ImplementationThe enactment of the ACA provided a uniqueopportunity to address the underlying social, economic, and physical factorswhich affect racial and ethnic groups’ access to and utilization of health careservices. Under the ACA, one major provision related to the law’s impact onhealth disparities is Medicaid program expansion.Medicaid expansion was meant to play asignificant role in reducing disparities, by increasing access to care for alland decreasing the number of uninsured. This provision also resulted in theestablishment of health insurance marketplaces, a platform where consumers can researchand compare coverage plans and apply any subsidies they are eligible for. Marketplaceinsurance is required to provide coverage for the ten essential healthbenefits: emergency services, outpatient care, prescription drugs, laboratoryservices, hospitalization, pediatric services (including oral and vision),mental health and substance abuse disorder services, maternity and newborncare, preventative and wellness services, and rehabilitative and habilitativeservices and devices (“Essential Health Benefits”). Regulations for themarketplace insurance plans protect the consumer from discrimination based onpre-existing conditions.
The main implementation challenge forMedicaid expansion was the Supreme Court’s ruling that states could not bemandated to expand their Medicaid program. The result is differential access tocare among states. Currently, 19 states have decided not to expand theirMedicaid programs.
Unfortunately, racial and ethnic minority groups are thepopulations most negatively impacted from this ruling because a significantportion of the non-expansion states are in the south and southeastern regionsof the US and these regions have the highest proportions of people ofcolor (Population Distribution by Race/Ethnicity, Kaiser Family Foundation,2016). These regions also have the highest proportions of uninsured individuals(Distribution of the Nonelderly Uninsured by Federal Poverty Level (FPL),Kaiser Family Foundation, 2016). Thus,the people who are in these non-expansion states are not being supported toobtain access to quality health services because of locality.As an unintended consequence, thenon-expansion states will benefit far less in the ACA provisions for Medicaid.
Despite this challenge, the Kaiser Family Foundation reports that 15.1 millionpeople have gained coverage from Medicaid expansion, including 11.9 million whowere newly eligible through the ACA.
There are 277,000 Maryland residents whoenrolled as a result of the expansion (Medicaid Expansion Enrollment, Kaiser FamilyFoundation, 2016). It is an unintended consequence that the Medicaid expansionwould be a counterproductive effort as it could actually be further exacerbatedisparities, even though its intent is to decrease disparities. Community Health Centers—What is the newACA funding being used for? Need to fix intro to include all threeparts (#2 community health, #3 improving workforce)ConclusionIt has been over seven years since the ACAwas created.
In some aspects, it might be too early to fully assess the law’seffectiveness on the health care delivery system, but in other ways, this is agood time to reflect on the progress made thus far and consider anymodifications that can be applied. The ACA’s most significant impact onchanges to health disparities since its implementation has been the decrease inthe number of uninsured, from 44 million in 2013 to 27.6 million in 2016 (“KeyFacts About the Uninsured Population”, Kaiser Family Foundation, 2017).Antonisse et. al reported the larger increases in health care coverage camefrom states that expanded its Medicaid program under the law (2016).For racial and ethnic minority groups, theACA not only sought to increase healthcare access, but it also containedseveral provisions to address barriers to affordable quality care. Among theseprovisions include support for community health centers and improving theexisting workforce by creating opportunities to diversify personnel, as well asstrengthening cultural competency.
Reducing health disparities is an importantissue given that racial and ethnic groups, specifically Blacks and Hispanicsexperience negative health outcomes at a disproportionate rate compared tonon-Hispanic White Americans. As discussed previously, barriers for thesegroups to access care is linked to underlying causes from issues in dimensionsof access. Health care reform is a convoluted,multifaceted initiative that continues to be a critical topic of our times. Asthe most significant health care legislation since Medicaid and Medicare wasestablished, the ACA is a major step to improving access to care by makingaffordable quality care available to low-income individuals.
With respect toimplementing provisions that support health disparities reduction, the ACA isliving up to its promise and most provisions discussed earlier are in progress.Combating health disparities should be an important goal for the government andI agree with the policies that have been implemented toward this goal. In orderto maintain progress towards reducing health disparities, the government mustdevelop innovative solutions to assist low-income individuals who reside inMedicaid non-expansion states and fall in the coverage gap because racial andethnic groups account are disproportionately represented among uninsured adultsin the coverage gap (Garfield and Damico, Kaiser Family Foundation, 2017). Hanet. al. found that health outcomes for low-income adults in non-expansionstates, who are disproportionately represented by Blacks and rural residents, tobe worse compared to their counterparts in expansion states.
Additionally,low-income residents in the non-expansion states had less annual careutilization and medical expenditures, but significantly higher out-of-pocketexpenditures compared to counterparts in expansion states (2015). Ultimately,the ACA need not be repealed or replaced, but recognized as a key step to equalcare access for all. It is not the end goal, but a stride in the rightdirection.