Health and health care disparities, which are differences between groups in their health status and their ability to obtain care, remain a persistent issue in the United States. This brief describes health and health care disparities today, highlights recent advancements in reducing disparities under the Affordable Care Act (ACA), and discusses how the American Health Care Act (AHCA) and proposed reductions in discretionary funding may affect ongoing efforts to address disparities. (1) There have been recent advancements in reducing disparities that reflect provisions under the ACA. People of color and low-income individuals face significant disparities in access to and use of care as well as health outcomes. ACA investments through discretionary programs to strengthen public health and prevention and the health care workforce and delivery system supported reduction of disparities. In addition, the Medicaid and Marketplace coverage expansions led to large gains in health insurance for low-income individuals and people of color, narrowing longstanding disparities in coverage. (2) The proposed changes to Medicaid under AHCA would disproportionately affect low-income individuals and people of color for whom the program is a central source of coverage. Medicaid covers over half of all poor families, one in five adults of color, and over half of children of color. The changes proposed in AHCA, including the cap on federal Medicaid financing and elimination of enhanced federal funding for the Medicaid expansion, would likely lead to large coverage losses among these groups as would the proposed changes to tax credits for private coverage. (3) Other reductions in discretionary health spending may also reduce availability of services, limit progress expanding the health care workforce, and constrain continued research to understand and address disparities. Specifically, AHCA would eliminate funding for the Prevention and Public Health Fund, and the President's 2018 budget proposes a 17.9% cut to discretionary funding for the Department of Health and Human Services (HHS).
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