Racial and ethnic health coverage inequities in California would widen if ACA is overturned

Joint publication by UC Berkeley Labor Center and UCLA Center for Health Policy Research
Part of the series, Affordable Care Act in California: What’s at Stake in California v. Texas?

The Affordable Care Act (ACA) reduced uninsured rates for all racial and ethnic groups in California, while also narrowing, but not eliminating, the coverage gaps for Latino and Black Californians in this state. If the ACA is ultimately overturned due to the California v. Texas case, scheduled to be heard by the Supreme Court starting on November 10, the progress on racial and ethnic health coverage disparities would be reversed. These coverage losses and widening inequity would occur in the middle of a pandemic and recession that have disproportionately harmed communities of color.

The uninsured rate fell between 2013 and 2018 under the ACA for all racial and ethnic groups in California. Latinos experienced the largest reduction in uninsured rate, though their rate continues to be the highest of all racial and ethnic groups. The gap in uninsured rates between non-Latino whites and all other racial and ethnic groups also narrowed under the ACA, though Black Californians still have higher rates of uninsured than non-Latino whites and Asians.

Exhibit 1. Uninsured Rates Among Californians Age 0-64 by Race and Ethnicity, 2013-2018

Source: Authors’ analysis of American Community Survey data

 

Approximately 4.7 million Californians relied on ACA coverage as of June 2018, including 3.5 million with Medi-Cal expansion coverage, and 1.2 million with insurance through Covered California with premium subsidies. Approximately one out of five Black (23%), Latino (21%), and Asian / Pacific Islander (18%) California adults under age 65 were enrolled in the Medi-Cal expansion or Covered California with subsidies in 2018, compared to 14% of non-Latino whites, based on analysis of administrative enrollment data and American Community Survey data. Latino and Black Californians are more likely to be eligible for and enrolled in ACA coverage for a variety of reasons such as lower rates of having job-based coverage, in part due to lower offer rates in the industries and occupations in which they work, and higher rates of low-wage work which makes income eligibility for ACA coverage more likely. Federal policy excluding undocumented immigrants from Medicaid and Marketplace coverage is part of the reason for the continued high uninsured rate among Latinos.

If the courts overturn the ACA during the middle of this pandemic and recession, Latino and Black Californians would not only be among the hardest hit by the loss of ACA coverage, but those coverage losses would be compounded by employment and COVID trends that are inordinately hurting these same groups. Job losses in the first half of 2020 were concentrated among Latino, Black, and Asian Californians whose unemployment rates increased more than the unemployment rate for non-Latino whites. Even as jobs begin to return to the economy, there is reason to believe that this recession and its recovery will exacerbate racial inequity. Latinos have experienced a disproportionate share of COVID infections in California, and Latino and Black Californians make up a disproportionate share of those who have died from COVID. Furthermore, if the ACA is overturned, insurers could once again deny coverage or charge higher premiums for people with pre-existing conditions, which could include COVID.

The ACA covered millions of people and reduced the racial and ethnic disparities in health coverage in California; to take away these coverage options especially during a global pandemic and recession would exacerbate racial and ethnic inequality in California.