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—in-cluding 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.
Bibliographical noteFunding Information:
This article was supported in part by the Robert Wood Johnson Foundation grant P01 AG032952. Although the idea for this study came out of our learnings from a 2-year study of the impact of the Affordable Care Act in Kentucky, funded by the Foundation for Healthy Kentucky, this research article represents original analysis that has not been published as part of that initial work.
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