Medicaid expansion

Study: Refusing To Expand Medicaid Hurts People Of Color the Hardest

by Sy Mukherjee

States refusing Obamacare’s Medicaid expansion will disproportionately harm minorities — particularly African-Americans who tend to reside in GOP-led southern states that have rejected the expansion — according to a new study by the Kaiser Family Foundation (KFF).

Obamacare allows states to accept generous federal funding to expand Medicaid to all Americans making up to 138 percent of the Federal Poverty Level (FPL). To date, 28 states and Washington, DC, are either going forward with or trying to go forward with the expansion, while 23 states — including those with large communities of color, such as Texas, Louisiana, Georgia, Alabama, the Carolinas and Florida — are not.


Over five million poor Americans who live in anti-expansion states will fall into a coverage gap in which they don’t qualify for either Medicaid or for federal subsidies to buy insurance through the Obamacare marketplaces. That’s because the health law only grants subsidies to Americans above the poverty level, and states without the Medicaid expansion have wildly divergent eligibility rules that cam leave someone making as little as half the poverty level without access to public health insurance.

The Medicaid expansion would provide millions of uninsured Americans — and particularly minorities — with basic coverage. Almost 60 percent of uninsured black Americans, 51 percent of uninsured Hispanics and 53 percent of uninsured people of color in general have incomes below the Medicaid expansion threshold, according to KFF.

In the states that haven’t expanded Medicaid, “four in ten uninsured blacks with incomes low enough to qualify for the Medicaid expansion fall into the [coverage] gap, compared to 24 percent of uninsured Hispanics and 29 percent of uninsured whites,” wrote the researchers. “These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access.”

A smaller percentage of Hispanic-Americans fall into the coverage gap because several states with large Hispanic populations, including California, Arizona and New York have embraced the expansion. Still, Florida — where nearly one in four residents and one in three of the nonelderly uninsured is Hispanic — has chosen not to expand Medicaid after briefly flirting with the idea.

Opposition to Medicaid expansion in states that already have higher rates of poverty and worse public health is also expected to widen existing health disparities. For instance, colon cancer death rates “are an average of 16 percent higher than in pro-expansion states,” according to a recent Los Angeles Times analysis. Unequal access to high-quality preventative and primary care is one of the major reasons that black Americans still die younger than white Americans.

“Given their high uninsured rates and low incomes, people of color will be disproportionately impacted by this coverage gap, particularly poor uninsured black adults residing in the southern region of the country where most states are not moving forward with the expansion,” concluded the KFF study authors. “These continued coverage gaps and their varied impacts across groups will result in millions of poor adults remaining uninsured and likely lead to widening racial and ethnic as well as geographic disparities in coverage and access to care.”