GOP Governors Blocking Affordable Care Act's Medicaid Expansion Exacerbate Racial Disparity in U.S. Health Care

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Posted Jan. 22, 2014

Interview with Brian Miller, executive director of United for a Fair Economy, conducted by Scott Harris


This year’s holiday honoring the life and work of the Rev. Martin Luther King Jr. comes as a national debate is gathering momentum on how to address growing income inequality. Although Dr. King is widely known for his accomplishments on civil rights and his famous "I have a dream" speech, what many Americans don't know is this American social justice champion was also a leader in supporting union rights, challenging corporate power and government policies that exacerbated poverty and economic inequality. King also took an uncompromising and controversial stand in opposition to the Vietnam War and Cold War militarism.

In a new report published on this year’s Martin Luther King holiday, the group United for a Fair Economy examined racial disparities in American’s health care outcomes. The report, “State of the Dream 2014: Healthcare for Whom? Enduring Racial Disparities,” is the group’s 11th annual MLK Day report which documents the “heavy toll that continued racial segregation and concentrated poverty takes on people's health.” The report looks at impoverished community’s inadequate healthcare facilities, full-service grocery stores, green spaces and disproportionate exposure to toxic chemicals and industrial pollutants.

Between The Lines’ Scott Harris spoke with Brian Miller, executive director of United for a Fair Economy, and author of the State of the Dream report, who focuses on the decision by 25 state governors to oppose expansion of the Medicaid program under the Obamacare health reform law, denying health insurance to nearly 5 million citizens, disproportionately people of color.

BRIAN MILLER: I think it's no great mystery to the listeners of your show that the Tea Party wing and the Republicans in general have done everything they can to undermine the Affordable Care Act, which is also commonly known as Obamacare. They shut down the federal government last year in an effort to dismantle the program. They failed. But they're succeeding at the state level in undermining the plan. In particular, the Supreme Court ruling last year gave states the option of – it basically stated they did not have to expand their Medicaid program. And as a result, the right-wing has been organizing governors and state assemblies to oppose expansion of Medicaid at the state level. In 25 states, as of now, have rejected the Medicaid expansion, including the entire South, with the exception of Arkansas, and a bunch of states in the northern mountains in the Dakotas, and so on, and a few other stragglers, including Maine and New Hampshire, actually, in our neck of the woods.

The impact of this is that, generally speaking, any rejection of Medicaid is going to disproportionately hit people of color, because people of color are lagging behind in insurance coverage to begin with. But in particular, because all the states in the South, with the exception of Arkansas, again – and if you know anything about demographics, there's what people call the black belt. It stretches from Virginia down to Georgia and across to Louisiana and Arkansas, where you've got massive numbers of counties in places where the counties are 25 to 50 percent of more African American. So you have large sections of the country where African Americans live, that are rejecting health care expansion for low-income families in their state. As a result, African Americans represent only 13 percent of the nation's population, but they're 27 percent of the people who are going to lose health care because of the GOP's 25-state coverage gap.

Similarly, Latinos are impacted, particularly because Texas and Florida have rejected Medicaid expansion. And as a result, Latinos, 15 percent of the population – once you take out undocumented immigrants who aren't covered in the original ACA. Yet they account for 21 percent of those who fall into this 25-state coverage gap. Part of the reason Latinos aren't hit as hard is because, fortunately, states like New Mexico, Arizona, California have expanded their Medicaid program. Nonetheless, Latinos still are disproportionately impacted by this decision or these decisions, I should say.

BETWEEN THE LINES: How does the rejection from these 25 states of the expansion of Medicaid disproportionately affecting people of color – how does it affect our society as a whole? The fabric of our society, given that this is a wide swath of the country that's being affected.

BRIAN MILLER: One of the things we talked about in the report is health – in addition, to being a fundamental moral issue, there's a great quote I think I mentioned by Dr. King: "Of all forms of inequality, injustice in health care is the most shocking and inhumane." There's moral implications to lack of health insurance. There's also significant economic impact with the lack of health care insurance both for society – because when people show up at the emergency room, they're still going to get covered and the cost gets passed on. But more importantly in this case, for the people, because you know, when people don't have health insurance, what happens is they mount up medical debt, which leads to bankruptcy, which leads to greater wealth loss, and these are communities that are already suffering, that already are getting kicked. And so it fuels this vicious cycle.

And one of the things we talk about in the report is a way to understand the way patterns of racial inequity have been ingrained in our society, and one system impacts the other system, impacts the other system. One could argue there's nothing inherently racist about an employer-based health care system. But, now we could argue a whole lot of reasons that it's terrible, but from a race standpoint, you could also argue there's nothing inherently racist about it. Nonetheless, it generates highly racialized outcomes because it's based on an employment sector where there's well-documented racial discrimination, where there's well-documented disparities in employment. So, as a result, 29 percent of Latinos lack health insurance, 19 percent of African Americans lack health insurance, vs. 11 percent of whites. So you have these vast disparities of health care.

As long as this health care system depends upon the employment system to determine who gets health care and who doesn't, we're going to have these disparities. And that's why in the report we really make the case for a single-payer system which breaks out of that paradigm. And if you look at those 65 and older, there's no disparities in health insurance by race. None. Ninety-nine point five percent of whites have health insurance; 99 percent of blacks have health insurance of those 65 and older. Why? Because we have a single-payer system for seniors in this country. And we make the case for a universal single-payer system. Obviously, the Affordable Care Act stops short of that. But what it does do is – a lot of folks are familiar with the health insurance exchanges that get all the media, that's for really the middle-income and lower middle-income families that don't get health care through their work. The other provision of the Affordable Care Act is expanding the Medicaid program for low-income families up to 138 percent of poverty. That one program right there would extend health care to 10 million Americans if it were allowed to be fully implemented. Fully half of those who would have gotten insurance are no longer going to get it because of this state-by-state GOP assault. And that's what we really talk about, one of the many things we talk about in this year's State of The Dream report, which your listeners can download at

Visit United for a Fair Economy at

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