4 ACA Marketplaces Take Action to Advance Health Equity

California, Connecticut, the District of Columbia, and Massachusetts pursued different Affordable Care Act marketplace strategies in order to improve health equity for underserved populations, according to an issue brief from Commonwealth Fund.

Some of the goals of the Affordable Care Act (ACA) included reducing uninsurance rates and increasing access to healthcare coverage. Health equity efforts are integral to achieving these aims and states have the freedom to address health equity in a variety of ways.

Curious about how various states’ strategies related to one another, researchers explored health equity strategies within four states.

The researchers found that, while the states’ health equity goals were similar, they took various approaches to achieving those goals and these approaches required some adjustments. Even though the marketplaces based their strategies on race, ethnicity, and gender, their methods of using this information and addressing disparities varied.

For example, after collecting data, California took steps to apply financial incentives to data use among insurers, with the goal of improving the quality of care. Meanwhile, the District of Columbia used race and ethnicity data to assess whether race-based differences, either in treatment or in technological clinical supports, might correlate with health outcome differences.

Each state took a different approach to monitoring the progress of its goals. For example, three states opened staff positions dedicated to tracking health equity and all related projects. Massachusetts implemented a strategy that entailed following a “racial equity checklist,” which the state used to confirm that the consideration of equity occurred during program implementation.

While there were some differences in data usage and health equity strategies, the states agreed that an equitable plan design is key to promoting access to care for underserved populations.

The states also were unified in their goal to reduce enrollees’ underuse of plan coverage, which can contribute to inequities in healthcare.

Researchers concluded from the collected data that, although the studied states did not employ similar strategies, they were unified in their aims and their efforts showed potential.

In the future, the researchers said that a practical next step would be to continue following marketplace data and note any collaboration between state marketplaces, health insurance, and health equity.

Regarding remaining barriers, federal law does restrict deviation in plan design to an extent. For example, when the District of Columbia attempted to adjust its strategy to an equity-based insurance design, the district was restricted on the changes it could make to cost-sharing due to federal regulations.

Following the actions taken by these state marketplaces, policymakers now have a better idea of what they must consider in the future.

For example, when collecting data, states and policymakers should assess demographic data, racial gaps, and inequities. Minority groups’ resources, benefits, and barriers must be considered in the plan design process.

On the twelfth anniversary of the law’s enactment, federal leaders discussed the impact of the ACA on the US healthcare system. CMS and the Department of Health and Human Services (HHS) leaders highlighted that the ACA is continuing to grow, reaching record-breaking enrollment in 2021. They also noted that Healthcare.gov enrollment rose 26 percent among the Hispanic community and 35 percent in the Black community.

Another report explained that under the ACA, there was an eight percent drop in the uninsurance rate among Black Americans. Prior to the implementation of the law, the uninsurance rate was 20 percent among Black Americans. However, by 2019, this dropped to 12 percent.