The ACA's Impact on Minority Health Insurance Disparities

The ACA's Impact on Minority Health Insurance Disparities

Numbers Show Improvements for Blacks, Latinos, Native Americans

Wharton and Penn Medicine Professor Daniel Polsky was one of ten speakers at this year's day-long Martin Luther King, Jr. Health Equity Symposium at the University of Pennsylvania Perelman School of Medicine.

Despite ongoing political battles and unexpected implementation challenges, the Affordable Care Act is nevertheless significantly diminishing the level of health insurance disparities for the country's racial and ethnic minorities.

That's according to an economics presentation by University of Pennsylvania professor and Executive Director of the Leonard Davis Institute of Health Economics (LDI) Daniel Polsky, PhD, at last week's Martin Luther King, Jr. Health Equity Symposium.

The Symposium, whose theme was "Health Equity: A Dream or an Achievable Goal?" was organized by Penn's Perelman School of Medicine's Office of Inclusion and Diversity headed by Vice Dean Eve Higgenbotham, SM, MD.

The story in numbers
Polsky, a health economist who currently serves on the Congressional Budget Office's Panel of Health Advisers and the Institute of Medicine's Board on Population Health and Public Health Practice, gave a talk heavily based on the numbers that illuminate the changing health insurance situation of millions of U.S. citizens.

His first graph showed the overall rate at which the status of the uninsured changed in a year's time. On the eve of the ACA's 2014 launch, 18% of the population was uninsured; twelve months later, that number had declined to 12.9%.

"African Americans and Latinos are overrepresented among the uninsured population," Polsky noted. "So as the ACA insurance expansions reduce the number of uninsured, it will also be addressing racial inequities in coverage."

Using data from a recent Urban Institute study, Polsky compared how the 2016 rate of insurance among racial and ethnic minorities will compare to that of whites. Without the ACA, 13% of whites would be uninsured along with 20% of African Americans, 31% of Latinos, and 26% of Native Americans.

Effect of ACA rules
But when researchers applied the current ACA rules, the number of uninsured whites went down to 6.3%; African Americans 11%; Latinos, 19%; and Native Americans, 13%.

Another way to look at the same data, Polsky pointed out, was to look at how the insurance disparity gap between whites and minorities is changing as a result of the reform law.

Without the ACA, the gap for African Americans would be nearly 7%; Latinos, 18%; and Native Americans 13%. But as a result of the ACA, the gap for African Americans declined to 5%; Latinos declined to 12.7%; and Native Americans to 6.7%.

'In the right direction'
"We are moving in the right direction," Polsky said, "but there are still things that need to be accomplished if we're going to move toward further addressing these disparities."

He noted that 23 states that have not expanded Medicaid has had a disproportional impact on minorities. Many of these non-expansion states, "have overwhelming need among African Americans," Polsky said. In fact, he pointed out, if all the states that didn't expand Medicaid DID suddenly expand, the gap between African American and white insurance levels could drop an additional 50%.

He also said "there's some hope," because five of the reticent states, including Pennsylvania, are expanding their Medicaid programs this year.

Crucial issues to watch
Looking to the immediate ACA future, Polsky listed some of the most important trends and issues that are "critical to continuing to move forward in the reduction of inequities in insurance coverage." Included are:

- The Congressional leadership change that is likely to ratchet up the hostility and raise the level of challenge for the health reform law.

- The Medicaid access challenge. The law provided a two-year fee bump for primary care providers who were serving Medicaid patients. That fee increase paid Medicaid providers the higher amount that Medicare providers get. But that bump went away on January 1.

- King vs. Burwell, the latest challenges to the ACA in the U.S. Supreme Court. Arguments will occur in March with a final ruling expected in July. The case pivots around whether or not subsidies can be legally given to customers on the insurance exchanges in states where the federally-run exchange is being used. If the challenge succeeds, it means "the economics of maintaining the insurance marketplace in those states would fall apart," Polsky said.

- CHIP authorization. The widely successful Children's Health Insurance Program's funding is due to expire in September and will have to re-negotiated in a very different environment on Capitol Hill.

- Undocumented immigrants are prohibited from enrolling in Medicaid or purchasing insurance coverage on the state exchanges at the same time they represent 25% of the uninsured. "This is a place where more work needs to be done," Polsky said.