Medicaid expansion decisions have disproportionate impact on blacks

African-Americans are disproportionately affected by states opting not to expand Medicaid, according to an analysis released by the Urban Institute.

That's in part because more than half of non-elderly black residents live in states that are not expanding eligibility to individuals who make up to 138% of the federal poverty level. By comparison, just 41.9% of the country's total non-elderly population lives in states that have opted not to pursue Medicaid expansion.

“Proportionately, there's a really big impact for blacks if there are more states that decide to expand Medicaid,” said Lisa Clemans-Cope, a health economist at the Urban Institute and co-author of the report.

Without the Patient Protection and Affordable Care Act, just under 20% of African-Americans would be uninsured in 2016, according to the Urban Institute analysis. Under the current state of Medicaid expansion, with just over half the states opting to widen eligibility, the uninsured rate for blacks would drop to 11.3% in 2016. However, if all states expanded Medicaid, as originally envisioned under the law, the percentage of African-Americans without coverage would fall to 7.2%. That would be lower than for any racial or ethnic group other than whites.

There are 1.4 million African-Americans in the coverage gap, meaning their incomes fall between the current Medicaid eligibility level in their states and 138% of the federal poverty level. That represents 23.1% of the entire non-elderly black uninsured population. If just five states with large African-American populations—Texas, North Carolina, Georgia, Florida and Louisiana—expanded Medicaid, it would increase the number of blacks projected to gain coverage by 30.2%, or nearly 1 million individuals.

The Urban Institute's analysis finds that the uninsured rate for other racial and ethnic groups would fall less dramatically if all states went forward with Medicaid expansion. If the ACA weren't in place, 13.1% of non-elderly whites would lack coverage in 2016. That figure is expected to fall to 6.3% under the current Medicaid expansion landscape. If all states went forward with benefit expansion, less than 5% of whites would lack coverage.

Latinos have the highest uninsured rate in the country. Nearly a third of non-elderly Latinos would lack coverage in 2016 if the ACA didn't exist. That number will dip below 20% under the current Medicaid expansion picture, and would fall to 16.6% if every state expanded coverage.

For Asians, 17.3% would lack coverage in 2016 without the federal healthcare law. That figure is expected to drop below 10% under the current Medicaid expansion landscape, and would fall only nominally if all states went forward with increased eligibility. For American Indians, their uninsured rate will decrease from 25.7% in 2016 without the federal healthcare law to 13% under the current Medicaid expansion landscape—a drop of nearly 50%. That figure would fall to 10% if all states expanded Medicaid.

“The most important thing is that uninsured rates are going to drop significantly for all races and ethnicities under the Affordable Care Act,” Clemans-Cope said.

Follow Paul Demko on Twitter: @MHpdemko