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Research: The ACA significantly reduced insurance coverage disparities for African Americans

New research from Lonnie Snowden, professor of Health Policy and Management at UC Berkeley School of Public Health, shows that the Affordable Care Act (ACA) reduced insurance coverage disparities between African American and White Americans. The disparity was reduced by both expanded Medicaid-provided public insurance coverage for low income people and subsidized insurance coverage.

Snowden’s study was published in The Journal of Racial and Ethnic Health Disparities in January 2022  and is the first of its kind in peer-reviewed literature.

The ACA established the Health Insurance Marketplace in 2014 to extend health coverage to low-income Americans. In this process, Snowden said,  “more African Americans qualified for subsidies and qualified for expanded Medicaid, and African Americans qualified for the most generous subsidies.”

As a lifelong health disparities researcher, Snowden saw this as a once-in-a-lifetime opportunity to assess widespread disparities reduction resulting from the ACA. While writing a grant proposal, and reviewing past literature for an under-review manuscript, Snowden’s team was surprised to discover that controlled studies of subsidies and exchanges and disparity reduction were missing.

Using data from the National Health Interview Survey for 2011-2013 and 2015-2018—before and after ACA implementation—Snowden and his coauthors determined that hundreds of thousands of African Americans whose individual incomes were between 100% and 400% of the Federal Poverty Line received coverage who previously did not have any. In terms of relative disparities, African Americans had 81.8% of White private coverage rates pre-ACA, rising to 91.6% post-ACA for a 9.8% gain, according to study results.

“I cannot fathom why, and find it frustrating, that this issue has received so little attention. In the real world, very many previously uninsured Black people got private coverage who previously were without,” said Snowden.

Snowden underlines the need for more research on subsidy increases and health disparities for African Americans below the poverty line, in order to guide future subsidy extensions as enacted in Biden’s American Rescue Plan.

“President Biden’s American Rescue Plan extended subsidies up the income scale so that even more people can purchase coverage,” he said. “How much did the subsidies themselves reduce disparities? What marketplace practices successfully reached African Americans? These are urgent questions presently without answers.”