Even as the Affordable Care Act (ACA) enables millions of uninsured people to gain coverage, a new survey shows that stark racial disparities in health insurance coverage remain a serious problem.
Data released by the CDC at the end of June shows that in 2013, among individuals under 65 years old, 30 percent of Hispanics and 19 percent of non-Hispanic blacks were uninsured. That’s significantly more than the percent of non-Hispanic Asians and non-Hispanic whites who were uninsured:
The report finds disparities in other areas of health, too. For example, Hispanic and African-American individuals were more likely than white individuals “to have failed to obtain needed medical care due to cost.” And Hispanics and African-Americans were more than 10 percent less likely to be in “excellent or very good health.”
The ACA includes important provisions to decrease those health disparities. However, some issues remain. For one thing, the refusal of some states to accept the law’s optional Medicaid expansion has set back this progress significantly and will continue to do so until states reverse course.
A recent Kaiser Family Foundation study revealed that 2.5 million persons of color fall into the coverage gap in 27 states that chose not to expand Medicaid. These are individuals who don’t qualify for their states’ current Medicaid programs, but are below the income level necessary to qualify for subsidies to purchase private insurance on the exchanges. Poor uninsured Black adults in the South are particularly affected by the resistance to Medicaid expansion.
Racial disparities have emerged among the people who signed up for private plans, too. Although over 8 million Americans successfully enrolled in Obamacare’s first open enrollment period, some communities were reached less effectively than others. Data released by the Department of Health and Human Services shows the enrollment pool, among those who reported race or ethnicity, consisted of 63 percent Whites, 17 percent African Americans, 11 percent Latinos, and 8 percent Asians. That’s not representative of the overall uninsured population. Of the 47 million people who were uninsured in 2012, 45 percent were White, 32 percent were Hispanic, 15 percent were Black, and 5 percent were Asian-American/Pacific Islander.
That’s partly because enrollment efforts underperformed in Latino communities. For instance, California struggled to enroll Latino individuals at a proportionate rate, with Latinos making up just 22 percent of enrollment even though they’re 57 percent of California’s uninsured population. The numbers reveal the importance of effective Spanish-language outreach, particularly because there were some concerns that the HealthCare.gov site was relying on poor Spanish translations.
Eliminating racial disparities is crucial, since studies show that health insurance can improve financial security and save lives. Plus, it can help save money by reducing unnecessary costs and inefficiencies. A 2009 study found that “eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion for the years 2003-2006.”
While the overall enrollment numbers in the exchanges and state Medicaid programs were encouraging, these racial disparities deserve more attention and haven’t received sufficient consideration from policymakers at the national or local level. There are a couple things that we could start doing. More data could be collected to fill in missing information gaps about non-white communities. Every state could agree to expand its Medicaid program. And we could work to improve outreach in communities speaking other languages, especially Spanish, going into the ACA’s second open enrollment period this November.
Vignesh Krishnaswamy is a health policy intern at the Center for American Progress.