Disparities Persist as Affordable Care Act Improves Uninsured Rate

Although the implementation of the Affordable Care Act (ACA) has reduced the uninsured rate, geographic, racial, and income disparities exist.

Investigators analyzed nearly 100 studies regarding the ACA that date back to 2010, according to a study published by Health Services Research. Since 2010, 11.7 million individuals have purchased a plan on the ACA exchanges, 10.8 million individuals have enrolled in Medicaid, and 3 million young adults are covered under their parents’ insurance.

This great progress has largely been the result of ACA exchanges, which accounted for 43% of individual plans purchased in 2014. Approximately 85% of those individuals also qualified for tax credits, which decreased premiums by an average of 76%.

Despite that fact, financial assistance may be denied for individuals who cannot afford their employer plan, and who do not qualify for subsidies to purchase health insurance through exchanges, according to the study. Additionally, premiums may continue to increase due to higher incomes and decreasing subsidies, the investigators noted.

A majority of studies reported that uninsured rates among men, unmarried individuals, and non-students decreased significantly. However, the investigators also found that racial, ethnic, and income disparities exist among young adults under 26-years-old.

The uninsured were likely to be young, low-income, and Hispanic. Other factors include lack of Medicaid expansion, being an undocumented immigrant, cost concerns, issues picking a plan, and even a lack of awareness about the exchanges. If the ACA were repealed, the Congressional Budget Office estimates that federal deficit would increase $137 billion from 2016 to 2025, according to the study.

Investigators discovered that health insurers saw value in the ACA. The amount of insurers participating in exchanges increased by 25% from 2014 to 2015, but this may be an issue in 2017, due to an increasing amount of large and small insurers withdrawing from the exchanges as a result of financial losses.

With the recent Aetna withdrawal, many counties are left with one or less insurers for the coming year. Medicaid expansion also presents a problem for many individuals.

There are approximately 3.7 million adults in states that did not expand Medicaid who do not qualify for Medicaid or tax credits. Investigators discovered that low-income blacks are disproportionately affected by this coverage gap.

An argument for not expanding Medicaid is that it will cost the state and taxpayers too much money to be a cost-saving program. However, a majority of the studies found that Medicaid expansion saved money, and that the federal government covers the cost of expansion for 3 years.

The states may experience a cost strain once the government does not fund the expansion, but the avoidance of hospitalizations and other care is likely to offset expansion costs.

“Our paper provides the public with a non-partisan, scientific perspective on the initial impact of the Affordable Care Act,” said co-author of the study Michael T. French, PhD. “With new research studies on the ACA being published every month, another comprehensive status report will be necessary in the near future.”