The ACA Narrowed Racial Disparities in Health Coverage and Access, Especially in States That Expanded Medicaid

The Affordable Care Act (ACA) helped to significantly reduce U.S. racial and ethnic disparities in health insurance coverage and to improve access to care, especially in states that expanded eligibility for their Medicaid programs. But U.S. uninsured rates for Black and Latinx/Hispanic adults remain significantly higher compared to white adults, with a larger divide in many of the states that have not yet expanded Medicaid eligibility, a new Commonwealth Fund data brief shows.

Focusing particularly on the state-level effects of Medicaid expansion on health equity, the Fund’s Jesse Baumgartner, Sara Collins, and David Radley examined trends in racial and ethnic disparities across three key measures:

While Medicaid expansion is associated with greater equity in coverage, the poorest adults in states that haven’t expanded Medicaid are disproportionately Black and Latinx/Hispanic, the researchers found. Two million people in the Medicaid coverage gap continue to lack access to affordable coverage.