Blacks, Latinos to Pay Disproportionate Price Over Blocked Medicaid Expansion

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

MIAMI, FL - DECEMBER 22: Rene Hernandez (2nd R) and his wife Nery Hernandez speak with Rosaly Hernandez an insurance agent with Sunshine Life and Health Advisors as they try to purchase health insurance under the Affordable Care Act at the kiosk setup at the Mall of Americas on December 22, 2013 in Miami, Florida. Tomorrow is the deadline for people to sign up if they want their new health benefits to kick in on the 1st of January. People have until March 31, to sign up for coverage that would start later.
National Journal
Clara Ritger
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Clara Ritger
Jan. 16, 2014, 6:04 a.m.

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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