More than half of all uninsured people of
color nationwide could get health care coverage if an additional 25 states
stopped playing anti-Obamacare politics and expanded Medicaid. Yet, is this
just about politics? Could it also be about race? At the
very worst, it’s rooted in racist politics. At the very best, it leaves that
impression by justifying racial inequality in access to health care. One thing
is certain—anti-expansion state policies disproportionately harm people of
color.
A December report by
Kaiser Family Foundation found that 53 percent of uninsured people of color
have incomes that qualify them for expanded Medicaid. Uninsured African
Americans have the most to gain, or lose, with 59 percent qualifying for
expanded Medicaid. 42 percent of uninsured whites would qualify for expanded
Medicaid. The implications of these findings are clear: minorities
benefit more from expansion, and anti-expansion states perpetuate, if not,
increase racial disparities in health coverage.
More people of color reside in
anti-expansion states, especially the Deep South, than expanded Medicaid
states. Out of the top ten states with the highest percentages of their
populations being black, eight have not expanded. Two of the three states
with the largest Latino populations in the United States, Texas and Florida,
have also not expanded. Because these anti-expansion states have more
people of color compared to most expansion states, choosing not to expand
Medicaid deepens differential access to health care services for people of
color. Another way to describe this result is “institutional racism.”
Today, there are significant racial and
ethnic disparities in health insurance coverage—fifteen percent of whites are
uninsured versus 33 percent of Hispanics and 25 percent of blacks. Racial
disparities shamefully persist in so many areas, like employment, education,
the criminal justice system, economic opportunity and health care. Expanding
access to Medicaid offers a rare opportunity to significantly diminish racial
disparities in at least one of them. Expansion would also provide those faced
with the many challenges associated with not being white (e.g., Empl
opportunity and Edu access) something to fall back on in cases of illness or
injury.
Medicaid expansion would also diminish the
racial disparities in life expectancy. The Congressional Budget Office released
a report in 2008
showing that there is a five year gap in life expectancy between whites and
blacks, citing “use of health care” as a contributing factor. By providing more
access to health care services, Medicaid expansion could contribute to reducing
racial disparities in life expectancy.
Anti-expansion may well just be more
anti-Obamacare posturing, but there is no doubt—intentional or not—the
consequences clearly disproportionately hurt people of color. As governors and
state legislatures continue to opt out of expansion, ignoring a magnitude of
financial and public policy benefits, their actions are perpetuating racial
disparities in health care. While sacrificing the good of some constituents for
the perceived good of one’s party may seem like smart politics, it’s not. It is
reckless, short sighted, and exacerbates an untenable system of inequality that
ultimately will be political fallout for future campaigns. Even if those refusing to expand don't go around hurling racial epithets, their policy decisions are racist because they have a blatant racial impact.
Most importantly, however, expanding
Medicaid is a rare opportunity for states to act in a judicious and equitable
manner by decreasing racial health disparities and providing health care to the
16.3 million people of all colors.
