New report estimates the effect of ACA on 14 large and diverse US cities

The Affordable Care Act (ACA) is estimated to provide increased federal funding to all states, but the amount is heavily influenced by the extent of Medicaid expansion and enrollment in federal marketplaces. States that decide not to expand Medicaid will forgo additional federal funds and need to address the needs of their uninsured populations.  Additionally, the ACA will reduce Medicare reimbursement as well as disproportionate hospital share payments. This will pose challenges for areas that serve the uninsured across a wide region. 

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The Urban Institute recently released a report on the ACA’s effect on 14 large and diverse cities. The following cities expanded Medicaid: Los Angeles, Chicago, Seattle, Columbus,  Phoenix, Denver, and Detroit. In these seven cities: 

  • the percentage of uninsured could decrease by 57% on average by 2016
  • enrollment into Medicaid and Children’s Health Insurance Programs (CHIP) will increase 38.5% 
  • a large percentage of those remaining uninsured are undocumented (41.4% in Houston, 28.4% in Charlotte, and 35.2% in Miami)

The following cities did not expand Medicaid: Charlotte, Houston, Philadelphia, Indianapolis, Memphis, Atlanta, and Miami. In these seven cities: 

  • the percentage of uninsured could decrease by 30% on average by 2016 (27% less than the average estimated decline among the seven Medicaid expansion cities).
  • enrollment into Medicaid and Children’s Health Insurance Programs (CHIP) will increase 10.7% (27.8% less than expansion cities) 
  • a large percentage of those remaining uninsured are undocumented (41.4% in Houston, 28.4% in Charlotte, and 35.2% in Miami)

The ACA will impact each city differently based on income, race/ethnicity, and immigration status. For example, approximately 80% of the uninsured population in Miami is Latino while more than 75% of the uninsured in Detroit are Black. Policymakers and researchers will need to observe how ACA will impact each area and address issues as it relates to each different population. 

Joanne Chan, Joint Center Graduate Scholar, Harvard School of Public Health

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