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Immigrants, particularly those who are not citizens, historically have faced disproportionate barriers to accessing health coverage and care. The ACA offers new options to increase coverage for naturalized citizens and lawfully present immigrants, but undocumented immigrants remain ineligible for assistance. This brief provides an overview of the noncitzen immigrant population and their health coverage and access to care. Overall, these findings show that noncitizens continue to face barriers to accessing health coverage and care.
The ACA coverage expansions may help mitigate some barriers people with limited English proficiency (LEP) face in accessing coverage and care. However, individuals with LEP may still face increased barriers to care with coverage. This analysis examines differences in health care experiences between English- and Spanish-speaking Hispanic adults with insurance using data from the 2014 Kaiser Survey of Low-Income Americans and the ACA.
Research demonstrates that improving population health and achieving health equity will require broad approaches that address social, economic, and environmental factors that influence health. Recently there has been increased recognition of the importance of these factors to health. Moreover, the ACA includes provisions to help bridge health care and community health. Reflecting the increased focus and new opportunities provided under the ACA, a growing number of initiatives are emerging at the national, state, and local level to address broader determinants of health. Given Medicaid’s longstanding role serving a diverse population with complex health, behavioral, and social needs, efforts to address social determinants of health are emerging through many Medicaid delivery and payment initiatives. This brief provides an overview of the broad factors that influence health and describes emerging efforts to address them, including initiatives within Medicaid.
This analysis provides national estimates of eligibility for ACA coverage options by race/ethnicity, including Whites, Blacks, and Hispanics. We estimate coverage and eligibility as of early 2015, which is prior to the end of the 2015 Marketplace open enrollment period. Overall, this analysis finds that more than half (55%) of the total 32.3 million nonelderly uninsured are people of color, including 34% who identify as Hispanic, 14% who identify as Black, and 8% who identify as another group or mixed race.
The Affordable Care Act (ACA) expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL) effectively became a state option following the Supreme Court decision, creating a “coverage gap” for many poor uninsured adults in states that do not expand Medicaid. This brief examines the coverage gap by race and ethnicity.
On September 8, 2015, the Department of Health and Human Services (HHS) proposed regulations to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age or disability, and, for the first time sex. This Issue Brief provides a technical summary of Section 1557 and the proposed rule and highlights new protections and provisions included in the law and rule . Notably, Section 1557 is the first federal civil rights law to prohibit discrimination on the basis of sex in health care. Moreover, the proposed rule extends the definition of sex discrimination to include discrimination on the basis of gender identity (but does not explicitly include sexual orientation). In addition, the proposed rule establishes regulations related to the provision of language assistance services based on long-standing HHS policy guidance. This brief does not assess the implications of the proposed rule.
This analysis based on data from the 2014 Kaiser Survey of Low-Income Americans examines differences in access to and utilization of care for Black and Hispanic adults compared to White adults among those who are uninsured, enrolled in Medicaid, and privately insured. The findings suggest that gains in health coverage under the ACA will lead to improvements in access to care and utilization for White, Black, and Hispanic adults. They also highlight the importance of increased attention to addressing racial and ethnic disparities in access to and utilization of care among privately insured adults, particularly as the privately insured population becomes more diverse as a result of greater enrollment of people of color into private plans through the ACA Marketplaces.
Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S.
Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. This issue brief examines population characteristics of the LGBT community including demographics, health challenges such as chronic conditions, HIV/AIDS epidemic and STIs, mental health and substance use, sexual and physical violence, adolescent and young adult health, and access to care and insurance coverage. Additionally, this brief examines the impacts of the Affordable Care Act (ACA), the recent Supreme Court rulings and other policy changes related to same-sex marriage on insurance coverage and access to health care services.