While black and Hispanic adult uninsured rates dramatically declined thanks to the Affordable Care Act, that progress has largely stalled in recent years and the overall uninsured rate has started to climb, according to a new study released Thursday.
Since 2015, black adults in Medicaid expansion states were more likely to be insured than white adults in those states, according to the Commonwealth Fund report. More than 74% of black adults and 58% of Hispanic adults reported having a regular healthcare provider in 2018 compared to 71% and 55% in 2013, the study showed.
But the gains made in uninsured rates and healthcare access began to slip in 2016, after the uninsured rate reached a record low of 8.8%.
The gap in uninsured rates between black and white adults decreased from 9.9 percentage points in 2013 to 5.8 percentage points in 2018. Coverage rates between Hispanic and white adults fell even more dramatically, from a 25.7 percentage-point margin in 2013 to 16.3 percentage points in 2018.
Researchers blamed the shift largely on continued lack of coverage for adults in the 15 states that hadn't expanded Medicaid. Almost half of black adults and more than a third of Hispanics reside in those states.
Study co-author and Commonwealth Fund Vice President Sara Collins said a lack of legislative action since the ACA went into effect has prevented building on the law's coverage-expanding impact.
Collins suggested that lawmakers could have made health insurance marketplace subsidies available to those earning less than 100% of the federal poverty level, which would have helped address the Medicaid coverage gap.
Congress also could have eliminated restrictions and allowed undocumented immigrants to purchase a health plan on the exchange or be eligible to receive Medicaid, she said.
"We know that coverage is the most important factor in people's ability to access healthcare," Collins said during a call with reporters on Wednesday.
Previous studies have highlighted how lacking healthcare coverage can affect the disparity in health outcomes based on racial and ethnic differences.
A study published last week in JAMA Oncology cited lacking health insurance coverage as a leading driver for racial disparities found in breast cancer mortality and outcomes. The study found racial and ethnic minority women were more likely to have their breast cancer diagnoses detected at later stages of their disease than white women, which lowered their chances of survival.
Collins said healthcare coverage is an important factor toward narrowing racial and ethnic health disparities by helping to remove the financial barriers to access to care.
But she pointed out just providing coverage isn't enough to address other factors causing racial health disparities. Social drivers such as lack of adequate transportation or differences in how minority patients are treated by healthcare providers also limit black and Hispanic patients from receiving access to high-quality care compared with white patients. She said those factors and their impact must also be investigated.
"When you look at people who are racial minorities, because of long-standing issues of racial bias and implicit bias in the delivery system, they face an even greater hurdle in making that leap from coverage to high-quality care and good health outcomes," Collins said.
