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Health Care

Blacks, Latinos to Pay Disproportionate Price Over Blocked Medicaid Expansion

Latinos are uninsured at nearly three times the rate of whites.

Applicants in Miami try to purchase health insurance under the Affordable Care Act at the kiosk at the Mall of Americas on Dec. 22.(Joe Raedle/Getty Images)

photo of Clara Ritger
January 16, 2014

Minorities are disproportionately affected by 25 states' decision to opt out of Medicaid expansion, a report finds.

Blacks make up 13 percent of the nation's population but will represent 27 percent of those who will lose out on Medicaid coverage because of these states' refusal to expand the program's eligibility to the national standard under Obamacare, according to the 11th Annual Martin Luther King Jr. State of the Dream Report.

Latinos make up 15 percent of the population and 21 percent of the coverage gap. Whites, meanwhile, will be underrepresented—they are 65 percent of the population but have only 47 percent in the gap.

 

Had the Affordable Care Act been fully implemented, half of the 50 million people who were uninsured before the 2010 law was passed would gain access to coverage through the state and federal health insurance exchanges or the Medicaid expansion. Because of the 2012 Supreme Court decision that ruled states' expansion of the program optional, 25 states have chosen not to expand Medicaid to include wage earners up to 138 percent of the federal poverty line.

The Medicaid coverage gap will leave out 5 million of the 10 million who would have gained coverage, exacerbating existing racial health disparities in the United States, a focus of Thursday's report from the equal-rights group United for a Fair Economy.

Poor blacks are 7.3 times—and poor Latinos 5.7 times—as likely as poor whites to live in high-poverty neighborhoods that aggravate health problems. That gap is because of minorities' limited access to health services and good food, as well as the great stresses from crime and racism, according to the report.

The data also find that 29 percent of Latinos, 19 percent of blacks, 15 percent of Asians, and 11 percent of whites were uninsured in 2012.

Republican governors are leading many of the states that have declined to expand the entitlement program. The federal government has committed to paying 100 percent of the expansion for the first few years, but the governors say they fear the feds will go back on their word, leaving states with unsustainable budget costs.

Other GOP governors have declined to expand the program out of ideological objections to an expansion of the nation's social safety net.

The report's authors are frustrated by the blocked expansion.

"With no expanded Medicaid, and little or no assistance to purchase insurance in the health exchanges, the actions of these elected leaders in these states are creating a vast hole in the new health care law—a 25-state coverage gap—through which nearly 5 million low income Americans will now fall," UFE writes.

"Access to health care is, first and foremost, a moral issue," the report continues. "It's a question of right and wrong. Tolerating vast inequalities in health and health care along the lines of race or class sends the disturbing message that we as a society value the lives of people in various groups differently."

Despite the blocked Medicaid expansion, the Affordable Care Act diminishes the racial health gap by expanding programs to promote diversity in health professions; supports cultural competency training to help doctors communicate with patients of color; and establishes research initiatives to explore the cause of health inequality. It also allows people with preexisting conditions—more common in impoverished neighborhoods due to the quality of life—to gain access to coverage.

But some people who do not have health insurance will continue to live without it. Others will be ineligible because of their immigration status. Still others won't qualify because of their employment situation. Blacks and Latinos are more likely to work in lower-wage or part-time jobs where they are less likely to receive employer-sponsored coverage.

In addition to the lack of insurance and access to affordable health services, residential segregation and the stress of living in poverty are primary factors contributing to poor health in the black and Latino communities. Those types of communities are commonly found in "food deserts," or areas of the country where people have little access to a grocery store with fresh produce and instead are surrounded by fast food joints. The report says that half of black neighborhoods lack a full-service grocery.

Among UFE's recommendations to permanently close the racial health gap are the continued pursuit of a single-payer, universal health insurance system, where employment and work situations would no longer play a role in access, quality, and cost of care. They also, of course, hope to see all 50 states expand Medicaid and take the lead on fully implementing and supporting the Affordable Care Act.

They also propose increasing funding to permanently fund Medicaid at the federal level, heighten funding for outreach and education efforts, and allow undocumented immigrants to take part in the system. More systemic policies—more diverse housing, improved access to services in areas of extreme poverty, raising the minimum wage—would also help address the disparity between the races in overall population health.

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