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Ten years of the Affordable Care Act: major gains and ongoing disparities
Ten years of the Affordable Care Act: major gains and ongoing disparities
- Collection:
- Health Policy and Services Research
- Author(s):
- Kominski, Gerald F., author
Rasmussen, Petra W., author
Zhang, Chengcheng, author
Hassan, Saffia, author
Freund, Deborah, author - Contributor(s):
- UCLA Center for Health Policy Research, issuing body.
Claremont Graduate University, issuing body. - Publication:
- Los Angeles, CA : UCLA Center for Health Policy Research, April 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Healthcare Disparities
Insurance Coverage -- statistics & numerical data
United States
United States. - Genre(s):
- Technical Report
- Abstract:
- The Patient Protection and Affordable Care Act (ACA) was enacted 10 years ago to expand health insurance coverage to significant portions of the population who fell through the cracks of our mix of private and public insurance programs in the United States. The coverage expansion provisions of the ACA were targeted primarily to three population groups with high rates of uninsurance: (1) low-income adults not otherwise eligible for Medicaid, (2) low- to middle-income individuals and families without employment-sponsored insurance (ESI) who were priced out of the individual market, and (3) young adults 18 and older who were no longer eligible for coverage through their parents' policies unless they were financially dependent (e.g., enrolled in college). The ACA has produced significant reductions in the number and percentage of uninsured individuals. Nevertheless, important disparities (i.e., differences in insurance coverage) among the remaining uninsured continue, based on a number of factors, including Medicaid expansion status, race and ethnicity, occupation, and employment status. Disparities occur when not all individuals benefit equally from new policies such as the ACA. Understanding and reducing disparities in insurance coverage are still important goals, because certain population groups remain vulnerable or disadvantaged because of low income, poor health, or personal circumstances that make it more difficult to obtain and retain health insurance. The primary goals of this report are: (1) to update information on the impacts of the ACA on rates of uninsurance, using the latest data available (from 2018), and (2) to examine disparities from a broad perspective, including some measures that have not received attention in previous studies. In this study, we used data from the American Community Survey, conducted annually by the U.S. Census Bureau, to examine annual changes from 2008 to 2018 in rates of uninsurance for various vulnerable population groups and to determine how those vulnerable groups have fared under the ACA. Specifically, we examined nine population characteristics that are associated with an increased likelihood of being uninsured: (1) State Medicaid expansion status; (2) Education; (3) Housing; (4) Employment; (5) Citizenship; (6) English proficiency; (7) Race/ethnicity; (8) Age; (9) Type of insurance. We also stratified our analyses by income as a percentage of the federal poverty level (FPL) and by state decisions on Medicaid expansion for each of the population characteristics listed above. We defined three categories of income as percentages of the federal poverty level (FPL): (1) low-income (i.e., below 100% FPL), (2) middle-income (100%–399% FPL), and (3) high-income (400% FPL or higher). The FPL for an individual in 2018 was $12,140; for a family of four, it was $25,100. We used 100% FPL rather than 138% as our cutoff point for the lowest income categories to account for the fact that individuals living in nonexpansion states can apply for subsidies to buy insurance in their ACA insurance exchange if their income is 100% FPL or higher. In expansion states, subsidies to buy insurance in the ACA insurance exchanges are limited to those with incomes of 138%-399% FPL. Therefore, rather than create a separate category for those with incomes from 100%-138% FPL, we combined this group with those with incomes of 139%-399% FPL.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (x, 47 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101773770 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101773770