Uninsurance Rate Among Black Americans Dropped 8% Under ACA

The Affordable Care Act may have led to reduced the uninsurance rate among Black Americans since it went into effect, according to a report from the Assistant Secretary for Planning and Evaluation’s (ASPE) Office of Health Policy.

The report relied upon US Census Bureau’s American Community Survey (ACS) and the National Health Interview Survey (NHIS) data to determine the rate of coverage in the Black community since 2012 when the Affordable Care Act was enacted.

“Since the passage of the Affordable Care Act nearly 12 years ago, the law has significantly expanded access to life-saving health coverage, including for Black communities across the country,” said CMS Administrator Chiquita Brooks-LaSure. 

“Advancing health equity is one of my top priorities, and, in pursuit of this goal, CMS invested in significant outreach to the Black community during this recent Open Enrollment period. The coverage gains achieved during Open Enrollment are just a first step – CMS will continue to advance health equity by expanding coverage access through Medicaid and the Children’s Health Insurance Program, Medicare and the ACA Marketplaces.”

Across the entire study period, the race with the third-highest uninsurance rate was the Black community. Before the law went into effect, uninsurance among Black Americans was 20 percent. By 2019, the uninsurance rate in this community had dropped eight percentage points to hit 12 percent.

While nine percent of White Americans were uninsured, 15 percent of Black Americans were uninsured. Almost three-quarters of White Americans had private insurance (73 percent), compared to 55 percent of Black Americans.

These disparities in coverage access had real implications for the population’s health.

Black Americans were more likely to experience barriers to care than White Americans. Even after the Affordable Care Act went into effect, Black Americans were more likely than their White counterparts to experience problems covering healthcare costs, worries about covering healthcare costs, and delays in prescription refills.

Nearly four out of ten uninsured Black Americans (37 percent) lived in states that had not adopted Medicaid expansion, specifically Texas, Florida, and Georgia.

The four states with the highest uninsurance rates among Black Americans (Alabama, Florida, Georgia, and Mississippi) also had not adopted Medicaid expansion. These four states have the highest concentration of Black Americans.

In contrast, Michigan and New York are two states that have large Black American communities but low uninsurance rates within those communities. The researchers noted that these northern states had adopted Medicaid expansion.

The trend of having higher uninsurance rates in states that had not adopted Medicaid expansion was true among Black children as well.

The researchers broke down the Black community into Latino and non-Latino subcategories, and they also broke down the population by income.

While there was a slight disparity between Latino Black Americans to non-Latino Black Americans’ uninsurance rates before the implementation of the Affordable Care Act, the two groups’ uninsurance rates were reasonably aligned since 2014. 

This indicated that many Latino Americans faced challenges accessing coverage—particularly among immigrants—but, overall, this population shared the same uninsurance rates as non-Latino Black Americans.

The results demonstrated reduced uninsurance across all income categories in the Black American community when comparing different income groups. For individuals in the income bracket between 100 and 138 percent of the federal poverty level, uninsurance dropped from 26 percent in 2011 to 14 percent in 2019.

Overall, the researchers found that, from 2012 through 2019, American Indians and Alaska Natives saw the highest uninsurance rates, displacing the Latino population after 2011. Still, after American Indians and Alaska Natives, the Latino community continued to see significantly higher uninsurance rates than other races that ASPE studied.

While uninsurance remains a major barrier to health equity, the report's results illuminated some areas of progress, and national trends may reinforce these advancements in 2021 and 2022. In the third quarter of 2021, the overall insurance rate dipped to a record low of 8.9 percent, coinciding with a boost to the Affordable Care Act marketplace and Medicaid enrollment that same year.