Recent changes to the Medicaid program aimed at shrinking health insurance coverage in the U.S. have left some Americans — especially people of color — behind.
Among the U.S. non-elderly population (those under 65 years old), insurance rates have increased during the coronavirus pandemic, with 3.4 million Americans have health insurance According to the KFF report, between 2019 and 2022. The shift is due in part to Medicaid and health care marketplace provisions created by the Affordable Care Act, the report said.
But as the global health crisis recedes and Medicaid coverage expansion faces delays in some states, enrollment is falling, with Black Americans less likely to be insured than white Americans, according to KFF, a nonprofit focused on health policy. Rates remain disproportionate.
In 2022, 10% of Black Americans were uninsured, compared to 6.6% of white Americans. Black people are 1.5 times more likely than white people to be uninsured in 2022, the report said. American Indians or Alaska Natives are 2.9 times more likely to be uninsured than white people, while Hispanics are 2.7 times more likely to be uninsured.
“The biggest drivers of the racial coverage gap are states that did not expand Medicaid under the Affordable Care Act,” said Jennifer Wagner, director of the Center on Budget and Policy Priorities. “These states have larger Black populations who lack access to care. grants because they don’t meet one of the state’s eligibility categories.”
Medicaid is a joint program between the federal government and states that provides health insurance to low-income adults and children. The Affordable Care Act passed in 2010 included a provision to expand Medicaid coverage to low-income people who may not be covered by private insurance companies. But not all states have expanded coverage requirements, according to KFF.
In states that have not expanded Medicaid, uninsured adults who do not meet coverage requirements but remain below the poverty line have no choice.
KFF data shows that by 2022, about half of black Americans under the age of 65 will be insured through an employer or a private insurance company, while nearly 40% will be insured through Medicaid or other public options.
According to the U.S. Bureau of Labor Statistics, the black unemployment rate has been higher than the national average and higher than other groups, which means that fewer black people have access to health insurance through their employers. The bureau said the black unemployment rate rose slightly to 5.3% in January, compared with the national average of 3.7% and the white unemployment rate of 3.4%.
“Most black people live in households with full-time workers, but they are less likely than white people to have private insurance, reflecting their greater likelihood of working in low-wage jobs that may not provide health insurance,” KFF health policy expert Samantha Artiga said.
KFF data shows that in states that did not offer Medicaid expansion, 13.3% of nonelderly black people are uninsured, compared with 7.3% in states that have expanded Medicaid.
An automatic re-enrollment provision in the Medicaid program ended in March 2023, exacerbating disparities in uninsured rates and forcing millions of Americans to proactively re-enroll. Many people were unaware of the changes and found their coverage was ineffective.
“We’re seeing a lot of administrative barriers to the renewal process that are very visible,” Wagner said. “People are losing coverage, not because they were determined ineligible or fell into a coverage gap, but because they didn’t receive the form, Or the state doesn’t have a timeline for processing it.”
At least since March 17.4 million people have had their Medicaid or related children’s health insurance program coverage removed. According to KFF, more than 35 million people have been renewed, while 41 million people have renewals pending or have not yet expired.
Community health centers like West Oakland Health, founded by four black women in 1967, are working to address gaps in coverage. WOH chief executive Robert Phillips said the center noticed a drop in patient numbers immediately after the end of continuous registration.
“The number of Medicaid patients has dropped dramatically,” Phillips said.
Phillips and his staff began reaching out to their Medicaid patients, and he said patients have returned as the center reminded them they needed to renew their insurance.
“It makes us work harder,” Phillips said. “We want people to know they are still eligible for coverage and those who just don’t know because they received a notice that their coverage has ended.”
WOH serves minority and low-income families seeking affordable health care at five locations in California’s East Bay Area. The majority of WOH’s patients are black and on Medicaid, according to the company.
Correction: This article has been updated to remove an inaccurate description of the nonprofit KFF.
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