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New report shows Medicaid expansion narrowed racial disparities in health insurance

Medicaid expansion has not only reduced the total number of people without health insurance in the US – it has also narrowed the racial gap in health insurance coverage.

Health insurance coverage for black, Hispanic/Latino and white adults is set to improve between 2013 and 2021, according to a new report from The Commonwealth Fund.

In 2013, before Medicaid expansion took effect, 40.2% of the Hispanic/Latino population, 24.4% of the Black population, and 14.5% of the White population were uninsured. By 2021, these numbers drop to 24.5%, 13.5% and 8.2%, respectively.

“There’s a lot of progress being made on uninsured rates and these disparities are narrowing [is] That certainly stems from the Affordable Care Act coverage expansion, Jesse Baumgartner, co-author of the report and senior research associate at The Commonwealth Fund, told Yahoo Finance. “They went into effect in 2014. So you see a big drop between 2013 and 2016 because market subsidies came online, [and] Many states expanded their Medicaid programs during that time. So that’s obviously a huge driver for that progress.

Expansion vs Non-expansion

Medicaid was expanded in 2013 through the Affordable Care Act (ACA)—more commonly known as Obamacare. The provision allows families whose income is less than 138% of the federal poverty level to become eligible for Medicaid.

After a Supreme Court ruling, however, it was left up to each state to decide whether to adopt the expansion. As of March 2023, 39 states and the District of Columbia have expanded Medicaid.

Between 2013 and 2021, states that adopted Medicaid expansion saw higher rates of insurance coverage and health care coverage than non-expansion states, according to a Commonwealth Fund report. They also found smaller disparities between racial and ethnic groups.

While every racial and ethnic group has made significant progress in health care coverage since 2013, gains in health care coverage for the Hispanic/Latino population have been particularly notable: Its uninsured rate decreased 15.7 percentage points between 2013 and 2021. is, most of any of these demographics.

“There have been huge gains,” Baumgartner said, “despite challenges such as low access to employer-sponsored insurance and rules related to immigration status affecting Medicaid eligibility.”

Still, the Hispanic/Latino population has the highest uninsured rate in the U.S., which Baumgartner said is “a huge remaining disparity” and one that “needs the most work to move forward.”

‘A clear, major risk to the progress made’

As of October 2022, more than 91 million Americans were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

Significant improvements occurred between 2019 and 2021, which Baumgartner attributed to federal policy actions taken in response to the coronavirus pandemic, specifically the Families First Coronavirus Response Act and the American Rescue Plan.

“The data in this report show that federal policy actions during the pandemic … not only made a major impact in preventing coverage losses, but actually led to some coverage gains for all those groups during that time, ” They said .

The Families First Coronavirus Response Act, which was signed into law in March 2020, allocated $3.5 trillion for things like coronavirus testing, nutrition services, and a public health and social services emergency fund.

The American Rescue Plan, passed a year later, expanded eligibility for ACA subsidies and increased the amount of financial assistance for those already eligible for the ACA. These subsidies have been extended till 2025.

“The data here really explains the impact of those expanded subsidies and how they’ve made coverage more affordable,” Baumgartner said. “Going forward, we think policymakers should keep in mind that extension past 2025 is certainly another option that this data highlights.”

However, beginning March 31, one provision of the federal policy response to the pandemic — continuous Medicaid enrollment — could expire, ending health care coverage for millions of Americans.

According to the Kaiser Family Foundation, “States that accepted increased federal funding can resume unenrollment beginning in April, but certain reporting and other requirements must be met during the unwinding process.”

This could affect some of the recent progress on insurance coverage, especially for black and Latino families.

Between 2019 and 2021, uninsured rates for black adults fell by at least two percentage points in 14 states, while rates for Hispanic/Latino adults fell by the same amount in 19 states, according to a Commonwealth Fund report Is.

“The big question is: What can the state and federal government do to reduce coverage losses and switch people who will inevitably be turned away from Medicaid?” Baumgartner said. “It’s a clear, huge risk to progress because clearly those policies, and continuous enrollment policies in particular, have had a huge impact.”

Former President Obama arrives at the White House on April 5, 2022 to deliver remarks on the Affordable Care Act and Medicaid. (Photo: Mandel Ngan / AFP)

Until that specific issue can be addressed, Baumgartner said federal policymakers should look into creating a federal withdrawal option for non-expansion states.

“The question becomes: how are states going to be able to get people on other coverages, to get them on the marketplace coverage that they might be eligible for, to really minimize disruption and continue to make progress and Not backsliding?” They said. “That’s the real key.”


Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and contact her at [email protected]

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