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.