Policy Analysis and Recommendation

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Affordable Care Act and Health Inequities Among Low-Income Communities and People of Color

Taliegha Carter

Capella University

Course name

Prof. Katti Carlson

8/23/26

Policy Analysis: Affordable Care Act and Health Inequities Among Low-Income Communities and People of Color

Health disparities in low-income individuals and minorities remain a vital issue of social justice in the United States. These social groups experience high rates of uninsured status, treatment delays, chronic illnesses, and preventable health issues. Although there may be many different causes of health disparities, economic barriers in accessing health care remain one of the most important ones. The chosen policy for this analysis is the Affordable Care Act (ACA), which is a part of health care reform from 2010. The objective is to promote access to affordable health insurance coverage and improve the quality of health care delivered. The Patient Protection and Affordable Care Act was enacted into law by Congress on March 23, 2010. This paper provides a brief analysis of policy's development, effectiveness, feasibility, and constraints through the social justice, anti-racist and anti-oppressive lenses.

Development of the Affordable Care Act

The ACA has been created to address longstanding issues within the American health care system. Prior to the legislation, millions of Americans were uninsured or lacked access to health care services. Low-income groups and members of racial and ethnic minorities were especially hard hit. Insurance companies would also be able to refuse coverage or increase their prices due to pre-existing medical conditions. Treatment of such pre-existing conditions would help ensure that preventive care is accessible to everyone. The ACA bill was introduced into Congress as H.R. 3590 in 2009 and enacted as Public Law 111-148 in March 23, 2010 (U.S. Department of Health and Human Services, 2022). Following its enactment, the Health Care and Education Reconciliation Act was also enacted and made changes to the ACA. These laws together developed a sweeping federal design for the financing, regulation and provision of health insurance.

The primary goals of the ACA were to expand health insurance coverage, make coverage more affordable, protect consumers, and improve access to health services. The law created insurance markets that would allow eligible people to get health insurance with financial help. It also barred insurance plans from denying coverage to individuals due to their preexisting conditions, and demanded that many preventative services be available for no cost-sharing. In general, young adults were eligible to continue on their parents' insurance plan up to age 26.

The Medicaid expansion was one of the largest features for low-income adults. State Medicaid programs were originally mandated to cover most adults who fall under about 138% of the federal poverty level. The Supreme Court's 2012 ruling, however, in the case of National Federation of Independent Business v. Sebelius, ruled that Medicaid expansion was effectively a decision for states. Consequently, states could decide whether to implement the expansion. This choice became one of the large hurdles of the ACA since access to Medicaid shifted partially based on the person's geographical location. The ACA thus sought to reduce health inequity. Public insurance was offered to adults with low income with the expansion of Medicaid. The subsidy amounts in the marketplace (based on the viewed household income) lowered premium costs for families who qualified for it. Consumer protection decreased discrimination in insurance. Restrictions on diseases being detected and treated at an early stage.

Effectiveness for the Target Population

The Affordable Care Act (ACA) has demonstrated moderate success in solving the issue of health inequalities faced by poor people and people of color. This policy has contributed to better access to health insurance, lessening of the burden and more chances to receive preventive and primary healthcare. Medicaid expansion has played an important role regarding poor adults, as it allows those individuals, whose income was previously too high to be eligible for Medicaid and too low to buy any insurance, to get covered. Implementation of ACA has positively affected insurance coverage by race or ethnicity and narrowed the gap in access to healthcare (Sommers et al., 2025). These enhancements directly reflect the cause of problem social justice as identified in previous analysis.

The ACA also has an effect on enhancing the social functioning of the target population. Affordable health care allows people to control their illnesses, get preventive services, be productive in their workplace, and stay away from getting indebted for health reasons. Improved acess will help to decrease the influence of family ties and involvement in the community (Johns & Rosenthal, 2024). However, this policy does not cover all the needs of poor people and people of color. The policy leaves room for states to decide whether to expand Medicaid or not, which leads to the creation of geographic inequities. Other barriers to timely access of insured people are the shortage of specialists, transportation problems, language issues, and limited availability of culturally appropriate services. Thus, the ACA helps to lower the number of barriers but does not change the context which creates health inequities.

The policy also preserves the important social values for target populations such as equality, non-discrimination, justice, respect, and access to necessities. The ACA fosters equity in health care by banning practices of insurance discrimination against preexisting conditions and increasing the number of health coverage opportunities. The requirements are especially beneficial to groups that have traditionally faced economic and racial obstacles to health care. However, health outcomes and disparities in coverage show that equal access to health care is not fully realized.

Ethically, the ACA is generally compatible with social work values and standards of good practice. As per the NASW Code of Ethics, social work values include social justice, dignity and worth of the individual, service, and non-discrimination. Enabling more people to access insurance coverage are consistent with these values, and would ensure that the less privileged members of society could receive the services that they require. This policy and other services offered in the community can help promote cultural competence. However, there are some ethical issues that cannot be ignored. Having insurance does not guarantee the provision of the same level of health care. Health care professionals are influenced by many biases, which can affect how they treat patients with common conditions coming from lower social class (Job et al., 2024). Furthermore, Medicaid eligibility is state-by-state, so people who are poor are not equally protected.

