ACA has reduced uninsurance rates for minorities

Further Medicaid expansion will close divide even more, Urban Institute says

The Affordable Care Act's premium subsidies and Medicaid expansion efforts have helped close racial and ethnic disparities among America's uninsured, according to a report from the Urban Institute.

The Institute projected uninsurance rates in 2016 under three scenarios: if the ACA hadn't passed at all; if Medicaid expansion remains in place in 27 states and the District of Columbia; and if all states are to expand Medicaid.

All racial and ethnic groups will see a dramatic drop in uninsured rates, the Institute outlines in a brief accompanying the full report. The rate of reduction ranges from 39 percent for Latinos to 52 percent for whites under the current Medicaid expansion model. The uninsurance rate remains highest among Latinos, but it will drop from 31 percent without the ACA to 19 percent with it. The rate remains lowest among whites, having dropped from 13 percent to just 6 percent.

Not surprisingly, uninsured rates have dropped in states that have expanded Medicaid. Under the ACA, Americans with an income below 138 percent of the federal poverty level now qualify for Medicaid, provided that their states opt to expand the program.

Further Medicaid expansion--which is now on the table in several states, including Indiana, Tennessee and Virginia--will close ethnic and racial divides even more, the Institute said.

Half of all black Americans, for example, live in the 23 states that haven't expanded Medicaid. This leaves 1.4 million blacks in the so-called "eligibility gap." They do not qualify for subsidies on the federal insurance exchange, but they now qualify for Medicaid, only they live in states that have not expanded Medicaid.

All told, the Institute found that nearly 5.5 million Americans fall in this eligibility gap.

"For uninsured individuals, where you live matters," the report's authors said in a blog post. "The ACA, through Medicaid expansion, is likely to reduce longstanding racial/ethnic differences in health insurance coverage between whites and minorities. But for those living in non-expansion states, health insurance coverage remains out of reach."

That said, progress has been made. Separate Institute research showed that 10.6 million Americans obtained health coverage from September 2013 to September 2014, FierceHealthPayer previously reported. As a result of the ACA, more than 22 million Americans will have been removed from the ranks of the uninsured by 2016, according to the Fiscal Times.

Along with pushing for Medicaid expansion--primarily in Florida and Texas, but also in Alaska and Oklahoma, to reach uninsured Native Americans--the Institute recommends that officials in California continue to focus on Latino enrollment outreach and that outreach efforts continue across the country in ethnic and racial communities with limited English proficiency.

For more:
- read the Urban Institute report (.pdf), brief (.pdf) and blog
- read the Fiscal Times article

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