Ten Years of the Affordable Care Act: Major Gains and Ongoing Disparities
Study focus: The primary goals of this report are: (1) to update information on the impacts of the Patient Protection and Affordable Care Act (ACA) on rates of uninsurance using the latest data available (from 2018), and (2) to examine disparities from a broad perspective, including some measures that have not received attention in previous studies.
Participants: For most analyses, authors focused on respondents ages 0 to 64, with exceptions depending on nine population characteristics (shown below). Authors used 2008 through 2018 data from the American Community Survey (ACS), a federal annual survey of about 3 million respondents conducted by the U.S. Census Bureau.
Outcomes studied: Each report chapter provides analyses of trends in insurance coverage according to the following population characteristics: (1) State Medicaid expansion status; (2) Education; (3) Housing; (4) Employment; (5) Citizenship; (6) English proficiency; (7) Race/ethnicity; (8) Age; (9) Type of insurance.
Findings: Highlights are detailed at the beginning of each chapter heading and include:
- Medicaid expansion states had similar improvements in coverage, regardless of when expansion occurred
- Higher education is associated with substantially lower rates of uninsurance at every income level
- Individuals whose homes lacked a basic necessity always had higher rates of uninsurance than those with complete housing, regardless of income level or state expansion status
- Coverage has improved regardless of citizenship status, but 1 in 3 non-citizens remain uninsured
- Uninsured rates decreased for all racial/ethnic groups, but Hispanics/Latinos and American Indians/Alaska Natives still have the highest uninsured rates
- All age groups have lower rates of uninsurance under the ACA, but 19- to 25-year-olds have had the largest gains in coverage
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