The Affordable Care Act: Efforts to Address Barriers to Health Equity

By Julia Embry, 2018 M.P.P. Candidate, Georgetown University McCourt School of Public Policy, originally posted on CHIRblog

On October 3, the Georgetown University School of Nursing and Health Studies hosted a talk, “Achieving Health Equity: Tools for a National Campaign Against Racism” as a part of their Health Equity Think Tank. Health equity is generally referred to as having equal opportunities for the highest attainment of health.

With the passage of the Affordable Care Act (ACA), there has been important progress to reduce health inequity; foremost with increasing access to health insurance coverage among people of color, who have been disproportionately at risk of being uninsured. In the six years since the legislation passed, the uninsured rate for non-elderly Blacks has dropped 47 percent and for non-elderly Hispanics, there has been a 35 percent reduction. However, according to the Kaiser Family Foundation, uninsured rates are still disproportionately higher among people of color.

The ACA also promotes health equity by prohibiting insurers from discriminatory marketing or benefit design. And as we blogged about earlier, Section 1557 of the ACA prohibits individuals from being subjected to discrimination, excluded from participation, or denied benefits on the basis of race, color, national origin, sex, age, or disability. Final regulations apply Section 1157 to any health program or activity that receives federal funding or is administered by an Executive agency, and to entities created under Title I of the ACA, including health insurance marketplaces.

The ACA also aims to increase health equity by requiring the coverage of preventive care, which is critical to promoting positive health outcomes. Under the ACA, insurers must offer preventive care benefits without cost-sharing, allowing individuals to receive general examinations and health screenings, which can prevent or mitigate more serious health conditions down the road. The lack of awareness, however, may remain a barrier for individuals to take full advantage of this benefit. However, the Office of Minority Health, Department of Health and Human Services, which the ACA reauthorized, has implemented the From Coverage to Care (C2C) Initiative to increase awareness and to highlight benefits of using health insurance. The initiative is part of the Office of Minority Health’s HHS Health Disparities Action Plan which designs programs to educate consumers on the new insurance coverage available to them and to encourage individuals to access preventative care services.

Overall, the ACA has made impressive strides in reducing health inequity, primarily with increasing access to health insurance coverage and to preventive care under such coverage. Moving forward, reducing health inequity in health insurance coverage will take better outreach and education to reach the remaining uninsured, particularly among groups with historically low and disproportionate uninsured rates.