Christopher Flavelle: Obamacare is working, unless you’re black

07/14/2014 12:00 AM

07/11/2014 5:40 PM

A new survey shows that Obamacare has done a fantastic job of reducing the un-insurance rate – for everybody except blacks.

The share of Americans ages 19 to 64 without health insurance fell from 20 percent last summer to 15 percent this spring, according to a telephone survey of 4,425 people from the Commonwealth Fund, a nonprofit health care research group. The number of adults without insurance fell by 9.5 million – a success by any measure, especially considering that we’re still in the early days of exchange enrollment, and about half the states have yet to expand Medicaid.

The drop in un-insurance rates held across almost every demographic group: young and old, male and female, married and unmarried, with children and without. The un-insurance rate for whites fell to 12 percent from 16 percent; for Latinos, it plummeted to 23 percent from 36 percent. For respondents who reported their race as “mixed” or “other,” the share without insurance was cut almost in half, to 11 percent from 20 percent.

The Commonwealth report doesn’t offer any theories for why that might be, and it’s hard to come up with any that are entirely satisfying. The answer has nothing to do with knowing about the law: Awareness of the Affordable Care Act’s financial assistance was the same for blacks (62 percent) as Latinos (60 percent). And blacks were more likely than Latinos to be aware of the state insurance exchanges.

A big part of the explanation, without question, is that a disproportionate share of blacks live in states that have so far refused federal money to expand Medicaid. Sixty-two percent of black respondents fall into that category, compared with just 39 percent of Latinos. Of the six states where blacks make up more than a quarter of residents (not including the District of Columbia), only Maryland has expanded its program.

The choppy progress on Medicaid, however, feels like an incomplete explanation of the racial disparities outlined in the Commonwealth report. After all, 38 percent of black respondents live in states that have expanded Medicaid. Meanwhile, two of the three states with the highest share of Hispanic residents, Texas and Florida, refused to expand Medicaid – yet the share of Latinos without insurance fell by a third.

Figuring out Obamacare’s inability to reduce un-insurance rates among blacks is going to be necessary to fix it. That starts, clearly, with persuading more Republican-led states to accept additional federal money for their Medicaid programs. But that may not be all that’s required.

One possibility is that blacks who can enroll in Medicaid are less likely to do so. Another is that blacks who are eligible for exchange-based plans are less likely than other groups to actually sign up for them. That would suggest the need for better outreach to blacks, as well as looking for barriers to enrollment.

Otherwise, one of the law’s major benefits – reducing racial inequality in U.S. health care, even if Democrats have preferred not to talk about the law in those terms – will be left unfulfilled.

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