African American Uninsured Rate Dropped by More Than a Third Under Affordable Care Act
The Affordable Care Act's (ACA) expansion of
Expanding health coverage among African Americans is critical to addressing disparities in health outcomes for this population. A greater share of African Americans report fair or poor health status than their white counterparts.[3] Nonelderly African Americans have death rates that are more than 40 percent higher than their white counterparts and are more likely to have diseases like high blood pressure, diabetes, and stroke at younger ages.[4]
While the ACA has produced significant progress in reducing the uninsured rate among African Americans -- and among the
Moreover, insurance coverage gained through the ACA is now under significant threat. The House Republican bill to repeal the ACA -- the American Health Care Act (AHCA) -- would cause 23 million people to lose health coverage,[6] and recent and anticipated executive actions by the
* Repealing the
* Health coverage and access to health care services would be at risk for all
* Erecting barriers to
* Undermining enrollment in ACA marketplaces. Continued efforts to repeal the ACA, along with administrative actions to undermine the stability of the marketplaces, are creating uncertainty among insurers regarding their continued participation in the marketplaces, as well as confusion among potential enrollees.[12] Destabilizing the marketplaces would put the ACA's coverage gains at risk for African Americans and others who've benefited under the ACA. Over 660,000 African Americans were among the 12 million people who signed up for ACA marketplace health plans during the 2017 open enrollment period in the 39 states that use the Healthcare.gov enrollment platform.[13]
Rather than fostering an environment of uncertainty, the Administration should seek to strengthen coverage through the marketplaces, which -- along with more states' adoption of the
Health Coverage Is Critical to Addressing Health Outcome Disparities for African Americans
Health coverage is not enough on its own to ensure good health outcomes, but it is critical. Without health coverage, people often forgo regular doctor's appointments, don't take necessary prescription medication, and delay care, resulting in emergency room visits and inpatient hospital stays that are expensive and often avoidable.[14]
Health coverage is especially important for African Americans and other racial and ethnic minorities because they often have worse health status than their white counterparts. African Americans live with chronic conditions such as diabetes, heart disease, and HIV/AIDS at far greater rates than other racial groups.[15] The
The ACA has improved access to health care services for those who gained coverage through its coverage expansions. People who were uninsured in 2013 and gained either marketplace or
Some States' Failure to Expand Medicaid Has Limited Progress in Closing Coverage Gap
Unfortunately, states that haven't expanded
In 2015, the uninsured rate for African Americans was at or below the national average of 12.1 percent in 25 of the 28 states that had expanded
Among the ten states with the largest
See the tables here (http://www.cbpp.org/research/health/african-american-uninsured-rate-dropped-by-more-than-a-third-under-affordable-care)
Federal and State Medicaid Proposals Would Create Barriers to Coverage
The federal government pays a fixed share of states'
The
In addition to the threat posed by the
* Work requirements. Work requirements have never been allowed in
* Enforceable premiums for people with incomes below the poverty line. A robust body of research shows that premiums reduce eligible beneficiaries' participation in health care programs and that cost-sharing keeps people from obtaining necessary health care services.[26] While a few states, including
* Drug screening and testing.
While capping
Moreover, evidence from
Strengthening Marketplace Outreach Would Help Close Remaining Coverage Gap
Over 660,000 African Americans were among the 12 million people who signed up for ACA marketplace health plans during the 2017 open enrollment period in the 39 states that use the Healthcare.gov enrollment platform.[34] This number understates the total number of African Americans receiving coverage in these 39 states because only 63 percent of enrollees provided information about their race or ethnicity to the marketplace. Of enrollees who provided their race, 11.8 percent are African American.[35]
Republican efforts to repeal the ACA, coupled with the
Millions would face higher premiums and have higher deductibles under the
Moreover, the ACA marketplace has begun to show signs of vulnerability related to actions of the
Rather than fostering an environment of uncertainty, the Administration should intensify efforts to reach groups that remain disproportionately uninsured, including African Americans. Steps that HHS, states, and other stakeholders could take include:
* Identifying areas with high concentrations of eligible but unenrolled African Americans and focusing additional resources on increasing awareness about the availability of marketplace coverage in those areas.
* Establishing and strengthening partnerships with groups familiar with enrollment barriers that persist for
* Developing messages and outreach materials targeted at African Americans that promote health insurance.
* Ensuring funding for sufficient navigator programs to conduct outreach and provide application and enrollment assistance in communities with high concentrations of African Americans.
Footnotes:
[1]
[2]
[3]
[4]
[5] CBPP analysis of
[6]
[7] For more on per capita caps, see
[8]
[9] CBPP analysis of Medicaid Budget & Expenditure System administrative data and
[10]
[11] HHS Secretary
[12] Center on Budget and Policy Priorities, "Sabotage Watch: Tracking Efforts to Undermine the ACA," http://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca.
[13]
[14]
[15]
[16]
[17]
[18] Annual Update to the HHS Poverty Guidelines, 82 Fed. Reg. 19 (2017).
[19]
[20] CBPP analysis of
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30] CBPP analysis of Medicaid Budget & Expenditure System administrative data and
[31]
[32]
[33]
[34]
[35]
[36] Center on Budget and Policy Priorities, "The House-Passed Health Bill Can't Be Fixed,"
[37] Center on Budget and Policy Priorities, "Sabotage Watch."
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