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The CHCF Blog

ACA Reduced Health Cost Burden Among African Americans in California

David M. Carlisle, President and CEO, Charles R. Drew University of Medicine and Science
David Carlisle
David M. Carlisle

In 2010, when President Barack Obama signed the Affordable Care Act (ACA) into law, the United States joined the ranks of virtually all other industrialized nations in ensuring improved access to health care with the intent of achieving better health for its residents. Some six years later, the benefits of the ACA are being demonstrated in a variety of ways in communities and populations across the United States.

Benefits of this law are driven home by two important data points newly available on the California Health Care Foundation's ACA 411 tool. First, the burden of high health care costs has dropped dramatically for California's African Americans, with the percentage of African Americans reporting a "high health care cost burden" (more than 10% of income spent on health care) falling from 18% to 14% between 2013 and 2014. Data show that out-of-pocket spending by African American families fell by just over 25%, from $2,053 in 2013 to $1,577 in 2014. Together, the data show a notable increase in the affordability of care not reported by other racial or ethnic groups.

Second, among all Californians, those with individual coverage spent almost $2,500 less in out-of-pocket costs for health care in 2014 than they did in 2013 — a roughly one-third decline — that is part of a similar trend seen across the United States.

This decline corresponds with the first year that Californians could purchase individual health insurance policies directly through Covered California, the state's ACA health insurance purchasing exchange, and the expansion of eligibility for Medi-Cal, California's Medicaid program. For those buying private insurance, the availability of these policies, which do not discriminate against those with existing chronic conditions such as diabetes and high blood pressure, has brought many African Americans into the mainstream marketplace for health insurance. And the percentage of African Americans enrolled in Medi-Cal and other public insurance programs rose to 32% in 2014 from 26% the year before, bringing coverage to thousands more.

Of course, the ACA has produced many other important and tangible benefits. Medi-Cal now covers one of every three Californians, including undocumented children added through State Senator Ricardo Lara's landmark Senate Bill 75. Dependent children are now eligible for inclusion on parents' employment-based policies up to the age of 26 (previously age 21). And private health insurance policies can no longer be canceled retroactively because of an accidentally unreported illness.

Here in Los Angeles, in California's largest African American community, we are noticing that many residents find it easier to see a health care provider of their choice — and in a way that is affordable and free of the fear of losing coverage as a result. More Angelenos are taking advantage of new coverage to obtain long-delayed preventive care services (many of which are now provided for free to those with Covered California and other private health plans) or to finally receive definitive care for known but neglected chronic medical conditions. As a result, we expect to see better health, improved functional status, and most importantly, better quality of life.

The data provided through CHCF's ACA 411 online tool is relevant to today's discourse on the future of the Affordable Care Act as California unexpectedly finds itself a late battleground in the 2016 presidential race. It's important not to let rhetoric overshadow facts. The ACA, while not perfect, is resulting in improvements in access to health insurance and therefore access to health care. Hopefully, this will result in better health for all. The law has already done much to address what the Reverend Dr. Martin Luther King Jr. meant when he said, "Of all forms of inequality, injustice in health care is the most shocking and inhumane."

About David

Dr. David M. Carlisle is president and CEO of Charles R. Drew University of Medicine and Science (CDU) in Los Angeles. He is former director of the Office of Statewide Health Planning and Development (OSHPD) where he served for 11 years for three governors. Dr. Carlisle holds a faculty appointment as a professor in the College of Medicine at CDU and is an adjunct professor in the Department of Medicine at the David Geffen School of Medicine at UCLA.