Medicaid Expansion and Health Disparities: African Americans

n the states that have chosen not to expand their Medicaid program, there are hundreds of thousands of uninsured, low-income African Americans who are lagging behind on key measures of access to health care. Whether individuals are insured or uninsured greatly affects their ability to obtain regular health care. And in communities of color, where rates of uninsurance and poor health outcomes are higher than in white communities, the differences between those who have insurance and those who lack it are stark.

To explore how expanding Medicaid can mitigate these disparities in health care, we compared how insured and uninsured low-income African Americans fare in terms of access to health care and preventive health services.

Findings: Low-income African Americans with health insurance fare better on three core indicators of access to health care than their uninsured counterparts

We looked at three core measures that are good indicators of an individual’s ability to see a doctor regularly and as needed in order to maintain good health and to identify and treat medical issues before they turn into more serious and costly conditions. For the low-income, African American insured and uninsured populations in our study, we examined these core indicators:

• An individual’s ability to afford the cost of going to the doctor: The major role of health insurance is to reduce cost as a barrier to getting necessary medical care. Our research shows that, for uninsured, low-income African Americans, cost is a significant barrier to seeing a doctor.
• Whether an individual has a regular doctor: In addition to helping people afford the care they need, insurance fosters ongoing relationships between patients and medical practitioners. Having a regular source of care allows a patient to have continuity of treatment for chronic conditions, as well as monitoring to prevent more severe problems from developing. Our findings point to notable disparities in access to a regular doctor between those who had insurance and those who didn’t.
• Whether an individual had a routine medical check-up in the past year: An annual check-up is critical to the prevention, early diagnosis, and effective treatment of health problems. We found that those who lacked health insurance were less likely to receive this important preventive health service.

Findings: Insured, low-income African Americans fare better on two indicators of access to preventive care than their uninsured counterparts

We examined two additional indicators of preventive care among African Americans: Whether individuals had received commonly used cancer screenings (mammograms and PSA testing for prostate cancer within the last three years). These screenings are an indicator of access to important preventive services.

• No access to a screening mammogram: Without access to doctors and check-ups, low-income African American women older than 40 may not receive a screening mammogram, which has been shown to be important to early detection and effective treatment of breast cancer. Our findings show disparities between insured and uninsured women in the use of screening mammograms.
• No access to a prostate cancer screening: Likewise, being uninsured puts low-income African American men at risk for a failure to detect prostate cancer until it is advanced and life-threatening. As with mammograms for women, we saw differences between insured and uninsured men in access to this screening tool.

About the data that we examined

Our goal was to compare access to health care and preventive health services for insured and uninsured low-income African Americans in the states that have not expanded Medicaid. The uninsured population we studied correlates roughly in income level to the population who could gain health coverage if their states expanded Medicaid.

Working with Dr. Shun Zhang, a researcher and biostatistician with the National Center for Primary Care at Morehouse School of Medicine, we used data from the U.S. Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS 2012) to compare access to health care and preventive health services for insured and uninsured individuals. We looked at low-income African American individuals with annual incomes of $35,000 or less (roughly 138 percent of the federal poverty level for a family of four to five people). This income group, although somewhat over-inclusive, provides a good picture of the Medicaid expansion population. For more information on our methodology and the BRFSS data, click here.