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Member Research & Reports

Member Research & Reports

Michigan Researchers Investigate ACA’s Effects on Racial Disparities in Health Coverage

The Affordable Care Act has reduced racial and ethnic disparities in health insurance coverage, although substantial disparities remain, a new study shows.

Researchers at the University of Michigan and University of Wisconsin say that Hispanics and Blacks had the largest percentage-point declines in their rate of uninsurance — 7.1 and 5.1 points, respectively, compared with three points for Whites.

Thomas Buchmueller Helen Levy
[Photo: Dr. Thomas Buchmueller (left) and Dr. Helen Levy]

However, a much larger percentage of Hispanics and Blacks remain uninsured, compared with Whites. Coverage gains for these two groups were greater in states that expanded Medicaid programs.

The analysis of data from the American Community Survey from 2008 to 2014 examined changes in the percentage of non-elderly adults who were uninsured, covered by Medicaid, or covered by private health insurance.

“The data suggests that both before and after the ACA coverage expansions went into effect, differences in income explain much, but not all, of the coverage gaps between Blacks and Whites,” said Dr. Thomas Buchmueller, professor of business economics and public policy at the UM’s Ross School of Business.

In 2014, the coverage gap between Blacks and Whites was 3.2 percentage points among adults in the lowest income category, compared with a gap of nine points among all adults of both groups. Income also appears to explain a sizeable, although smaller, portion of the coverage gap between Whites and Hispanic citizens.

The coverage gap between Whites and Hispanic noncitizens was extremely large — it was more than 40 percentage points in both non-expansion and expansion states. The eligibility restrictions facing many Hispanic immigrants, along with language barriers and a reluctance to use benefits, have a negative effect on coverage for this group, the researchers say.

“To increase coverage for low-income adults in expansion states will require the adoption of Medicaid expansion by more states along with an improvement in program enrollment in states that have already done so,” said Dr. Helen Levy, research associate professor at UM’s Ford School of Public Policy.

In addition to Drs. Buchmueller and Levy, other researchers include Mr. Zachary Levinson, a doctoral student at the UM SPH, and University of Wisconsin Professor Barbara Wolfe. Their study was published in the American Journal of Public Health.

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