Increasing Coverage, Lingering Barriers

That’s according to the first in-depth examination of data from the Colorado Health Access Survey, or CHAS, on black and African-American Coloradans’ health care access and experiences. 

On the national level, health care disparities that affect black and African-American Coloradans are well-documented.¹ Studies show these groups receive lower quality care and less of it, and therefore experience worse health outcomes than white Americans.^{2, 3}  

But the CHAS points to a significant improvement in both insurance coverage and health among the state’s black and African-American residents between 2011 and 2017. 

Insurance Status

The share of black and African-American Coloradans who report being uninsured decreased by almost 10 percentage points after full implementation of the ACA. In 2011-13, according to the CHAS, more than 16 percent were uninsured. That was slightly higher than the rate for the state as a whole, 14.8 percent. In 2015-17, 6.5 percent of black and African-American Coloradans were uninsured, the same as the statewide rate. 

Most of the decrease came from the expansion of Medicaid in 2014, which allowed adults with incomes up to 138 percent of the federal poverty line to enroll in public insurance. Approximately 35 percent of black and African-American Coloradans were insured through public insurance before the ACA, compared with 44 percent post-ACA. During this time, there was essentially no change in private insurance coverage. 

Research shows that people without health insurance receive less medical care, have worse health outcomes, and face a financial burden when forced to seek care without insurance.⁴ 

Access to Health Care

Although insurance may open the door for people to get care, it does not guarantee that they receive services and treatment. 

Despite having an uninsured rate equal to other Coloradans’, black and African-American Coloradans were less likely to report seeing doctors and specialists in the previous year and more likely to visit the emergency room for non-emergency reasons than other Coloradans after the ACA, the CHAS analysis showed. More than one in three people who identified as black or African American report not having gone to the doctor in the previous year, compared with one in four other Coloradans.

However, black and African-American Coloradans report having a usual source of care on par with the state average, around 86 percent. Having a usual source of care indicates that people know where to go for primary or preventive care. 

Barriers Remain

In general, the ACA appears to have improved access to care. For example, a smaller portion of those who identified as black or African American cited cost as a barrier to care after the ACA than before, as did other Coloradans, according to CHAS data. (See Figures 3 and 4.)

After the ACA, fewer black and African-American Coloradans reported that cost was a barrier to getting prescriptions, though they were still more likely to cite cost than white Coloradans. After the ACA, about the same percentage of African-Americans and white Coloradans reported that cost prevented them from seeing a doctor. 

Transportation remains a barrier to health care for black and African-American Coloradans. Nearly one in 10 reported not getting care because of a transportation challenge, nearly double the state average. 

A combination of factors, including income, insurance status, geography and transportation policies, influence a person’s ability to access transportation to health care. 

Health Outcomes

Despite having some differences in access and barriers to care, black and African-American Coloradans reported having either excellent, very good or good health at a rate on par with the rest of Colorado in 2015-17 — approximately eight in nine for both populations. The same goes for mental health, with about 90 percent of both black and African-Americans and other Coloradans reporting good mental health. 

A higher proportion of black and African-American Coloradans reported good general health after the implementation of the ACA than before it (87 percent versus 81 percent). 

The ACA, and the large numbers of black and African Americans covered by the expansion of Medicaid, could be part of the reason why there is an improvement in reported health status.

Conclusion

This first-ever analysis of black and African Americans’ responses to the CHAS reveals landmark improvements in insurance coverage and affordability. In the most recent surveys, black and African-American Coloradans were insured at much higher rates, were less likely to say cost is a barrier to care, and reported good health at similar rates to the rest of Colorado.

Future efforts to address non-emergency ER visits and reduce barriers to care like cost and transportation may help more black and African Americans access the care they need.