Obamacare improved the uninsured gap between black and white Americans, study says

Obamacare has allowed many black Americans to recieve the proper health care— in some states, more than whites.
Obamacare has allowed many black Americans to recieve the proper health care— in some states, more than whites.Angel Valentin/The New York Times

There are deep and abiding health disparities between white and minority Americans. But in one small but significant way, Obamacare flipped them.

Black Americans living in states that expanded their Medicaid programs are now more likely to be insured compared with white Americans living in states that shunned Medicaid expansion, according to a study released Thursday by the Commonwealth Fund.

This wasn’t the case before President Barack Obama signed the Affordable Care Act a decade ago. Uninsured rates have long been much higher among African Americans than whites, regardless of where they lived.

But the ACA and a subsequent Supreme Court decision allowing states to reject its expansion of Medicaid to those earning up to 133 percent of the federal poverty level means states now basically fall into two buckets. The pro-expansion states have seen more improvements in health and reductions in racial disparities than the anti-expansion states.


Just look at the 31 states that had expanded Medicaid by 2018. In that year, 10.1 percent of their black residents were uninsured. That’s several points lower than the 12.3 percent uninsured rate among whites living in non-expansion states.

But in 2013, the year before the ACA’s major provisions went into place, the black uninsured rate was higher across the board when compared with white uninsured rates.

Now, a black person living in Colorado, which expanded Medicaid, is more likely to be covered by a health insurance plan than a white person in Texas, which rejected expansion. This comparison doesn’t hold true for every single state — in Kansas, for example, the white uninsured rate has dropped below 10 percent — but it does underscore Obamacare’s outsize gains for minorities.

Those findings are detailed in the new Commonwealth study, which examined whether Obamacare has helped minorities buy health coverage and access care at rates more equal to whites. They found the biggest improvements in Medicaid expansion states, but there were positive trends throughout the country.


Consider these trends between 2013 and 2018. The country’s overall uninsured rate fell from 20.4 percent to 12.4 percent, but for blacks it dropped from 24.4 percent to 14.4 percent. Meanwhile, the gap between black and white uninsured rates declined 4.1 percentage points.

Progress on expanding health coverage has recently stalled and may even be reversing. But if more states expand Medicaid — as Kansas’ Democratic governor and a top Republican lawmaker proposed last week — minorities could see further gains, said Sara Collins, a vice president at Commonwealth and a co-author of the study.

But Collins also stressed that black Americans can face additional obstacles to getting good care, even after getting insurance.

‘‘Because of bias in the delivery system, they face an even greater hurdle in making that leap to higher-quality care and good outcomes,’’ Collins said.

Now that the ACA has been in place for six years, other researchers have had time to examine the effects of expanding Medicaid to a larger swath of the public. They’re finding a range of positive outcomes, even as Republican policymakers have complained the program is too costly to run.

Harvard and Vanderbilt researchers recently found that adults living in south states with Medicaid expansion experienced lower rates of physical and mental health decline.

The Washington Post reported last week that Medicaid expansion may have saved as many as 8,132 people from fatal opioid overdoses, virtually all involving heroin and fentanyl, according to another new study. The research, published in JAMA Network Open, found an association between the decline in overdose deaths in the 32 states and the District of Columbia that had expanded Medicaid at the time of the study.


‘‘The researchers concluded that additional access to drug-abuse treatment was linked to a 6% lower overdose rate for states that allowed more people to enroll in Medicaid than in states that did not,’’ The Post reported.

There’s a vigorous debate going on in the Democratic presidential primary about how to bridge the uninsured gap left by Obamacare. More African American voters who identify as Democrats support a public option to compete with private plans over a single, government-sponsored plan, according to a national Washingon Post-Ipsos poll of black Americans conducted Jan. 2-8.