The potential and realized impact of the affordable care act on health equity

Abstract

The Affordable Care Act (ACA) was designed with multiple goals in mind, including a reduction in social disparities in health care and health status. This was to be accomplished through some novel provisions and a significant infusion of resources into long-standing public programs with an existing track record related to health equity. In this article,wediscuss sevenACAprovisions with regard to their intended and realized impact on social inequalities in health, focusing primarily on socioeconomic and racial/ethnic disparities. Arriving at its 10th anniversary, there is significant evidence that theACAhas reduced social disparities in key health care outcomes, including insurance coverage, health care access, and the use of primary care. In addition, theACA has had a significant impact on the volume/range of services offered and the financial security ofcommunity health centers, and through section 1557, theACAbroadened the civil rights landscape in which the health care system operates. Less clear is how the ACA has contributed to improved health outcomes and health equity. Extant evidence suggests that the part of theACAthat has had the greatest impact on social disparities in health outcomes-including preterm births and mortality-is the Medicaid expansion.