We know that access to health care is correlated with many demographic and socioeconomic characteristics. The Affordable Care Act, through the Medicaid expansion and the marketplace, extended coverage to uninsured populations with the hope of reducing disparities in access to health care. After the first couple of years of the insurance expansions, research shows that those disparities are narrowing, though they still persist.
A new study found that access for non-elderly, low-income individuals—those with a household income under $25,000—improved from 2011 through 2015. Gains were larger in Medicaid expansion states: the gap in insurance coverage between individuals in households with incomes below $25,000 and those in households above $75,000 dropped from 31 percent to 17 percent in expansion states and 36 percent to 28 percent in non-expansion states.
Also in expansion states, the percentage of low-income individuals with insurance coverage rose 15 points and the percentage with a primary care provider rose 7.7 points. Gains were larger for individuals without a college degree (compared to those with a degree), renters (compared to homeowners) and the unemployed (compared to the employed). Gains for those in households with incomes above $75,000 were smaller. The authors estimate that, overall, the Medicaid expansion was associated with a 2.2 percentage point increase in insurance coverage.
Another new study found that insurance coverage and well-child visits for children of all racial/ethnic groups improved after the ACA, but disparities in access to health care still remain. Latino children had the largest drop in the rates of uninsured after the ACA, but they also started off at the highest levels.
Both Latino and white children had a significant increase in the likelihood of a well-child visit, but Latino children still lag behind African American and white children in likelihood of having a well-child visit in the past 12 months. Lastly, the authors found improvements in coverage for children in families with incomes under the poverty line–an indication of the welcome mat effect because these children were already eligible for Medicaid/CHIP before the passage of the ACA.
