Recent changes to Medicaid programs, aimed at closing the health coverage gap in the United States, have left some Americans behind — especially people of color.
Among the non-elderly population in the United States — those under 65 — insurance rates have risen during the Covid pandemic, with 3.4 million Americans enrolling in health coverage between 2019 and 2022, according to a report from KFF. This shift is due in part to Medicaid and health care marketplace provisions put in place as a result of the Affordable Care Act, the report said.
But as the global health crisis has subsided and Medicaid coverage expansions have been delayed in some states, insurance rates have fallen and Black Americans remain disproportionately uninsured compared with white Americans, according to KFF, a nonprofit focused on health policy.
In 2022, 10% of Black Americans were uninsured, compared to 6.6% of white Americans. The report said Black people were 1.5 times more likely to be uninsured than their white peers in 2022. People who identified as American Indian or Alaska Native were 2.9 times more likely than their white counterparts to be uninsured, while Americans Hispanics are 2.7 times more likely to be uninsured.
“The biggest driver of the racial coverage gap is states that did not expand Medicaid under the Affordable Care Act,” said Jennifer Wagner, director of the Center on Budget and Policy Priorities. “Those states have a higher number of Black individuals who are unable to access Medicaid coverage because they do not fit one of the eligibility categories within that state.”
Medicaid, a joint program between the federal government and the states, provides health insurance to low-income adults and children. The Affordable Care Act, passed in 2010, includes a provision to expand Medicaid coverage to people with low income levels who may not be covered by private insurance companies. But not all states have expanded coverage requirements, according to KFF.
In those states that have not expanded Medicaid, uninsured adults who do not meet coverage requirements but still fall below the poverty line are left with few options.
In 2022, about half of Black Americans under 65 were insured through an employer or private insurer, according to KFF, while nearly 40% were insured through Medicaid or another public option.
Unemployment rates among Blacks are consistently higher than the national average and higher than other groups, according to data from the U.S. Bureau of Labor Statistics, meaning fewer Blacks have access to health insurance through their employers. In January, black unemployment rose slightly to 5.3%, according to the bureau, compared with a national average of 3.7% and a white unemployment rate of 3.4%.
“Most Blacks live in a family with a full-time worker, but are less likely to have private coverage than their white counterparts, reflecting that they are more likely to work in low-income jobs that may not provide health coverage.” Samantha Arteaga, health policy expert at KFF, said:
In states that do not offer Medicaid expansion, 13.3% of non-elderly Black Americans are uninsured, according to KFF, compared to 7.3% of that population in states that have already adopted expansion.
Adding to the disparity in uninsured rates, a separate provision in Medicaid that automatically re-enrolled participants for coverage expired in March 2023, leaving millions of Americans to preemptively re-enroll themselves. Many, unaware of the changes, saw their coverage ended.
“We're seeing a lot of administrative hurdles with the renewal process that have become very apparent,” Wagner said. “People are losing coverage, not because they don't qualify or fall into the coverage gap, but because they didn't get the form or the state didn't address the scheduling.”
Since March, at least 17.4 million people have disenrolled from Medicaid or the related children's health insurance program. More than 35 million people have had their coverage renewed, while 41 million renewals are either pending or not yet due, according to KFF.
Community health centers, such as West Oakland Health, founded by four black women in 1967, are working to address the coverage gap. Robert Phillips, CEO of WOH, said the center noticed a slight decrease in the number of patients immediately after continuous enrollment ended.
“The decline in Medicaid patients has been steep,” Phillips said.
Phillips and his staff have begun reaching out to their Medicaid patients, and he said patients are coming back as the centers alert them that they need to renew their coverage.
“It makes us work harder,” Phillips said. “We want people to know they are still eligible for coverage and for those who don't know because they received a notice that their coverage has ended.”
WOH's five locations in California's East Bay region serve minority and low-income families seeking affordable health care. Most patients at WOH are Black and are covered under Medicaid, according to the company.
Correction: This story has been updated to remove the inaccurate description of the KFF nonprofit.
