Elimination of the Affordable Care Act’s Individual Mandate Increased Disparities

Research led by Alex Ortega, PhD, professor of health management and policy at the Dornsife School of Public Health (DSPH), compared health care access and utilization data of a nationally representative sample of U.S. adults from before the Patient Protection and Affordable Care Act (ACA) went into effect (2011-2013), the start of ACA implementation (2014-2015), when the individual mandate was enforced (2016-2018), and then when the individual mandate was eliminated (2019).

Looking at indicators of health care access, including insurance coverage and delaying health care because of costs, they estimated the impact of the elimination of the ACA’s individual mandate on Black, Latino, and white populations.

5% increase in probability of Latinos being uninsured

In the study published in JAMA Network Open in March 2022, Ortega and researchers from other institutions found that in 2019, which is the period when the mandate was eliminated, there was a 3-percentage point increase from the prior period in the probability of being uninsured for everyone. There was also a striking ethnic disparity in the increase of the percentage of those who were uninsured and delayed seeking health care due to costs after the mandate was eliminated, with a 5-percentage point increase in the probability of being uninsured for Latinos. The probability of being uninsured for Latinos (30.1 percent) was more than double the probability for Black individuals (14.0 percent) and white individuals (9.9 perfect). Latinos also had a significant increase in the probability of delaying care due to costs.

Authors suggest that policies restricting public benefits for immigrants may have contributed to the increase in being uninsured among Latinos. The authors also note that efforts to expand Medicaid and support communitybased health services may also help reverse health inequities for Latino populations.

Alexandra “Ali” Rivera-González, a PhD Candidate in the Department of Health Management and Policy at DSPH, contributed to this publication as well.