The uninsured rate for lower-income working-age blacks and Latinos dropped by at least 10 percentage points between 2010, when the first Affordable Care Act coverage expansions went into effect, and 2016, according to the latest Commonwealth Fund Biennial Health Insurance Survey. These adults — who had family incomes below 400 percent of poverty ($47,520 for an individual and $97,200 for a family of four) — were also more likely to get needed care in 2016.

States’ Decisions on Medicaid Expansion Mattered

Uninsured rates varied considerably by state Medicaid expansion status. In states that expanded Medicaid, uninsured rates in 2016 were below 10 percent for lower-income whites, blacks, and Latinos born in the United States. Uninsured rates for adults living in nonexpansion states, however, remained high among low- to moderate-income adults, with 16 percent of whites, 18 percent of blacks, and 22 percent of U.S.-born Latinos uninsured in 2016.

While all eligible adults who earned less than 400 percent of poverty in states that expanded their Medicaid programs had the option to receive subsidized coverage, adults earning less than 100 percent of poverty in the 19 states that hadn’t expanded their Medicaid programs had no subsidized coverage options. This coverage gap in nonexpansion states left an estimated 4.3 million to 5.2 million people uninsured.

The uninsured rate among foreign-born Latinos in both Medicaid expansion and nonexpansion states remained significantly higher than that of other groups. Large shares of uninsured foreign-born Latinos are undocumented and are therefore ineligible for coverage through the ACA marketplaces or the Medicaid expansion.

The Affordability of Care and Receipt of Preventive Services Also Improved

Rates of delaying or forgoing care also declined between 2010 and 2016 for all adults with low incomes. But the biggest improvements were seen among blacks and Latinos, who saw a 17 percentage-point and a 11 percentage-point decline, respectively, in cost-related access problems over this six-year period.

At the same time, a greater share of adults with lower incomes got their blood pressure and cholesterol checked. This was particularly good news for blacks and Latinos, who historically have had higher rates of chronic diseases compared to whites.

Looking Forward

Despite the historic gains in coverage since the passage of the ACA in 2010, 28 million people under age 65 in the United States remain uninsured. Ongoing coverage gains for low- and moderate-income adults will require the commitment of state and federal policymakers. To start, the uninsured rates for low- and moderate-income whites, blacks, and Latinos could be more than halved in the 19 nonexpansion states if those states decided to expand. Policymakers also could reduce uninsured rates with increased outreach and enrollment assistance to lower-income Latinos and blacks. Research has found that awareness of coverage options remains lower among groups most at risk for being uninsured — and that outreach and enrollment assistance has a significant impact on sign-ups.

In addition, immigration reform or loosening the ACA’s restrictions of marketplace and Medicaid eligibility for undocumented immigrants would help improve insured rates among Latinos in particular.