Back when the Obama administration was finalizing their plans for the Affordable Care Act, they added a provision that allowed states to expand their Medicaid eligibility standards, with the help of the federal government. The idea was that millions of Americans who previously had not been eligible for Medicaid would become eligible. Sounds like a pretty good idea, right?
Well, not all states decided to take the government up on this offer, thanks to a 2012 Supreme Court ruling that left Medicaid expansion optional.
Since then, a handful of states each year decline Medicaid expansion. According to the Henry J. Kaiser Family Foundation, as of March 2019, 14 states – including Texas, Florida, Georgia, and North Carolina – did not elect to expand Medicaid for their citizens. Essentially, this left about 2 million people who could have been eligible for Medicaid in a “coverage gap” category, meaning that they are “too rich” for Medicaid, but “too poor” to qualify for an ACA marketplace health insurance plan.
“Nationally, more than two million poor uninsured adults fall into the ‘coverage gap’ that results from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits,” explains the Henry J. Kaiser Family Foundation. “These individuals would be eligible for Medicaid, had their state chosen to expand coverage.”
This is absolutely infuriating, because what we are talking about here aren’t just numbers, but people – real people and families – who often end up going without health insurance because they simply cannot afford it.
For example, as the Henry J. Kaiser Family Foundation points out, if you are a family of three who makes more than $8,935 per year, you make too much money to qualify for Medicaid. This is not a joke. It’s absolutely abhorrent. Medicaid is set up for families who are poor or struggling, so if even these families can’t receive it, states who have chosen not to expand Medicaid are basically telling poor folks that their lives and livelihoods don’t matter one bit.
And the results of this cruelty are tangible, especially when it comes to our most vulnerable citizens – our babies. A 2018 study published in the American Journal of Public Health found that in states where Medicaid was expanded, infant mortality saw a drop, whereas in states where it wasn’t expanded, infant mortality rose. Just awful.
The study researchers looked at data from 2010 to 2016 and 2014 to 2016, comparing infant mortality rates in Medicaid expansion vs. non-Medicaid expansion states. The results were that in the states where Medicaid was expanded, infant mortality dropped slightly, from 5.9 to 5.6 deaths per 100,000 infants. In states that declined expansion, infant mortality increased from 6.4 to 6.5 deaths per 100,000 infants.
Health insurance saves lives. There’s really no other way to say it. And states that make an active choice not to offer their citizens as much coverage as possible – well, I don’t have any words for how unbelievably evil this is. It is no coincidence that many of the same states that have decided not to expand Medicaid are also the states taking active steps to restrict abortion, because we know how much these states care about babies (*insert major eyeroll*).
It is important to highlight another key finding of this study, which is that not expanding Medicaid affects people of color disproportionately more. According to the study, in states where Medicaid was expanded, black infants saw a 14.5% decline in infant mortality, whereas in states that did not expand, it was only a 6.6% decline.
This is not okay.
The U.S. has one of the worst infant mortality rates in developed countries, but it’s twice as high among black babies. There are so many reasons for this, including inadequate access to prenatal care, racism among healthcare providers, and possibly even epigenetic changes due to past traumas that make black moms and babies more vulnerable to health issues.
Either way, giving black babies the best possible healthcare should be a top priority. And the good news – if there’s any in all this – is that expanding Medicaid actually does a very good job of addressing this issue, as a 2019 study published in JAMA found.
The researchers of that study looked at 15, 631, 174 births from 2011 to 2016 and found that in states where Medicaid was expanded, there were notable differences in terms of low birth weight and preterm birth, specifically among black babies, as the study researchers note:
“State Medicaid expansion was not associated with differences in rates of low birth weight or preterm birth outcomes overall, but was associated with improvements in relative disparities for black infants compared with white infants among the states that expanded compared with those that did not,” they explained.
According to CNN, black babies are “about twice as likely to be born at low birth weight and 1.5 times as likely to be born prematurely than white infants,” making this study a clear and important testament to the power of giving health insurance to families of color.
“It’s one more piece of the puzzle that points to the gains in health from Medicaid expansion, especially to certain populations,” J. Mick Tilford, senior author of the study, told CNN. “We believe that these findings should be considered in policymakers’ calculus of whether to expand Medicaid or not.”
Damn right it should. Now, if only state policymakers would listen to researchers, medical experts, and the real people who live in their communities about what really matters and what is needed for a healthy, thriving society.
I said it before, and I’ll say it again: Health insurance saves lives. And all people – regardless of race, economic status, and what freaking state they live in – deserve an equal shot at health and well being. Not tomorrow, not next year, but NOW.