The Race Gap in Healthcare Closed a Little Under Obamacare

Fewer black and hispanic adults skipped doctors’ visits after the law passed.

by Ed Cara
Aug 25 2017, 4:45pm

Alex Wong/Getty Images

However flawed the Affordable Care Act was in its rollout, one thing has remained clear: Many of the most vulnerable among us have better healthcare than they did before. The latest bit of evidence to support that notion comes courtesy of a report released Thursday by the Commonwealth Fund.

The authors, sifting through data from the US Census, found noticeable improvements in the number of people who could afford to see their doctor from 2013 to 2015. More importantly, those improvements were more pronounced among black and Hispanic patients, which led to a narrowing of long-seen racial disparities in healthcare access. And the closing of these gaps were even larger in states that expanded their Medicaid coverage.

"Whatever the fate of the Affordable Care Act, these findings illustrate its successes—coverage expansion and improved access to healthcare for millions of blacks and Hispanics," the authors wrote.

Across the board, black and Hispanic patients had the most to gain from the ACA's numerous reforms, which largely came into effect starting in 2014, if only because they often had worse healthcare to prior to the law. For example, the national uninsured rate dropped by 9 and 12 percent respectively for blacks and Hispanics from 2013 to 2015, while whites only saw a 5 percent drop. But more than 90 percent of white Americans had an insurance plan by 2015, compared to only three-fourths of Hispanics who did, so disparities still exist.

More relevant than insurance status was whether people avoided the doctor because they couldn't afford to go. In 2013, 21 percent of blacks said they skipped doctor visits because of cost, compared to 27 percent of Hispanics and 12 percent of whites. By 2015, those numbers fell to 17 percent of blacks, 21 percent of Hispanics, and 10 percent of whites said the same.

Adding fuel to the raging debate over what kind of healthcare infrastructure America needs, the authors also found that, generally, these disparities narrowed more in states that expanded Medicaid coverage to include anyone making up to 138 percent of the poverty line.

And in what might be music to the ears of proponents of a single-payer system like Vermont senator Bernie Sanders (who will introduce a bill for the universal expansion of government-provided health insurance next month), the authors were unequivocal about what that particular finding should mean.

"This analysis shows that the Affordable Care Act's health insurance coverage provisions have helped the US make progress toward ensuring that everyone, regardless of race or ethnicity, has access to the health care they need," Pamela Riley, a coauthor of the report and the Commonwealth Fund's Vice President for Delivery System Reform, said in a statement.

"However, blacks and Hispanics are still much more likely than whites to be unable to get the health care they need. If we are going to reduce these disparities, we must continue to focus on policies like expanding eligibility for Medicaid that will address our health care system's historic inequities," she added.

Currently, 19 states, including Texas and Florida, have declined to expand Medicaid coverage.

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Affordable Care Act