Although the ACA has helped close some care gaps, improvement has plateaued as some racial health disparities persist.
The Affordable Care Act (ACA) may have sparked significant gains in patient care access, effectively addressing prominent racial health disparities, but in recent years those improvements have stagnated, according to a new report from the Commonwealth Fund.
On the whole, the ACA aimed to improve access to insurance coverage both by presenting low-cost coverage options on the federal insurance exchanges and by presenting states with the option to expand Medicaid eligibility.
And while both prongs of the law have effectively increased the number of individuals with insurance coverage, it’s that Medicaid expansion piece that has truly changed the face of healthcare and closed considerable care gaps dividing healthcare access trends for white and minority patients.
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Through Medicaid expansion, differences in insurance coverage, healthcare access barriers due to cost, and the number of patients with regular source for care have all gotten better, most reports show.
But this latest report, which looked at those three trends from 2013 to 2018, shows there is still significant room to grow. Although racial health disparities are closing, progress in this area has largely stagnated.
“It’s encouraging to see that the gaps in access to health care for black and Hispanic adults are narrowing over time, but we cannot let the progress we’ve made slip through our fingers,” David Blumenthal, MD, president of the Commonwealth Fund, said in a statement. “Improving upon the Affordable Care Act, and expanding Medicaid in all states, will be critical to ensuring that everyone can get the affordable, high-quality health care they deserve.”
Overall, racial health disparities are looking better than they did before ACA passage, the researchers noted. In 2013, for example, the uninsured rate among Hispanic adults came in at 24.4 percent, dropping to only 14.4 percent by 2018.
For black patients, those uninsured numbers were 40.2 percent in 2013 and 24.9 percent in 2018. Overall, this closed the insurance access disparity between black or Hispanic patients and white patients by 5.3 percentage points, the researchers pointed out.
These findings were most pronounced in Medicaid expansion states, the researchers pointed out. The black-white coverage gap in states that expanded Medicaid dropped from 8.4 percentage points to 3.7 percentage points, and the gap between Hispanic and white patients went down from 23.2 percentage points to 12.7.
This trend was seen tangibly in Louisiana and Georgia, two southern states that both have large black adult populations and that both saw coverage gains immediately following ACA implementation. Louisiana, which expanded Medicaid in 2016, saw uninsured rates for both black and white adults go down even more after expansion.
The uninsured rate for black adults went down by 16 percentage points, the report noted, while white uninsurance went down by 12.2 percentage points. This brought the total black uninsurance rate down to 11.3 percent by 2018, which is lower than the uninsured rate for both black and white patients in Georgia.
But most of those improvements were made soon after the ACA passed and have plateaued since. Nationally, the biggest drop in the uninsured rate among both Hispanic and black patients happened between 2013 and 2015, and have since flattened out. For black patients, the uninsurance rate has even gotten worse (rising by 0.7 percent) since it hit an all-time low in 2016.
The researchers also looked patient access to care and habits of skipping care due to high healthcare costs, finding that the ACA helped in this area, too.
In 2013, just under one-quarter (23 percent) of black patients said they skipped medical care because it was too expensive. In 2018, that number was 17.6 percent. A similar story follows for Hispanic patients, who saw the number of patients skipping care due to costs go down from 27.8 to 21.2 percent.
However, most of this improvement happened between 2013 and 2016, and, like the uninsured rate, has plateaued since.
These results suggest the nation needs to push further with ACA provisions. Foremost, health policymakers may push more states to opt into Medicaid expansion. Congress may also consider subsidies to help individuals in the Medicaid coverage gap, or low-income individuals who make too much to qualify for Medicaid.
Moves to expand subsidy access for families purchasing plans on the federal insurance exchange may also increase access to care.
Finally, state-specific moves such as allowing undocumented immigrants to purchase on the insurance exchanges or to qualify for Medicaid could close health disparities while promoting better population health, the experts wrote.
“The Affordable Care Act’s coverage expansions have helped drive historic progress in reducing racial and ethnic gaps in health care, but we still have a long way to go,” said Sara Collins, study coauthor and vice president for Health Coverage, Access, and Tracking at the Commonwealth Fund. “Too many black and Hispanic adults are still unable to get health insurance or the health care they need, which contributes to inequitable health outcomes. Whether we can build on progress made since the ACA will depend on policies like expanding eligibility for Medicaid and enhancing subsidies, as well as addressing discrimination and related causes of our health system’s long-standing racial inequities.”
Source: Patient Engagement Hit