Feasibility of the Policy

The ACA is politically viable because it has largely been able to pass a sizeable number of political hurdles and many different attempts to repeal and dramatically take down it has endured. There has been on going political debate as Congress has regularly looked at bills that would change the law. However, political feasibility remains complicated because health care policy is strongly influenced by partisan differences at the federal and state levels. Medicaid expansion is an obvious example since each state has the power to choose whether to expand eligibility. The ACA is economically viable because millions of people who would not otherwise be able to afford coverage are eligible and able to receive federal financial support for those costs. Medicaid expansion offers significant federal dollars to states that cover the expansion, and eligible households can obtain coverage through marketplace subsidies (KFF, 2025). These investments may also bring about indirect economic benefits by cutting rates of untreated sickness or people's ability to work or be involved in their communities.

The Government Accountability Office (GAO) has offered evidence of value of Medicaid expansion. This finding found that adults in lower income states with Medicaid expansion had a lower level of unmet medical needs than adults in non-expansion states. However, out of the millions of low-income uninsured adults that qualified for expansion, many were from non-expansion states. Administratively, the implementation of the ACA is feasible because institutions have already developed significant parts of the ACA implementation, including the federal government, states, insurance companies, health care institutions, and community-based organizations. On the other hand, administrative challenges might become a hindrance for enrollment and retention in insurance coverage due to the required eligibility criteria, documentation, and other reasons. Limited-income individuals can be hindered by eligibility requirements, documents needed, renewals, or variations in the way Medicaid is administered from state to state.

Policy Constraints

The most significant limitation is that some states have not expanded Medicaid. States have the option of expanding Medicaid, meaning that two people with identical incomes may have different coverage levels. Congress' own analysis confirms the disparities in eligibility for, the benefits for, and the payment rate of Medicaid provision across the states. This geographic difference makes moving towards national coverage with ACA less effective. One drawback is the lack of a shortage of health care providers. Coverage does not mean that someone will be able to get an appointment. Access to primary care providers, specialists, pharmacies or behavioral health professionals in low-income communities might be less. Low reimbursement rates is another obstacle to providers taking on Medicaid patients. Consequently, an individual may possess insurance but still experience delayed treatment.

Implicit bias and racial inequity also prevent the policy from being successful. Job et al. (2024) determined that implicit bias of health professionals can influence clinical or treatment decisions and interactions with their patients from lower socioeconomic status. This bias can impact diagnosis, treatment and patient experiences. Therefore, insurance expansion alone cannot eliminate inequities created within health care institutions.

Language barriers and cultural differences become another challenge. Some patients might find it difficult to comprehend the registration process, medical instructions, or services offered. Immigration regulations will also make certain individuals less likely to be able to get insurance or to be afraid to get in touch with public organizations. These factors will disproportionately burden the marginalized communities. Transport and access to technology can become another limitation. The use of the ACA will include registering online, using electronic communications, and visiting medical centers. Individuals who lack adequate means of transportation, internet access, and technological knowledge may fail to reap all the benefits from this policy. The barriers underscore the necessity for reform in health insurance to go along with more wide-reaching social policies in areas of housing, employment, mobility, education, and community relations.

Conclusion

The Affordable Care Act (ACA) is an important policy response to health inequities within low-income communities and communities of color. The ACA increased insurance coverage, provided improved primary care, and reduced some health inequities based on race and income. Nevertheless, large inequities persist due to varying degrees of Medicaid expansion, shortage of providers, discrimination, language barriers, and other factors. Thus, the ACA has made a difference for health outcomes but not necessarily for improving health disparities. Advocacy is needed to continue increasing Medicaid access, promote culturally responsive care, diversify providers and overcome barriers to getting transportation and digital access from a social work perspective. These efforts support the NASW Code of Ethics and promote social justice.

References

Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R. (2024). Health professionals' implicit bias of patients with low socioeconomic status and its effects on clinical decision-making: A scoping review. BMJ Open, 14(7), e081723. https://doi.org/10.1136/bmjopen-2023-081723

Johns, M., & Rosenthal, J. (2024). How the affordable care act improved access to preventive health services. In Center for American Progress. https://www.americanprogress.org/article/how-the-affordable-care-act-improved-access-to-preventive-health-services/

KFF. (2025). Status of State Medicaid Expansion Decisions | KFF. In KFF. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/

National Association of Social Workers. (2025). Code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

Sommers, B. D., Smith, R. B., & Figueroa, J. F. (2025). Closing gaps or holding steady? The Affordable Care Act, Medicaid expansion, and racial disparities in coverage, 2010–2021. Journal of Health Politics, Policy and Law, 50(2), 253–281. https://doi.org/10.1215/03616878-11567660

U.S. Department of Health and Human Services. (2022). About the affordable care act. In U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-aca/index.html