New report highlights lesser known factors that impact insurance rates after ACA

​​A decade after the landmark Affordable Care Act (ACA) was enacted to expand health insurance coverage to the nation's most vulnerable uninsured, a new report by researchers at the UCLA Center for Health Policy Research and Claremont Graduate University addresses the question: How large of an impact has the ACA made over the past 10 years?

This study provides updates on national uninsured rates and looks at disparities across a spectrum of population groups, including several that haven't received attention in other studies. These include state Medicaid expansion status, education, housing, employment, citizenship, English proficiency, race/ethnicity, and age. Using annual data from the 2008 through 2018 American Community Surveys, conducted by the Census Bureau, the authors discuss uninsured rates related to these factors, as well as changes in type of coverage among the insured. 

"Many studies have pointed to the ACA's investments in reducing cost, improving quality of health care, and increasing access for those who are insured, but we wanted to delve deeper into various social determinants to discover more links to insurance coverage," said Deborah Freund, co-lead author of the study and university professor at Claremont Graduate University.

Key findings include:

• ​All population groups had improved coverage from 2014 to 2016, but progress has eroded for some groups since 2017
• States that expanded Medicaid saw more reduced uninsured rates
• Higher education is related to lower uninsured rates at every income level
• People who had full housing basic amenities had lower uninsured rates than those who lacked at least one
• Both employed and non-employed individuals gained coverage under the ACA, but higher rates are seen among the employed
• One in three non-citizens remain uninsured
• Higher uninsured rates are seen among those with lower levels of English proficiency
• All racial/ethnic groups saw declines in uninsured rates, though disparities still exist, especially among Latino and American Indian/Alaska Native populations
• Individuals ages 19 to 25 had the largest gains in coverage, and all age groups experienced lower uninsured rates

"Research has shown that the ACA is a landmark law that increased insurance coverage across diverse groups throughout the nation," said Gerald Kominski, co-lead author of the report and senior fellow at the UCLA Center for Health Policy Research.

"We wanted to demonstrate that although coverage improved for all groups under the ACA, some groups have improved less than others. We call on fellow researchers to look into these persistent disparities and to identify possible pathways to insure all individuals," he said.

This study was conducted jointly by the UCLA Center for Health Policy Research and the Claremont Graduate University with support from the A-Mark Foundation.

About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.