What It Means For Your Health When Your State Refuses to Expand Medicaid

Even though the Affordable Care Act (ACA) has helped millions of people get health insurance, quality health care is still out of reach for a large number of people of color, low-income families and those with language barriers. The high cost of insurance premiums and co-pays was the main reason cited for those who remain uninsured. The complexity of the enrollment process was also a deterrent.

Those were some of the findings in a report released Thursday by the Alliance for a Just Society (AJS) that interviewed 1,200 low-income people in 10 states, including California.

The report indicated that people who were hurting the most were those living in states that had not expanded Medicaid.

As the ACA was being rolled out, states were given the option of whether or not to expand their Medicaid program. Twenty-two states have chosen not to. The expansion allowed people whose income fell below 138 percent of the federal poverty level (about $16,000 for an individual and $33,000 for a family of four) -- up from the earlier requirement of 133 percent -- to enroll. It also removed the asset cap and the requirement that individuals had to have a child in order to qualify for Medicaid.

Nearly 60 percent of African Americans and 40 percent of Latinos live in states that have not expanded Medicaid.

A total of 2.2 million people have been denied access to health care because nearly half the states have chosen not to expand Medicaid, noted Gary Delgado, the report’s author. Nearly half of the respondents said they live with a chronic health condition, while 16.5 percent of Latinos, 18.7 percent of African Americans, 20.9 percent of whites and 22.2 percent of people who identified as mixed race reported living with two or more chronic conditions.

In Mississippi, a state that refused to expand Medicaid, there is a high incidence of infant mortality and diabetes among immigrant workers, said panelist Antron McKay-West of Upgrade Mississippi. Not all homes have Internet access so they can’t enroll online.

At 33 percent, Latino respondents had the lowest percentage of email addresses, followed by African Americans at 50 percent.

During Open Enrollment time, many people in Mississippi were told to “go the library and use the Internet.”

“In the neighborhood where I grew up, the library is 15 miles away,” McKay-West said.

A very small percentage (8.5 percent) of survey respondents said they had to travel about an hour to see their health care provider. But the percentage of Native American respondents (26.3 percent) was almost three times that of any other group.

Delgado, who is a visiting scholar at the Institute of Social Change at the University of California at Berkeley, said that for the ACA to be successful, the program needs to be retooled in such a way that it makes it easier for communities that have historically been left out of the American health care system to be included in it. The ACA has not addressed health care disparities – something it said it would do -- making it a “valiant attempt to build a new house with old bricks,” he said.

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