The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults

Med Care Res Rev. 2019 Feb;76(1):32-55. doi: 10.1177/1077558717706575. Epub 2017 Apr 27.


Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Keywords: Affordable Care Act; access to care; health insurance coverage; racial/ethnic disparities.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ethnicity / statistics & numerical data
  • Health Services Accessibility*
  • Healthcare Disparities / ethnology*
  • Humans
  • Insurance Coverage*
  • Insurance, Health*
  • Patient Protection and Affordable Care Act / legislation & jurisprudence*
  • Young Adult