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Health Coverage by Race and Ethnicity: Changes Under the ACA

Key Takeaways
People of color historically have been more likely to be uninsured and to face more barriers accessing care than Whites. The Affordable Care Act (ACA) health coverage expansions provided an opportunity to help reduce these disparities. This brief examines changes in health coverage under the ACA by race and ethnicity and discusses the implications for health coverage disparities. Based on Kaiser Family Foundation analysis of Current Population Survey data for the nonelderly population, it finds:

  • People of color have had larger gains in coverage compared to Whites since implementation of the ACA, helping to narrow racial and ethnic disparities in coverage. All racial and ethnic groups had coverage gains. Gains were largest for nonelderly Hispanics, whose uninsured rate decreased from 26% to 17%, reducing the number of uninsured by 4.0 million. The number of nonelderly uninsured Asians fell by 0.9 million, and their uninsured rate decreased by almost half from 15% to 8%. Among nonelderly Blacks, the number of uninsured fell by 1.8 million and the uninsured rate decreased from 17% to 12%. Nonelderly Whites had a smaller change in their uninsured rate, which fell from 12% to 8%, but the largest decrease in the number of uninsured (6.7 million), reflecting their larger overall population size.
  • Despite larger coverage gains for people of color, disparities in coverage persist, particularly for Hispanics. Medicaid plays a key role helping to fill gaps in private coverage for nonelderly Hispanics and Blacks, but they remain more likely to be uninsured than Whites. Hispanics are at the highest risk of being uninsured, with nonelderly adult Hispanics nearly two and half times as likely to be uninsured than nonelderly adult Whites (22% vs. 9%). Uninsured rates for children are lower than rates for adults, but Hispanic children are still twice as likely a White children to be uninsured (8% vs. 4%).
  • Opportunities remain to increase coverage through enrollment of eligible but uninsured individuals in Medicaid or subsidized Marketplace coverage, but eligibility for coverage varies by race and ethnicity. Nonelderly uninsured Blacks are more likely than nonelderly uninsured Whites to be ineligible for coverage because they fall into the coverage gap in states that have not implemented the Medicaid expansion. Nonelderly uninsured Asians and Hispanics have lower eligibility rates because they include higher shares of noncitizens, and some are ineligible due to immigration status.
  • Progress reducing coverage disparities could be eroded by recent cuts to outreach funding, changes to Medicaid, and repeal of the individual mandate. These changes could limit enrollment of eligible people and lead to coverage losses that would disproportionately affect people of color.
Issue Brief

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.