State Medicaid Decisions Impact People of Color

By Fred Kammer, S.J.

A report this month from the Kaiser Family Foundation highlights the disproportionately negative impact on people of color of decisions by Gulf South governors and legislatures and those in other states.  While the potential Medicaid expansion will increase health coverage for low-income Americans of all races and ethnic groups, people of color are more likely than whites to be uninsured and low-income.  They tend to work in low-wage jobs that do not offer employer-sponsored health insurance and, when it is offered, often have difficulty affording coverage.

The report indicates that, in the United States, “people of color comprised six in ten of the total 25.4 million nonelderly uninsured with incomes at or below the 138% FPL [Federal Poverty Level] Medicaid expansion limit.” [1]  Most of the elderly are covered by either Medicare or Medicaid; so it is the non-elderly with incomes below the federal limit who would most benefit from the Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA). Key Gulf South states have significant portions of the uninsured people of color in the nation who would benefit. Texas has sixteen percent and Florida nine percent of those affected.

Nationally, as of 2011, nearly one of three Hispanics—thirty-one percent—were uninsured.  As the report further indicates, “nearly six in ten uninsured Hispanics had incomes below the Medicaid expansion limit.” [2]  Twenty-two percent of these live in Texas and nine percent live in Florida.

Of African-Americans, in 2011 nearly one of five—nineteen percent—were uninsured; and, of those, nearly two out of three had incomes below the Medicaid expansion limit. [3]  In eight states, including Alabama and Mississippi, at least seventy percent of uninsured Blacks had incomes below the Medicaid expansion limit.

The table below indicates some of the key statistics on those uninsured who are eligible for Medicaid expansion (those who are uninsured and who have incomes below 138% FPL) in the five Gulf South states:

NONELDERLY UNINSURED—ELIGIBLE FOR MEDICAID EXPANSION
Total Number and Percentage of Racial/Ethnic Groups - U.S. and Gulf South States

As can be seen from these figures, one important implication of Medicaid expansion—if the states adopt it—is the opportunity to advance greater equity in health coverage and care.  As the Kaiser Report indicates, with regard to communities of color, “Increased coverage would not only improve their access to care, but also help reduce longstanding disparities in coverage and care.” [4]

Some states have hesitated or refused to implement the Medicaid expansion provisions of the PPACA, even though the federal share of the cost of expansion is 100 percent for three years and then gradually declines to a floor of 90 percent by the year 2020.  In November 2009, the United States Conference of Catholic Bishops wrote in a letter to the U.S. Senate as it considered the PPACA, “The bishops support the expansion of Medicaid eligibility for people living at 133 percent or lower of the federal poverty level.  The bill does not burden states with excessive Medicaid matching rates.” 

[1] Cf. Impact of Medicaid Expansion for Low-Income Communities of Color Across States, Kaiser Commission on Medicaid and the Uninsured, April 2013, p. 2, at http://www.kff.org/minorityhealth/upload/8435.pdf (accesses April 25, 2013).

[2] Ibid., p. 3.

[3] Ibid., p. 4.

[4] Ibid., p. 6.