The US Congress has been focused on healthcare reform for the better part of 2017 and once again, the plight of people of color is being forgotten and ignored. I’m a family physician and care deeply about healthcare policy. I’ve read dozens of articles on the details of what was first the House bill (AHCA) and now the Senate version (BCRA). In my reading, I have come across only one article addressing the ways in which these bills will affect people of color. The reality is that this issue always deserves more attention.
People of Color Face Health Disparities
Health disparities for people of color in the United States are ubiquitous, especially for Blacks. These disparities are a systemic injustice facing people of color in our country and are well described, although rarely discussed. From access to healthcare to health outcomes, people of color face greater health disparities than whites, as this chart shows.
And among people of color, Blacks are disproportionately affected. The below chart shows death rates, by race, for three common diseases. Blacks have the highest age-adjusted death rate from both heart disease and cancer and second-highest from diabetes, second only to American Indians and Alaska Natives.
Medicaid Expansion Under Obamacare
Obamacare improved these disparities. This was largely through the expansion of Medicaid, the state-based coverage for “eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.”
And because people of color are disproportionately poor, the expansion of this program by over 14 million Americans provided greater assistance to these groups. The data shows that the coverage gaps that existed prior to ACA were reduced after Medicaid was expanded.
Importantly, Medicaid expansion ended up being optional for states and several states chose not to expand their programs. More often these states were in the South with larger Black populations. Had these states also expanded their Medicaid programs the disparities could have been reduced even further.
The Current Threat of Healthcare Reform
Given the above facts, it isn’t hard to imagine what will happen if the Obamacare Medicaid expansion is reversed or deeply cut. Many groups will lose. We have seen the disability community come out in force against these efforts. The elderly in nursing homes will face cuts. Women and children will be affected. But we cannot forget that these policies will also disproportionately affect people of color.
Nearly 50% of maternity care is covered by Medicaid. Look at the infant mortality rates by race in 2013. Black infants are more than twice as likely to die than white infants. Yet the Senate healthcare bill will disproportionately cut off Medicaid access to Black mothers.
People of color are more likely to face mental illness. We know that access to Medicaid significantly reduces rates of depression. If coverage is limited, these disparities will grow.
What about the opioid epidemic? The media has widely reported that Senate bill currently under consideration will decimate what resources are currently available to fight this growing crisis. This is at a time when we need more funding, not less. While Whites are dying of opiate overdose at a higher rate than Blacks, both groups are seeing dramatic increases in the opioid overdose death rates in the past several years. The majority of these individuals access treatment through Medicaid. Now is not the time to be limiting coverage for these groups, as this Kaiser Family Foundation graph of US opioid death rates per 100,000 persons shows.
People of color have worse health outcomes than whites. They are also enrolled in Medicaid in higher percentages because they are poorer, on average. The increased Medicaid coverage from Obamacare has reduced these coverage disparities, although it hasn’t eliminated them.
Medicaid is among the most efficient healthcare coverage options in the US. It has high favorability ratings among Americans, regardless of political party. Cutting access to a program that works is bad policy for many reasons. But let us not forget that doing so will jeopardize the gains people of color have seen in their healthcare access and set us back more than a decade in our fight for racial health equity.