California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Millions of Low-Income Individuals To Remain Uninsured Under ACA

About two-thirds of low-income blacks and single mothers and more than half of low-wage workers who lack health coverage are expected to be left uninsured despite implementation of the Affordable Care Act, according to an analysis of U.S. Census data, the New York Times reports.

The primary reason is that they live in states that have declined to expand Medicaid and have incomes too high to qualify for federal subsidies to purchase coverage in the ACA's insurance exchanges, the analysis found.

According to the Times, the 26 states that have opted out of Medicaid expansion are home to:

  • About 50% of the U.S. population;
  • About 68% of low-income and uninsured blacks and single mothers; and
  • About 60% of low-income working residents who are uninsured.

The analysis also found that blacks are disproportionately affected by states' decisions to reject the expansion because about six in 10 black U.S. residents live in such states, which are mostly in the South. For example in Mississippi -- which has the highest percentage of low-income and uninsured residents, at 13% -- 56% of low-income and uninsured residents are black, even though they account for just 38% of the total state population.

H. Jack Geiger -- a founder of the community health center model -- said, "The irony is that these states that are rejecting Medicaid expansion -- many of them Southern -- are the very places where the concentration of poverty and lack of health insurance are the most acute." He added, "It is their populations that have the highest burden of illness and costs to the entire health care system."

Most Republican leaders and lawmakers in those states have said their decision to opt out of the Medicaid expansion is largely based on economic concerns, according to the Times (Tavernise/Gebeloff, New York Times, 10/2).

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