A recent brief from Kaiser Family Foundation (KFF) found that after years of progression in coverage across all racial/ethnic groups, uninsured rates have increased through 2019.
After years of significant gains in coverage among racial/ethnic populations under the Affordable Care Act (ACA), progress has been declining since 2016 for three consecutive years, according to the KFF brief, which used data from the American Community Survey for nonelderly populations from 2010 through 2019 to observe trends in uninsured rates by race and ethnicity.
In 2010, prior to implementation of the ACA, nonelderly Hispanic and American Indian and Alaska Native (AIAN) individuals had the highest uninsured rates, with around one third without coverage. After implementation of the ACA, uninsured rates decreased across all racial/ethnic groups between 2010 and 2016, with the most significant percentage drop among Hispanic people (32.6 percent to 19.1 percent). While coverage improved, racial and ethnic minorities remained more likely to be uninsured compared to white people.
After six years of progress in health coverage, uninsured rates began to increase between 2016 and 2019 among Hispanic, Black, and white people, which researchers attribute to policy changes from the Trump administration that contributed to limited access to coverage.
As of 2019, the most recent year analyzed in the brief, nonelderly AIAN, Hispanic, Native Hawaiian and Other Pacific Islanders (NHOPI), and Black people are more likely to lack health insurance than white people. Researchers found uninsured rates among racial and ethnic populations were higher and Medicaid coverage levels were lower in the states that have not expanded Medicaid versus those that have adopted the ACA Medicaid expansion. Indeed, KFF found racial/ethnic groups uninsured rates were nearly twice as high in states that have not expanded Medicaid compared to those that have. The same was true even among children, with 15 percent Hispanic children in non-expansion states uninsured compared to 6 percent Hispanic children in expansion states.
The COVID-19 pandemic, which has drastically disproportionately impacted communities of color, is likely further exacerbating health coverage disruptions beyond 2019 due to job and income loss.
States adopting the ACA Medicaid expansion is vital to narrow disparities in coverage among racial and ethnic populations, noted researchers. However, some uninsured individuals remain ineligible for Medicaid or marketplace subsidies, such as immigrants who face eligibility restrictions.
“The Biden administration and Congress have taken a range of actions to expand access to and enrollment in health coverage, which may help increase coverage and reduce disparities in coverage among people of color,” wrote KFF researchers. “Eliminating disparities in health coverage is an important component of addressing longstanding racial disparities in health. However, to advance health equity, it also will be important to address other inequities within the health care system as well as inequities across the broad range of social and economic factors that drive health.”