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​ACA Has Led to More African Americans Getting Health Insurance

​New HHS report also shows disparities in access to care persist​

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The number of Black Americans under age 65 without health insurance has dropped by 40 percent since the implementation of the Affordable Care Act (ACA), according to a new report by the U.S. Department of Health and Human Services.

In 2011 about 7.1 million African Americans lacked coverage, but by 2019 that number had dropped to 4.4 million, according to the report by researchers in HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE).

But the report also shows that there are still racial and ethnic disparities in health coverage. The uninsured rate for Black Americans is 12 percent, compared to 9 percent for white Americans, the study shows. And Black Americans also report more barriers to accessing health care than white Americans.

For example, 9 percent of African Americans reported delaying prescription refills to save money compared with 6 percent of white Americans. And 18 percent of Black Americans reported being worried about medical bills compared with 11 percent of white Americans. In both of these categories, however, these percentages have declined substantially since the implementation of the ACA.


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“We will continue to work tirelessly to remove barriers to coverage and double down on our efforts to get more Black Americans insured,” HHS Secretary Xavier Becerra said in releasing the report.

Researchers also found that states that have not expanded Medicaid have the highest percentage of uninsured people who are Black. “If the remaining 12 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming) were to expand Medicaid, an estimated 957,000 Black Americans without insurance coverage would become eligible for Medicaid coverage,” an HHS press release says. More than one-third — 37 percent — of uninsured Black Americans live in three states: Florida, Georgia and Texas.

In addition, the report found that non-Latino American Indians and Alaska Natives had the highest uninsured rate in 2019 (22 percent), followed by Latinos of all races (20 percent). Asian American and Pacific Islanders and white Americans had uninsured rates in the 7 to 8 percent range in 2019.

ASPE used data from the U.S. Census Bureau’s American Community Survey and the National Health Interview Survey for its report. While there were surveys in 2020, the pandemic made data collection difficult, the report says, so researchers mainly relied on the 2019 surveys for their analysis.

Dena Bunis covers Medicare, health care, health policy and Congress. She also writes the Medicare Made Easy column for the AARP Bulletin. An award-winning journalist, Bunis spent decades working for metropolitan daily newspapers, including as Washington bureau chief for the Orange County Register and as a health policy and workplace writer for Newsday.