Health Coverage by Race and Ethnicity: Examining Changes Under the ACA and the Remaining Uninsured
People of color historically have been more likely to be uninsured and to face more barriers accessing care than Whites, often resulting in lower use of care and worse health outcomes. The Affordable Care Act (ACA) provides an opportunity to reduce these disparities through its health coverage expansions. This brief examines changes in health coverage by race and ethnicity under the ACA and reviews characteristics of the remaining uninsured by race and ethnicity and their eligibility for ACA coverage. It is based on Kaiser Family Foundation analysis of Current Population Survey data for the nonelderly population. It finds:
People of color have had larger gains in coverage compared to Whites since implementation of the ACA. Between 2013 and 2015, the uninsured rate fell for all racial and ethnic groups. Declines were larger among people of color compared to Whites, with particularly large decreases among nonelderly Hispanics.
Despite these gains, nonelderly Hispanics, Blacks, and American Indian and Alaska Natives (AIANs) remained more likely than Whites to be uninsured as of 2015. AIANs and Hispanics were at the highest risk of being uninsured. Uninsured rates for children were lower than rates for adults, but Hispanic and AIAN children were more likely than White children to be uninsured. People of color accounted for over half of nonelderly uninsured individuals in 2015. Characteristics of remaining uninsured individuals, including work status, income, age, family status, and citizenship status, vary by racial and ethnic group.
Potential coverage gains that may be achieved through continued enrollment efforts differ by race and ethnicity, reflecting variation in eligibility for coverage. AIANs have the highest share of uninsured nonelderly individuals who are eligible for coverage at 67%. Nearly half (47%) of uninsured nonelderly Blacks are eligible for coverage, but they are twice as likely as uninsured Whites (20% vs. 10%) to fall into the coverage gap in states that did not expand Medicaid. Smaller shares of nonelderly uninsured Asians (34%) and Hispanics (33%) are eligible for coverage compared to uninsured Whites (49%), because they include larger shares of non-citizens who are ineligible due to immigration status.
Together these findings show that continued outreach and enrollment efforts may lead to continued coverage gains and further reduce coverage disparities. Understanding which groups remain at higher risk of being uninsured, their characteristics, and how eligibility for coverage varies across groups can help inform these efforts. The data also show that some uninsured individuals remain ineligible for coverage assistance. As such, safety-net resources will remain particularly important for serving these populations.Issue Brief