Even if healthcare.gov, the web portal for federal health insurance exchange, worked perfectly, more than 5 million poor, uninsured adults, many of them Black, will continue to go without coverage because they live in states that didn’t expand Medicaid, according to a recent brief by the Kaiser Family Foundation.
Through the Affordable Care Act, the federal government agreed to pay 100 percent of the cost of the Medicaid expansion through 2016 and at least 90 percent through 2020.
The Obama administration planned for nationwide expansion of Medicaid, the health insurance program that covers the poor and disabled, setting the Medicaid income eligibility at 138 percent of the federal poverty level, or roughly $27,000 annually for a family of three. In June 2012, the Supreme Court ruled that states could decide whether they want to expand Medicaid. According to the Kaiser Commission, more than half of the states, including many in the South, decided not to expand Medicaid. That decision created a coverage gap affecting 27 percent of uninsured adults.
“A fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Fifteen percent live in Florida, eight percent in Georgia, six percent live in North Carolina, and another six percent live in Ohio,” the Kaiser Commission brief said.
More than half of all Blacks live in eight states: Texas, Florida, Georgia, New York, California, North Carolina, Illinois, and Maryland.
According to the Kaiser Commission on Medicaid and the Uninsured, “The largest uninsured non-elderly Black populations reside in Florida (718,800), Texas (613,100), and Georgia (594,600). In addition, Blacks comprise a large share of the uninsured population in the District of Columbia (52%), Mississippi (48%), and Louisiana (42%).”
Florida, Texas, Georgia, Mississippi and Louisiana chose not to expand Medicaid leaving billions of dollars unspent, forcing many of their citizens to either go without health insurance or to sign up for health insurance on the federal-facilitated marketplace.
Because 40 percent of all Blacks are under age 26, compared to 30 percent of Whites, the very people needed to make the health care formula work may be less inclined to participate.
“With many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, option for health coverage,” the Kaiser Commission brief said. “Most do not have access to employer-based coverage through a job, few can afford coverage on their own, and most are currently ineligible for public coverage in their state.”