By: Johanna Husena
In 2010, the Affordable Care Act was implemented and required all individuals to sign up for health insurance. It aimed to reduce the number of uninsured populations and provide the option for affordable care through Medicaid, which did not go into full effect until 2014. All states were left to decide if they wanted to expand Medicaid to their citizens, even though it required taxation and state funding.
Since Republican-dominated and some swing states chose not to expand Medicaid, it resulted in disparities for racial minorities. Certain races and ethnicities can’t attain the healthcare they need due to financial hardships, which Medicaid would cover. Expanding Medicaid forces states to address racial disparities. With non-expansion, states decide to stay on the sidelines while the coverage gap increases.
Medicaid expansion and non-expansion trends reveal racial differences
As seen in the chart(s) above, uninsured populations are decreasing due to the ACA’s implementation, but rates are lower in expansion states than in non-expansion states. There is a distinct difference between races in their uninsured rates, such as Hispanics show to be the least insured whereas whites are the most insured. A possible explanation for the difference between races would be that many Hispanic populations face the problem of documentation and the fear of being deported when they seek medical care. The black population deals heavily with poverty due to systemic racism.
The chart above reveals the ACA’s impact on the number of uninsured people. After it was enacted, the ACA brought forth more access to care for all races and ethnicities. However, the ACA and Medicaid expansion affected some communities more than others. For example, when one compares the impact the ACA had on white Americans versus Latino Americans, Latinos had a much more significant increase in insurance rates (Whites: 4.6% decrease in uninsured individuals; Latinos: 12.2% decrease in uninsured individuals)
This interactive map shows the differences between states and races in access to care and insurance. States who chose not to adopt Medicaid include Alabama, Florida, Georgia, Kansas, Missippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. In these non-expanding (and primarily Republican-dominated or swing) states, there are higher numbers of uninsured BIPOC individuals, which reveals how much Medicaid expansion determines accessibility to care for people of color. For example, South Carolina has yet to expand Medicaid and has caused 48.2% of Pacific Islanders and Hawaiians to be uninsured. However, in California, an expanded state with a high HPI population, there are only 8.6% uninsured.
Harmful outcomes impacting BIPOC due to Medicaid non-expansion
It has been shown that Medicaid expansion brings better healthcare coverage and access to care. To better serve their community and citizens, all states who have remained non-expanded should expand Medicaid. By not expanding, these states are trying to make a political statement at the expense of BIPOC citizens. Additionally, not expanding reveals that these states are more concerned with cutting taxes than supporting their citizens of color.
While BIPOC communities remain uninsured, there will face financial hardships when accessing health services. It is harder to obtain employer-based coverage for BIPOC due to systemic racism in the workforce, which offers limited rates and options. The lack of health insurance available to the BIPOC community through their employer shows why it is central to expand Medicaid.
New Presidential Administration sees importance in Medicaid Expansion
A huge aspect of Donald Trump’s presidency was focused on removing and replacing the Affordable Care Act. This focus has undoubtedly delayed Medicaid expansion and has prevented Republican states from seeing the benefits of the ACA. However, with a new democrat administration, perhaps Medicaid expansion across all states may be possible, especially as Biden recognizes COVID-19 struggles and has put incentives into place.