Medicaid, ACA changes to widen health disparities: 5 report findings

Sixteen years after the ACA was signed into law, the program is facing renewed political scrutiny, rising costs and coverage shifts. Federal policymakers have proposed changes to ACA structure and oversight, while the expiration of enhanced premium tax credits has increased out-of-pocket costs and contributed to coverage losses and plan downgrades.

Those pressures come as racial and ethnic disparities in healthcare access and outcomes persist nationwide — and may worsen under current policy changes. Medicaid eligibility redeterminations and ACA-related shifts are expected to increase uninsured rates and affordability challenges, disproportionately affecting Black, Hispanic and American Indian and Alaska Native populations, according to an April 29 Commonwealth Fund report.

Here are five notes from the report:

• Disparities persist nationwide: Racial and ethnic health disparities exist in every state, with no state eliminating gaps in access, quality or outcomes. Top-performing states such as Connecticut, Maryland, Massachusetts, New York and Rhode Island still report disparities within populations.

• Coverage gaps remain uneven: Black, Hispanic and American Indian and Alaska Native populations face higher uninsured rates and greater barriers to care than white and Asian American populations, with wide variation across states.

• Policy changes may worsen gaps: Medicaid redeterminations and ACA changes — including the expiration of enhanced premium tax credits — are expected to increase uninsured rates and out-of-pocket costs, with state policy decisions playing a key role in the impact.

• Cost barriers rising again: Rates of patients skipping needed care due to cost are increasing, with the steepest rises among Hispanic and American Indian and Alaska Native communities. Hispanic adults are the most likely to forgo care in 43 states.

• Outcomes vary by race and state: Premature deaths from avoidable causes remain higher among Black and American Indian and Alaska Native populations, while lower-performing states such as Arkansas, Mississippi, Oklahoma and West Virginia lag across multiple measures.

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