This blog post is cross-posted from my post published on the “Voices” blog of the Leonard Davis Institute of Health Economics at the Wharton School of the University of Pennsylvania.
As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This first post of a five-part series describes the current state of insurance coverage and health disparities among racial and ethnic minorities.
Prior to the ACA, racial and ethnic disparities in health and health carewere widespread and well-known. They included documented differences in insurance coverage, access to care, the prevalence of chronic diseases, and overall health. As major provisions of the Affordable Care Act take root, let’s take a look at some measures of health equity and outcomes.
Uninsured level
First, there’s the level of uninsurance. Although the link between insurance coverage and health outcomes is not direct, it is a good measure of access to care. In 2010 (prior to the ACA), the National Health Insurance Surveyfound that non-elderly Blacks (20.8%) and Hispanics (31.9%) had much higher rates of uninsurance than non-elderly White non-Hispanics (13.7%). The Kaiser Family Foundation noted the ACA’s potential to reduce this disparities because 94% of uninsured Blacks have incomes low enough to be eligible for premium subsidies or coverage under (fully) expanded Medicaid. Similarly, KFF noted the ACA’s potential impact on Hispanics, with more than a third of uninsured Hispanics eligible for premium subsidies and more than half qualifying for expanded Medicaid. In a subsequent post, we will discuss how the ACA’s potential impact on coverage for racial and ethnic disparities has been limited by some states’ refusal to expand their Medicaid programs.
With this potential in mind, how has the ACA done thus far in increasing insurance rates among minorities? New data from the NHIS reveal that in the first six months of 2014, uninsurance rates dropped from 18.9% to 13.7 % for Blacks, from 30.3% to 26.2% for Hispanics, from 13.8% to 11.6% for Asians, and from 12.1% to 10.5% for non-Hispanic Whites. The latest Gallup poll http://www.gallup.com/poll/180425/uninsured-rate-sinks.aspxreports drops of 6.9 percentage points for Blacks and 6.3 percentage points for Hispanics since the end of 2013.
Racial/ethnic minorities face a wide array of disparities in behavioral risk factors, chronic diseases, and health outcomes. One of the hopes is that increased insurance coverage will help reduce these glaring disparities, but the evidence linking coverage and health does not unambiguously point towards this hope being fulfilled.
Prevalence of diabetes
The stakes are quite high for minority populations. According to the CDC, the prevalence of diabetes is higher among Blacks (10.9%) and Hispanics (9%) than among Whites (6%). The rate of HIV infection among Black (84 per 100,000 population) and Hispanic (30.9 per 100,000 population) adults is much higher than Whites (9.1 per 100,000 population) adults. Blacks have a higher rate of hypertension (41.3%) than Whites (28.6%) and Hispanics (27.7%). Further, the rate of controlled blood pressure is lower among Hispanics (34.4%) and blacks (42.5%) than Whites (52.6%).
The difference in quality of life between Whites and Blacks, as measured by the years of life free from disability caused by chronic disease, has decreased in the 21st century but remains significant at six years. Furthermore, a higher proportion of Blacks (21.3%) and Hispanics (31%) self-rate their health as “fair” or “poor” compared with Whites (13.%).
It is much too early to tell the extent to which the ACA will affect these health disparities. Beyond increasing coverage rates, the ACA’s requirement that plans cover recommended preventive services without cost-sharing may boost screening rates for hypertension, diabetes, and cancer.
The subsequent posts in this series will take an in-depth look at how the Affordable Care Act approaches the challenge of reducing health disparities: the benefits and shortfalls of Medicaid expansion, new models of care management and delivery, initiatives to diversify the health care workforce, and access to health services for American Indians.
Imran Cronk 