Closing the Racial and Ethnic Disparity Gap through Medicaid Expansion
By Jessica Gehr
Thanks to the Affordable Care Act (ACA), a historic number of Americans have health insurance. Research has shown that uninsured rates have declined among all racial and ethnic groups under the ACA. Now, a new Commonwealth Fund report confirms that these coverage gains have reduced racial and ethnic disparities in access to care among adults. This is a huge step toward reducing the gaps in life expectancy and health outcomes, such as prevalence of asthma, diabetes, and cardiovascular disease, that disproportionately affect Black and Hispanic children and adults.
The Commonwealth Fund’s report shows that the ACA narrowed disparities in access to care for Black and Hispanic adults when compared to White adults, with greater improvements in states that used the ACA provision to expand Medicaid. Between 2013 and 2015, disparities with White adults narrowed for Black and Hispanic adults among three key groups:
- Uninsured working-age adults;
- Those who skipped care because of costs; and
- Those who lacked a usual care provider.
Although the ACA has been successful in increasing access to health care, persistent gaps still remain, especially for those in states that have chosen not to expand Medicaid coverage. Moreover, the patchwork expansion of Medicaid makes coverage disparities worse, especially for Black adults since a large share of this population resides in the South where many states have not yet expanded Medicaid; a previous Kaiser Family Foundation study found that uninsured Black adults are more than twice as likely as White and Hispanic uninsured adults to fall into the “coverage gap” that Medicaid expansion addresses.
Further, additional evidence shows that state Medicaid expansion decisions are racialized in two ways. First, there are large differences in support levels for the expansion by race, with people of color having higher levels of support; and second, state adoption decisions are positively related to White opinion and are not responsive to the levels of support among people of color. Most noteworthy—when the size of the Black population increases and White support levels for expansion are relatively low, the state is significantly less likely to expand Medicaid.
These findings have profound implications for advocates and policymakers.
The lesson for non-expansion states is simple: expand Medicaid, which brings needed federal resources into the states and results in decreased health disparities for communities of color. The ACA is the law of the land, and this is a pivotal time for the remaining 19 states to expand Medicaid and significantly reduce the coverage gap.
More broadly, the report also underscores the importance of protecting Medicaid expansion. The national averages mask notable differences in coverage and access to care between adults living in states that expanded Medicaid and those in states that did not. Medicaid expansion provides affordable insurance to those who need critical health and mental health services. The Commonwealth Fund report confirms that the Medicaid expansion is a critical tool to reduce health disparities in coverage and access to care. With the continued public attention on the importance of affordable health care—and the heightened understanding of and appreciation for Medicaid—now is the right moment to expand coverage and continue to work to reduce health disparities.