Kansas State University


Issues in Health Reform

Persisting disparities in who is insured

While overall the US is experience decreasing rates of people uninsured, these gains are not shared among the races equally.  Racial disparities that are related to more people of color working in part time and/or lower paying jobs, and in general, increase the rates of poverty among blacks and other nonwhites, are also having an impact on who gets health insurance.

Most of those part time and lower paying jobs do not come with health insurance.  Fortunately, there are now options in the state and federally run Marketplaces where many can purchase health insurance without worrying about pre-existing conditions excluding them.  Also, in many cases, people are eligible to receive substantial financial assistance in paying for premiums (Advance Premium Tax Credits) and the cost-sharing portions of insurance (Cost Sharing Subsidies).

However, in order to qualify for that financial assistance the family income must be above the federal poverty line ($11,880 for an individual; $24,300 for a family of 4).  In the 18 states where Medicaid has expanded to include individuals under 138% of that level, there are options for those who are ineligible to receive financial assistance.  Those individuals are insured through their states’ Medicaid systems.

In the 32 states that have not expanded however, there are no affordable options for insurance.   This is where we observe being poor and without a job that offers health insurance to impact racial minorities the hardest.   (The one exception is Wisconsin that has its own Medicaid coverage outside of the federal Expansion.)  And, as all uninsured people, those without coverage do often use health care, but they access care at inappropriate times (less preventive, more acute and severe care needs), and in inappropriate places (emergency rooms for routine care).  Finding a way to insure this population or provide them with more consistent health care would improve their health outcomes and community outcomes that thrive with a healthy workforce.

This issue is covered in detail in a news article and in a Kansas Health Institute issue brief.

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