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Affordable Care Act narrowed racial disparities in care access, study finds


But much of the progress slowed or eroded in 2016, according to the Commonwealth Fund.

The Affordable Care Act (ACA) led to reductions in racial disparity in access to care since 2014, but things have been looking more bleak since 2016,  according to a new study from the Commonwealth Fund.

The study found the gap between black and white adult uninsured rates dropped by 4.1 percent and the gap between Hispanic and white adults fell by 9.4 percent. The drop could be seen both in states which expanded Medicaid eligibility and those which not, but in states that did expand Medicaid all three groups had better overall access and there was a smaller difference between whites and the other two groups.

Medicaid expansion has benefitted black working age adults significantly with many reporting coverage and access to care as good as or better than white adults in non-expansion states, but 46 percent of black adults live in the 15 states which have not expanded their Medicaid programs, the study says.

Despite the initial gains, the uninsured rates seemed to have stalled since 2016, and the study’s authors say that may be due, in part, to the federal government’s actions, and in some cases inaction.

“That can be linked in part to congressional inaction: there has been no federal legislation since 2010 to enhance or reinforce the ACA,” the authors wrote. “At the same time, recent legislation and executive actions have negatively affected Americans’ coverage and access to care, including: the repeal of the individual mandate penalty for not having health insurance; substantial reductions in funding for outreach and enrollment assistance for people who may be eligible for marketplace or Medicaid coverage; and the loosening of restrictions on health plans that don’t comply with the ACA’s rules.”

The fate of the ACA is currently in limbo as a panel of appellate judges ruled the law’s signature individual mandate unconstitutional in December. That panel ordered a lower court judge to reexamine the law and rule on whether the mandate, which was lowered to $0 by congressional Republicans in 2017, can be severed from the rest of the ACA, or if the whole law must be thrown out.

Groups like the American Medical Association, American College of Physicians, and the American Academy of Family Physicians have spoken out against the ruling and have proposed taking the case to the U.S. Supreme Court.

President Donald J. Trump was far more positive about the prospect of the law being stricken saying the ruling was “win for all Americans.”

The Trump administration, which has signed on with the parties challenging the law, has filed a brief with the Supreme Court saying that a ruling on the case is not urgently needed.

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Jennifer N. Lee, MD, FAAFP
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© National Institute for Occupational Safety and Health
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