Since its passage in 2010, the Affordable Care Act (ACA) has helped cut the U.S. uninsured rate nearly in half while significantly reducing racial and ethnic disparities in both insurance coverage and access to care--particularly in states that expanded their Medicaid programs. While much of that progress occurred between 2013 and 2016, federal data show that more than 5 million people gained coverage between 2020 and early 2022, driving the uninsured rate down to a historic low of 8 percent. This recent progress has been driven by federal and state policy actions that increased Medicaid and ACA marketplace coverage, primarily: (1) a requirement in the Families First Coronavirus Response Act of 2020 that states keep people with Medicaid coverage continuously enrolled during the COVID-19 public health emergency, in exchange for greater federal funding (2) additional states expanding eligibility for their Medicaid programs (3) enhanced marketplace premium subsidies. In this brief, we update our 2020 and 2021 analyses of coverage and access inequities for Black and Hispanic adults in the U.S. using 2013–2021 data from the American Community Survey and the Behavioral Risk Factor Surveillance System. With a focus on the effects of Medicaid expansion and pandemic-era coverage policies, our update examines trends among and disparities between Black, Hispanic, and white adults across the following measures: (1) adults ages 19 to 64 who are uninsured (2) adults ages 18 to 64 who went without care in the past 12 months because of cost (3) adults ages 18 to 64 who report having a usual health care provider.
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