Good Health Insurance News for Latinos, Bad News for Blacks
Dr. Algernon Austin is a Senior Research Fellow at the Center for Global Policy Solutions. Previously, he directed the Economic Policy Institute’s Program on Race, Ethnicity, and the Economy (PREE). As the first director of PREE, Algernon built the program over six years into a nationally-recognized source for expert reports and policy analyses on the economic condition of America’s people of color.
Newly released data on health insurance coverage from the U.S. Census Bureau shows a continued significant decline in the uninsured rate for all major racial and ethnic groups—except for African Americans.
Latinos had the strongest decline between 2014 and 2015. Their uninsured rate fell 3.7 percentage points, to 17.2 percent (see figure). Still, Latinos have the highest uninsured rate among the major racial and ethnic groups. Asian Americans had the second strongest decline, 1.9 percentage points, which put them at exactly the same uninsured rate as Whites, 8.1 percent. American Indians had a 1.6 percentage point decline in their rate, but they still had the second highest uninsured rate. The White rate declined 1 percentage point.
But the African American rate declined a negligible half a percentage point.
Although the Hispanic population continues to have the highest uninsured rate, it has experienced the most dramatic reduction since the implementation of the major provisions of the Affordable Care Act, or Obamacare, in 2014. (For 2013 data, see “Obamacare Reduces Racial Disparities in Health Coverage.”) The Hispanic uninsured rate was 25.7 percent in 2013, 8.5 percentage points higher than where it was two years later. This change translates to an additional 4.5 million Hispanics with health insurance. It is likely that the improving economy, in addition to the Affordable Care Act, played some role in the increasing rate of insurance coverage for Hispanics. But much of the strong growth in government insurance coverage for Hispanics since 2013 is likely due to the expansion of Medicaid under Obamacare.
The tiny decline in the uninsured rate for Blacks from 2014 to 2015 appears to be because there was no increase—zero—in government health insurance coverage for Blacks. Over this period, Latinos had an increase of 1.7 percentage points in government insurance. The Affordable Care Act allows states to expand Medicaid to more of their low-income population, but as of January 1, 2015, 23 states had not taken advantage of this opportunity. These non-expansion states have a relatively large share of the Black population. It is possible that the non-expansion policy prevented a decline in the uninsured rate for Blacks.
The Census data suggests a slowing rate of decline in the uninsured rate. From 2013 to 2014, the overall uninsured rate fell 3.3 percentage points for individuals under the age of 65. From 2014 to 2015, the overall rate was reduced 1.5 percentage points, less than half the size of the previous decline. Unless the remaining states expand Medicaid coverage, we may be quickly approaching the maximum health insurance coverage that the Affordable Care Act can achieve.
The good news on this front is that an additional four states (Alaska, Indiana, Louisiana, and Montana) have joined the Medicaid expansion since January 1, 2015. These states will likely show an increase in the health insurance coverage rate of low-income Americans of all races and ethnicities in next year’s Census data. Alaska and Montana should add significantly to the coverage rate of American Indians and Alaska Natives. Louisiana and Indiana should add to the coverage rate of African Americans. Low-income Whites make up a large share of the low-income population in all four of these states, and they should see a rising coverage rate from the Medicaid expansion.
I have argued previously that “substantial racial disparities in health insurance coverage for nonelderly adults will remain under Obamacare” (see “Obamacare Reduces Racial Disparities in Health Coverage”), and it still appears that this will be the case. This likely reality should not diminish the value of the reductions in uninsured rates for all racial groups. But, as I also argued previously, a larger expansion of government health insurance is the more promising direction for eliminating racial and ethnic disparities in health insurance coverage.