Progress stalled on closing racial gap in health insurance since Trump took office

While the Affordable Care Act ushered in huge improvements in access to health care for black and Hispanic adults in the United States, that progress appears to have stalled, according to new research.

Between 2013 and 2016, the uninsured rate dropped from 24.4% to 13.7% among black adults, and from 40.2% to 25.5% among Hispanic adults, according to a report published Thursday by the Commonwealth Fund, a nonprofit research foundation. Uninsured white Americans dropped from 14.5% to 8.2% during the same period.

Those gains narrowed the gap in insurance coverage between Americans of color and white Americans until 2016. Beginning that year, that progress came to a halt, with the gap increasing slightly for blacks and only decreasing slightly for Hispanics by 2018.

The study examined federal survey data between 2013 and 2018 from adults ages 18 to 64, to determine how the ACA affected racial and ethnic disparities in health care.

"Historically, black and Hispanics in the U.S. have been far less likely to have health insurance," said Sara Collins, vice president of health care coverage and access at the Commonwealth Fund. She pointed to the changes in insurance rates since the ACA went into effect, which made it easier for people, especially low-income Americans, to get health care.

While disparities between black and white adults decreased, there's been "no improvement in this gap since 2016," she stressed.

That turning point can be linked to in part to congressional inaction, according to the researchers. Since 2010, there's been no federal legislation to enhance the health care law and myriad efforts to dismantle it. Weakening efforts include repealing the individual mandate penalty for having health care coverage and loosening restrictions on plans that don't comply with ACA guidelines.

In addition to examining the rate of uninsured adults, a key measure of health care access, the researchers also looked at Americans who went without health care because of cost during the previous year, as well as whether or not survey respondents said they had a regular health care provider.

In both cases, the researchers found improvements in the years after the ACA was implemented. Fewer adults in every racial group reported avoiding health care because of high costs between 2013 and 2018, and more adults reported having a regular health care provider during the same time frame. Similar to insurance rates, however, adults reporting consistent provider care tapered off after 2016, and by 2018 had decreased slightly.

One key driver of what Collins called "historic improvements" in health care access was Medicaid expansion under the Affordable Care Act. But while all states had the option to expand the program, many have chosen not to do so.

In states that did expand, black and Hispanic Americans benefited the most of any racial group, the report found. In turn, in states that did not expand their Medicaid programs, those groups suffered more from the decision. Expanded Medicaid isn't available to "nearly half of black adults and more than a third of Hispanics," who disproportionately live in non-expansion states, according to the report.

"This means that the failure to expand Medicaid in the remaining 15 states has a larger impact on black and Hispanic populations," said Jesse Baumgartner, a research associate at the Commonwealth Fund.