Millions of low-income Americans, disproportionately minorities living in the South, will remain uninsured, and that will "likely lead to widening racial and ethnic as well as geographic disparities in coverage and access to care." That's the conclusion of a
pair of
new studies from the Kaiser Family Foundation in its ongoing coverage of Medicaid expansion.
The uninsured are already disproportionately members of minority communities. "Hispanic non-elderly adults are at the highest risk of being uninsured, with one in three lacking coverage. Moreover, one in four (25 percent) non-elderly Black adults lacks coverage." That's compared to 15 percent of Whites. They are mostly the working poor, with jobs that pay too much for them to qualify for regular Medicaid, and too little to allow them to purchase insurance on their own. And it's a lot of people.
- Nearly five million non-elderly people living in the 26 states that have refused expansion fall into the gap.
- Nearly 80 percent of them live in the South: more than 20 percent in Texas alone, 16 percent in Florida, 8 percent in Georgia, and 7 percent in North Carolina.
- About 47 percent are White, 53 percent minority.
The outlook, unless state leaders in those 26 states change their minds on expansion, is grim.
If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they do require medical care, potentially serious financial consequences. Many are in fair or poor health or are in the age range when health problems start to arise, but lack of coverage may lead them to postpone needed care due to the cost. While the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be an important source of care for the remaining uninsured under the ACA, this system has been stretched in recent years due to increasing demand and limited resources.
Further, the racial and ethnic composition of the population that falls into the coverage gap indicates that state decisions not to expand their programs disproportionately affect people of color, particularly Black Americans. This disproportionate effect occurs because the racial and ethnic composition of states not expanding their Medicaid programs differs from the ones that are expanding. As a result, state decisions about whether to expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes among people of color.
These are the people increasingly left behind: who are seeing their unemployment benefits end; who have to have multiple minimum wage jobs just for the basics of survival which don't include health care; who are seeing their food stamps cut; the people—not too coincidentally—who are the prime targets of voter suppression. Being denied the promise of access to adequate, timely, and affordable medical care is just insult to ongoing, worsening injury.