As of November, some four million poor adults
were included in the national "coverage gap," a consequence of state decisions not to expand Medicaid. As the chart shows, Latinos and blacks make up a highly disproportionate share of these uninsured Americans.
These uninsured earn too much money to meet current Medicaid eligibility requirements but below the lower limit for Marketplace premium tax credits. If all the states had expanded their Medicaid programs, these four million would be newly eligible for coverage.
On a more positive note, the coverage gap has declined markedly in the past year. In three states alone—Ohio, Pennsylvania and New Hampshire—600,000 previously ineligible people have become insured since September 2013 because of Medicaid expansion. Again, this is a major benefit to all who meet the eligibility requirements, but blacks and Latinos especially gain because they are more likely to fall into the income eligibility parameters of the program.
In some other good news, a study published in The New England Journal of Medicine indicates significant improvements are taking place in hospital care of Latinos and blacks, at least when it comes to heart attacks, heart failure and pneumonia.
Most hospitals report their performance caring for patients suffering from these ailments, but they don't report the outcome based on race or ethnicity, making it difficult to determine whether there have been improvements in the quality and equity of care based on those characteristics. A team of researchers led by Dr. Amal N. Trivedi sought to find out.
They adjusted for 17 quality measures and found that "racial disparities were reduced in every category between 2005 and 2010. Importantly, they found hospitals were providing care more equally within hospitals, as well as between hospitals—meaning hospitals that serve higher rates of minority patients also saw improvements, the study authors wrote." Specifically, performance rates in the 17 categories improved by 3.4 to 57.6 percentage points in that five-year period for white, black, and Latino adults:
“Reviewing more than 12 million hospitalizations between 2005 and 2010, researchers set out to find whether hospital quality was improving—and whether minority groups were still being left behind. By 2010, angioplasty rates for all heart attack victims rose dramatically as the disparity gap also narrowed, according to the study. That year, 91.7 percent of white patients received the procedure within 90 minutes, compared to 86.3 percent of blacks and 89.7 of Hispanic patients—so the treatment gap between whites and blacks was cut by more than half in those five years.”
The closing of the gap is encouraging. It would be instructive to learn whether this improvement in care and equity when dealing with heart problems and pneumonia apply to other areas of care.