Obamacare Opponents Are Making Racial Inequality Worse

CREDIT: AP Photo/Lynne Sladky

Kamalah Fletcher wears a medical mask over her face saying "No Coverage = Death" during a protest in support of Florida lawmakers expanding the eligibility criteria for Medicaid

The ongoing political resistance to fully implementing the major provisions of Obamacare is serving to deepen racial inequality in the health care sector, according to a new analysis from researchers at the nonpartisan Kaiser Family Foundation.

There are already significant disparities in health outcomes that fall along racial, ethnic, and socioeconomic lines. Historically, people of color in the United States have been less likely to be insured and more likely to receive substandard health care. Racial gaps have contributed to the fact that black Americans are still dying younger than their white counterparts.

Obamacare’s optional Medicaid expansion represents a step forward in this area, largely because it was expected to help reduce the coverage disparity between non-white and white Americans. And in some parts of the country, it’s working as planned. But in the states where GOP politicians have continued to refuse to expand Medicaid, low-income people of color are paying the price.

Without Medicaid expansion, millions of impoverished Americans fall into what’s known as a “coverage gap” — making too much money to qualify for their state’s more restrictive Medicaid program, but too little money to qualify for the federal subsidies intended to help people purchase private insurance on Obamacare’s marketplaces. Ultimately, according to the Kaiser researchers, those people are disproportionately likely to be African American.

“The impact of the coverage gap varies by race and ethnicity, with poor uninsured Blacks most likely to fall into the gap, since they disproportionately reside in the southern region of the country where most states are not implementing the expansion,” the researchers conclude. “The continued disparities in access to health coverage will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access to care.”

If every state accepted the expansion, Kaiser estimates that more than four in ten uninsured non-white adults would gain coverage. Instead, about 2.1 million people of color are being locked out of affordable insurance. Of the 2.9 million uninsured black Americans in the country, about 34 percent fall into the coverage gap created by anti-Obamacare lawmakers — who typically say the policy will be too expensive, even though the federal government will pick up nearly all of the costs of coverage.

Kaiser’s research confirms what previous analyses have also reported. Back in 2013, the New York Times crunched the numbers and found that the GOP resistance to Medicaid expansion was disproportionately harming the working poor: People of color who work as cashiers, cooks, nurses’ aides, waiters and waitresses, and janitors yet aren’t offered insurance benefits through their hourly jobs.

Much of the fate of the coverage gap, and the future of health disparities among people of color, rests with three key states that have particularly high rates of uninsurance. According to the new Kaiser report, more than half of the Americans who are locked out of Obamacare reside in Texas, Florida, and North Carolina.

Medicaid proponents were hopeful — and somewhat shocked — when Florida Gov. Rick Scott (R) expressed support for expansion in 2013. But the state’s GOP-controlled legislature has fiercely resisted the policy, and just this week, the governor walked back his endorsement of this particular Obamacare provision. About 800,000 of Scott’s constituents fall into the coverage gap.

North Carolina Gov. Pat McCrory (R), meanwhile, has firmly rejected the traditional Medicaid expansion as it’s laid out under the Affordable Care Act, but has recently suggested that perhaps the state could come up with an acceptable compromise. Texas Gov. Rick Perry (R) has been steadfastly opposed to expanding Medicaid, and once compared the policy to “putting 1,000 more people on the Titanic.”