Want More Equitable Healthcare? Start by Expanding Medicaid

We are not all experiencing the same pandemic. 

According to Georges C. Benjamin MD, the Executive Director of the American Public Health Association, minorities bear this catastrophe’s brunt by a large margin. 

“African-Americans, for example, with this COVID outbreak, are three times more likely to get infected and two times more likely to die,” he told Mila during our recent interview. Dr. Benjamin explained there are several contributing factors to the lower health outcomes Black and brown Americans face. Discrimination within the healthcare system, lower-paying, customer-facing jobs, and, critically, a lack of healthcare. 

“We know that in our country, the ‘get-into-the-system’ card is an insurance card,” he said.

It’s true. Without an insurance card, you can’t build a relationship with a primary care doctor who may be able to identify and treat health problems before they become serious. Other preventive medication and testing also becomes nearly impossible to find or afford. Many non-union or low-wage jobs across America, such as restaurant or domestic work, don’t offer health insurance and are more likely to employ minorities, further compounding the problem. 

“We have to have a system with everyone in it and no one out,” Benjamin noted. “Every industrialized nation on the planet has figured out how to do it except the United States of America…And I might add that the Affordable Care Act got us very, very close to that. And then, the Supreme Court ruled that all states did not have to cover every low-income individual with Medicaid, and that reduced our ability to do it.”

The court case Dr. Benjamin is referring to was NATIONAL FEDERATION OF INDEPENDENT BUSINESS v. SEBELIUS. Before this case, the Affordable Care Act required states to expand their Medicaid offerings to citizens. This expansion loosened eligibility requirements, allowing millions of low-income Americans to join the program and receive health benefits. The Supreme Court, particularly the Court’s conservative majority, ruled this provision was unconstitutional and left it up to individual states to decide whether to expand Medicaid. 

Thirty-nine states (and Washington, D.C.) decided to expand Medicaid or are in the process of doing so. Unfortunately, Medicaid expansion became a partisan issue (thanks to Republicans, surprise, surprise), and twelve states refused to expand coverage to their most needy. This partisan refusal has cost more than 2.2 million Americans the opportunity to receive health insurance. These Americans live mainly in the South and are disproportionately Black

The (mainly Republican) governors of states without Medicaid expansion are callously disregarding millions of Americans’ needs, and they’re leaving money on the table. The federal government covers Medicaid expansion, and billions of dollars of aid go unused thanks to a political decision-making process that is quite literally killing people

Due to unequal access to insurance and unequal care, Black babies are twice as likely to die in infancy than their white crib-mates. White Americans live an average of six years longer than their Black counterparts. 

Expanding Medicaid to the rest of the country wouldn’t fix the rampant inequality in our healthcare system, but it would provide everyone with that “get-into-the-system” card. Millions of Americans would then have access to the benefits of primary and preventive care, which is critical to healthy, happy populations. 

WORKS CITED: 

Colarossi, Natalie. “White Americans Average 6 More Years than Black Americans, as COVID Widens Life Expectancy Gap.” Newsweek, Newsweek, 18 Feb. 2021, www.newsweek.com/white-americans-average-6-more-years-Black-americans-covid-widens-life-expectancy-gap-1570257. 

“NATIONAL FEDERATION OF INDEPENDENT BUSINESS v. SEBELIUS.” Legal Information Institute, Legal Information Institute, www.law.cornell.edu/supremecourt/text/11-393. 

Pollack, Harold. “Death on the Installment Plan.” POLITICO Magazine, 7 May 2014, www.politico.com/magazine/story/2014/05/the-deadliest-republican-policy-yet-106453/. 

Published: Mar 12, 2021. “Status of State Medicaid Expansion Decisions: Interactive Map.” KFF, 12 Mar. 2021, www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/. 

Rachel Garfield , Kendal Orgera. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” KFF, 21 Jan. 2021, www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/. 

Samantha Artiga , Kendal Orgera. “Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018.” KFF, 5 Mar. 2020, www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/. 

Schoendorf, Kenneth C., et al. “Mortality among Infants of Black as Compared with White College-Educated Parents: NEJM.” New England Journal of Medicine, 17 Sept. 1992, www.nejm.org/doi/full/10.1056/nejm199206043262303. 

“Supreme Inequality: Adam Cohen.” Future Hindsight, www.futurehindsight.com/episode/supreme-inequality-adam-cohen/. 

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