Unintended Consequences: Medicaid Expansion and Racial Inequality in Access to Health Insurance

Source: Christina Andrews, Health & Social Work, Advance Access, First published online: June 20, 2014
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From the extract:
The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148), commonly referred to as the Affordable Care Act (ACA), has sparked dramatic change in health care in the United States. It has an ambitious and far-reaching agenda: to improve the accessibility, quality, and cost-effectiveness of health care and prevention services in United States. Among the most significant policy changes within the ACA is expansion of Medicaid, the nation’s major public insurance program for low-income citizens. The ACA eliminated categorical restrictions on Medicaid eligibility that have traditionally limited enrollment to parents, children, the elderly, and disabled people. As a consequence, any citizen who meets income eligibility criteria, regardless of age, health, or parental status, qualifies for Medicaid. As the ACA was originally designed, approximately 17 million people would become eligible for the program—34 percent of the 50 million uninsured (Congressional Budget Office, 2012). This revision of eligibility requirements represents the greatest expansion of Medicaid in its history and marked a major victory of advocates for expanded health insurance coverage for the poor.

Yet, the promise of expanded insurance access for low-income Americans through Medicaid has only been partially realized. The ACA—and the Medicaid expansion it established—came under attack as soon as it was enacted. Within hours of the legislation’s passage, several states filed constitutional challenges to the law with the U.S. Supreme Court. These challenges were considered by the court in June 2012 in the National Federation of Independent Business vs. Sebelius case (SCOTUSblog, 2012). One of several major objections voiced by the plaintiffs was regarding Medicaid expansion: The plaintiffs argued that it was unduly coercive to require states to expand Medicaid or lose federal matching funds for their current Medicaid enrollees. In their final decision, the Supreme Court agreed with the plaintiffs on this point, ruling that it …