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Affordable Care Act Impact in Kentucky: Increasing Access, Reducing Disparities
Lynn A Blewett1, Colin Planalp1, Giovann Alarcon1
1All of the authors are with the State Health Access Data Assistance Center, University of Minnesota School of Public Health, Minneapolis. Lynn Blewett is also with the Division of Health Policy and Management, University of Minnesota School of Public Health. Giovann Alarcon is also a PhD student in the Department of Applied Economics, University of Minnesota, Minneapolis.
Objectives:
To examine health insurance disparities since Kentucky's implementation of the Affordable Care Act (ACA).
Methods:
Using the American Community Survey, we estimated coverage rates by race/ethnicity before and after implementation of the ACA (2013 and 2015), and we estimated whether groups were over- or underrepresented among the uninsured, compared with their share of the state population.
Results:
Kentucky's uninsurance rate declined from 14.4% in 2013 to 6.1% in 2015 (P < .001). Uninsurance rates also declined for most racial/ethnic groups, including Blacks (16.7% to 5.5%; P < .001) and Whites (13.3% to 5.3%; P < .001). In 2015, Blacks were no longer overrepresented among Kentucky's uninsured, with a significant decline in the ratio of Blacks among the state uninsured population compared with their share of the state population (1.16-0.91; P = .045).
Conclusions:
In Kentucky, which mounted a robust implementation of the ACA-including Medicaid expansion, a state-based marketplace, and an extensive outreach and enrollment campaign-the state experienced not only a decline in the overall uninsurance rate but also an elimination in coverage disparities among Blacks, who historically were overrepresented among the uninsured.
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