Many Black Americans remain uninsured due to challenges with Medicaid

Recent changes to Medicaid programs in the U.S. have left many Black Americans uninsured, highlighting the challenges they face in accessing healthcare. While insured rates rose among the non-elderly population during the Covid pandemic, with 3.4 million Americans enrolling in health coverage between 2019 and 2022, Black Americans remained disproportionately uninsured compared to white Americans. In 2022, 10% of Black Americans were uninsured, compared with 6.6% of white Americans. This disparity can be attributed to states that have not expanded Medicaid under the Affordable Care Act, which have a higher population of Black individuals who do not fit into the eligibility categories within their state.

Medicaid, a joint program between the federal government and states, provides health insurance to low-income adults and children. The Affordable Care Act included a provision to expand Medicaid coverage to people at lower income levels who may not be covered by private insurers. However, not all states have expanded their coverage requirements, leaving uninsured adults who don’t meet the criteria for coverage but fall under the poverty line with limited options.

In 2022, about half of Black Americans under 65 were insured through an employer or private insurer, while nearly 40% were insured through Medicaid or another public option. High Black unemployment rates contribute to the lack of access to employer-based health insurance. Black unemployment rates consistently surpass the national average and that of other racial groups, meaning many Black individuals are more likely to be in low-income jobs that do not offer health coverage.

In states without Medicaid expansion, 13.3% of non-elderly Black Americans are uninsured, compared to 7.3% in states that have adopted the expansion. The disparity in uninsured rates is further exacerbated by a provision of Medicaid that automatically reenrolled participants for coverage, which ended in March 2023. Many individuals were unaware of the changes and saw their coverage lapse as a result.

The discontinuation of continuous enrollment in Medicaid has had a significant impact on community health centers such as West Oakland Health (WOH), which serves minorities and low-income households in California. WOH noticed a significant drop in Medicaid patients following the end of continuous enrollment. To address this coverage gap, WOH began reaching out to their Medicaid patients and informing them of the need to renew their coverage. The center is working hard to ensure that eligible individuals are aware that they can still access coverage.

Overall, the challenges with Medicaid and the lack of access to employer-based health insurance contribute to the high uninsured rates among Black Americans. The disparities highlight the need for continued efforts to expand Medicaid coverage, eliminate administrative barriers, and increase access to affordable healthcare for all Americans.