The Affordable Care Act (ACA) helped to significantly reduce U.S. racial and ethnic disparities in health insurance coverage and to improve access to care, especially in states that expanded eligibility for their Medicaid programs. But, after 2016, coverage gains stalled and slightly eroded. Combined with job and income losses stemming from COVID-19, this interruption in progress has left many people vulnerable to the health and economic risk of lacking comprehensive and affordable insurance during a public health crisis, particularly lower-income residents of the 14 states that have not expanded Medicaid.
However, the American Rescue Plan Act (ARP) provides non-expansion states with even greater incentives to expand their Medicaid programs to include all low-income adults. States that pursue expansion will receive a temporary increase in the federal matching rate for their existing Medicaid population and will still pay only 10 percent of the cost for the new enrollees. In addition, the ARP temporarily enhances premium subsidies for plans purchased through the marketplaces, including $0 premium plans for individuals with incomes up to $19,140 and for families of four earning up to $39,300. President Biden’s American Families Plan proposes to make these subsidies permanent.
In this brief, we update our 2020 report on coverage and access inequities using 2013–2019 data from the American Community Survey Public Use Microdata Sample (ACS PUMS) and the Behavioral Risk Factor Surveillance System (BRFSS). We examine trends in Black and Latinx/Hispanic disparities across the following measures, with a particular focus on the effects of Medicaid expansion on equity at the state level:
- adults ages 19 to 64 who are uninsured
- adults ages 18 to 64 who went without care in the past 12 months because of cost
- adults ages 18 to 64 who report having a usual health care provider (author introduction)