The Affordable Care Act’s Coverage Expansions Will Reduce Differences in Uninsurance Rates by Race and Ethnicity

Study Questions:

What is the likely impact of the implementation of the Affordable Care Act on the distribution of coverage by race and ethnicity?


The analysis used a microsimulation model, the Urban Institute’s Health Insurance Policy Simulation Model, to derive estimates of insurance coverage for children and adults, by racial and ethnic group, under the Affordable Care Act. This model provides estimates of the effects of implementation of key provisions of the Affordable Care Act relative to current law. The model relied on multiple data sources to reflect demographic characteristics, health insurance coverage and premiums, health spending, and employers at the state and national levels. The analytic sample for this analysis was the nonelderly resident civilian noninstitutionalized US population.


The microsimulation model showed that racial and ethnic differentials in coverage could be greatly reduced, potentially cutting the eight-percentage-point black-white differential in uninsurance rates by more than one-half and the nineteen-percentage-point Hispanic-white differential by just under one-quarter. However, blacks and Hispanics are still projected to remain more likely to be uninsured than whites. Achieving low uninsurance under the Affordable Care Act will depend on effective state policies to attain high enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) and the new insurance exchanges.


The authors concluded that the Affordable Care Act will greatly expand health insurance coverage for all racial and ethnic groups.


The estimates from this microsimulation model suggest that the Affordable Care Act will greatly expand health insurance coverage for all racial and ethnic groups, largely because of increased access to free or subsidized health insurance through Medicaid and CHIP and the new exchanges. The largest reductions in uninsurance rates are predicted among blacks and Hispanics. If the Supreme Court upholds the constitutionality of the Affordable Care Act, and the law reduces uninsurance to the extent projected in this analysis, substantial reduction in long-standing racial and ethnic differentials in access to health care and health status are likely to follow.

Keywords: Continental Population Groups, Insurance Coverage, Medically Uninsured, Demography, Medicaid, European Continental Ancestry Group, Cardiovascular Diseases, Hispanic Americans, Patient Protection and Affordable Care Act, United States

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