Affordable Care Act expands health coverage but disparities based on income and ethnicity persist

The progress Obamacare has made so far is encouraging, but access problems remain, particularly among low-income Hispanics and African-Americans, researchers said.
By Jack McCarthy
08:55 AM
Affordable Care Act disparities

President Barack Obama's Affordable Care Act has significantly improved access to healthcare, according to a new report. But gaps in coverage continue among low income Hispanics and African-Americans.

The report, however, comes as major payers are withdrawing from health insurance exchanges established under the ACA.

"Scientific research so far suggests that ACA's progress is encouraging, especially in terms of expanding coverage," co-author Gulcin Gumus, associate professor of Management Programs, Health Administration, at the Florida Atlantic University College of Business, said in a statement.

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In the first five years of Obamacare, in fact, 11.7 million people purchased new plans from the marketplace, 10.8 million more now have Medicaid coverage, and 3 million young adults are on their parents' policies.

The research paper will be published in Health Services Research, and was authored by professors at the University of Miami School of Business Administration and the Florida Atlantic University College of Business, Science Daily reported. For the report, the authors reviewed almost 100 studies of the ACA in 2015.

The report also found that that despite growing participation in the ACA, disparities by geography, income and ethnicity persist. 

While the proportion of those without a regular source of care decreased from 29.8 percent in 2013 to 26 percent in 2014, almost 40 percent of respondents still had at least one access problem, the report found. 

“The uninsured are more likely to be young, low-income, and Hispanic,” the report said.

What’s more, the authors noted that in states that have not joined the ACA's health exchanges an estimated 3.7 million adults are in the "coverage gap," with low-income blacks disproportionately affected. This means they earn too much to qualify for Medicaid, but not enough to be eligible for premium tax credits in the marketplace.

The use of marketplace subsidies has played an important role in increasing participation.

Plans purchased in the marketplace accounted for 43 percent of all individually purchased coverage in 2014, and 85 percent of those enrolling in marketplace plans qualified for tax credits.

Due to the ACA's so-called "family glitch," whereby a low-income employees can't afford family coverage through an employer and don’t qualify for subsidies via the exchanges, however, a significant number of low- to moderate-income individuals may be denied financial assistance. Various estimates put that number at 2.4 million.

"As the ACA matures, participation may increase further -- 25 percent more insurance companies joined the marketplace in 2015 than in 2014," the authors wrote.

This year, however, several large health insurers stopped participating in state exchanges. And in mid-August Aetna announced its decision to stop offering much of its individual coverage through Obamacare.

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