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Impact on Minority Populations of State Refusals to Expand Medicaid under the Affordable Care Act

By: Aaron Kostyk

Blog Category: Race & Healthcare

The recent Supreme Court decision in National Federation of Independent Businesses v. Sebelius struck down federal penalties on states that refuse to expand their Medicaid programs under the Affordable Care Act (“ACA”). The Court held that these penalties exceeded the scope of the government’s spending powers. This made the expansion of Medicaid programs essentially voluntary on a state by state basis. Not surprisingly, some states don’t want to accept federal funds to expand their programs. As of October 22, 2013, twenty six states were moving forward with Medicaid expansion and twenty four were not.

Refusal to accept federal funding for Medicaid expansion creates a “gap” in coverage between existing Medicaid programs and subsidies under the ACA and minorities account for a significant portion of the persons in this gap. Minority populations are more likely to be uninsured than the White population (13%), as compared with nonelderly Hispanics (32%), followed by American Indians/Alaska Natives (27%), Blacks (21%), and Asians/Pacific Islanders (18%). These populations are also more likely to have issues accessing affordable healthcare. Furthermore, given that roughly six out of ten Medicaid recipients are persons of color, minorities are more likely to be disproportionately affected by state refusals to expand their Medicaid programs. People in the gap who fall between one hundred percent of the federal poverty level (the current level of Medicaid coverage) and one hundred and thirty eight percent of the federal poverty level (the level at which ACA subsidies apply) will again be without options if states refuse to accept the money to cover them. The ACA has the potential to improve access to healthcare for historically under served populations. Furthermore, it is important to note that the majority of Medicaid recipients are children. In conclusion, states should set aside ideology and act in the best interest of their most vulnerable populations by expanding Medicaid.

The opinions expressed herein are strictly those of the author and do not necessarily reflect the opinions of the Widener Journal of Law, Economics & Race.

Sources:

Nat’l Fed’n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566, 2607 (2012).

Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act, The Henry J. Kaiser Family Foundation, available at http://kff.org/disparities-policy/issue-brief/health-coverage-by-race-and-ethnicity-the-potential-impact-of-the-affordable-care-act/, (publication #8423).

Samantha Artiga & Jessica Stephens, The Impact of Current State Medicaid Expansion Decisions on Coverage by Race and Ethnicity, The Henry J. Kaiser Family Foundation, July 02, 2013, available at http://kff.org/disparities-policy/issue-brief/the-impact-of-current-state-medicaid-expansion-decisions-on-coverage-by-race-and-ethnicity/, (publication #8450).

Status of State Action on the Medicaid Expansion Decision, as of October 22, 2013, The Henry J. Kaiser Family Foundation, available at http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ (last visited Oct. 26, 2013).

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