted the narrowing of racial coverage gaps.

The report's authors offer up five suggestions for close the gap in access to care:

Expand Medicaid without restriction in the 15 states that have not yet done so.
Offer health insurance subsidies to those making less than 100 percent of the federal poverty level.
Remove the income cap on marketplace subsidy eligibility.
Continue state-specific Medicaid expansions
Allow undocumented immigrants to shop for coverage on the exchanges.

"All the policies presented here can help make the U.S. health care system more equitable," the authors conclude. "But they will need to be accompanied by efforts to address drivers of racial inequities in health that extend beyond access to health insurance."

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ACA cut racial disparity in health care coverage... for a while

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