Health insurance coverage has improved across racial and ethnic groups over the past decade, yet deep disparities remain, according to new analysis from KFF. While the Affordable Care Act (ACA) and pandemic-era policies expanded coverage, Black, Hispanic, American Indian, Alaska Native, and Pacific Islander communities continue to face higher uninsured rates than white Americans.
The report shows that as of 2023, nearly one in five Hispanic and American Indian or Alaska Native people under 65 were uninsured, at 17.9% and 18.7% respectively. Native Hawaiian and Pacific Islander people had uninsured rates of 12.8%, while 9.7% of Black Americans lacked coverage. By comparison, just 6.5% of white individuals were uninsured. Despite overall gains since the ACA, disparities have in some cases widened. Between 2010 and 2023, the uninsured rate for Hispanic people grew from 2.5 to 2.8 times higher than for whites, while for American Indian and Alaska Native communities, the gap grew from 2.4 to 2.9 times higher.
Medicaid expansion played a major role in narrowing gaps, but its uneven adoption across states leaves millions at risk. Black and Hispanic adults are especially vulnerable in non-expansion states, where uninsured rates are significantly higher. Immigration restrictions further limit coverage for Asian and Hispanic immigrants, many of whom remain excluded from Medicaid and ACA marketplaces.
With enhanced subsidies set to expire in 2025 and potential Medicaid cuts under debate, experts warn disparities could worsen, threatening hard-won gains in coverage for communities of color.
See: “Health Coverage by Race and Ethnicity, 2010-2023” (February 13, 2025)
