Another Big Divide between People of Color and Mainstream Whites

Map of US states by life expectancy at birth (years)
Legend:

80-81.3   79.5–80.0   78.4–79.5

77.2-78.4   75.0–77.2

On June 25^th, the Supreme Court ruled on the big healthcare issue, deciding via a 6-3 opinion with a scathing dissent from Justice Antonin Scalia. “There are about 10.2 million people who had signed up and paid their premiums as of March, and 6.4 million were receiving subsidies in the 34 states that had not set up their own health insurance marketplaces.” Washington Post, June 25^th.  Their fate was decided by the court.

In King vs. Burwell, the court upheld the ability of citizens in states without healthcare exchanges, virtually all red states as we shall see, to be able to access subsidized federal exchanges instead. Chief Justice John Roberts, Jr. wrote the majority opinion, grappling with statutory words that could have allowed the Affordable Care Act (“Obamacare”) to relegate access only to state exchanges and the residents in those states, excluding states that refused to go along with the ACA.

The gist of Robert’s opinion can be summarized in these words: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former, and avoids the latter.” Stalwarts in the GOP vowed to fight on against the act.

All this amidst some of the worst racially-motivated violence against black Americans we have ever experienced. People of color constitute a group that stood to lose the most if the court had ruled the other way. But there is a strong ocean of anti-poor, even down and dirty racism, among those fighting so hard against what they love to call “Obamacare.”

The great battle over the ACA is as much a fight by conservative white traditionalists against minorities, particularly our black and brown citizens. There is a rather dramatic difference in the quality of healthcare and your actual health, depending on whether you live in one of those Tea Party/GOP strongholds, where opposition the Affordable Care Act is most virulent, or whether you live in a more moderate jurisdiction. And still, the ruling does not change one thing: under an earlier ruling, states maintain the prerogative of expanding Medicaid under the ACA, and the most conservative venues have simply refused to play that game. The above maps tell it all.

The analysis is very simple. I chose life expectancy as a simple metric (top map), but no matter how you look at the data, people are sicker, heavier and less healthy in states where conservative, anti-Affordable Care Act sentiments are strongest (the bottom map shows which states have refused to create healthcare exchanges under the ACA). Those conservative states that have also refused to expand their Medicaid coverage (aimed at low income citizens) – the middle map – also have their biggest healthcare issues among their poorest residents.

The greatest beneficiaries of the ACA have been those high enough in the economic spectrum to afford subsidized healthcare but otherwise not sufficiently income-deprived to qualify for Medicaid, expanded or not. A National Health Interview Survey provides the statistics to support this trend. “The survey… registered a sharp decline in the share of black Americans who were uninsured, which fell by nearly a third to 13.5 percent from 18.9 percent in 2013. That was the largest annual change for any racial or ethnic group since the survey began in 1997…

“The gains were particularly significant for poor Americans in part because a larger share of them lacked health insurance to begin with. But the poor also benefited from the subsidies, and from a vast expansion of Medicaid, the government insurance program for the poor. More than 20 states refused to expand the program, and many experts said the gains would have been even larger had they done so.

“While black Americans under the age of 65 made the biggest gains, Hispanics in the same age group also benefited substantially, with the share of uninsured dropping by nearly 17 percent from 2013 to 25.2 percent. The share of whites who were uninsured fell to 9.8 percent, down from 12.1 percent in 2013.

“‘The law has had a more pronounced effect in covering African-Americans than whites,’ said Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, a health research organization. He said part of the reason was that blacks were more likely to be poor, and the law specifically targeted poor Americans for help with coverage. ‘If all states were expanding Medicaid, you’d see an even bigger effect.’

“Many of the states that declined to expand Medicaid were those with the highest share of their populations that were uninsured. They were also home to a large proportion of the country’s poor black residents. Low- and middle-income families above the poverty level are eligible for subsidies to pay for private insurance, but those below are not, and in states that did not expand Medicaid, they were left without coverage.” New York Times, June 23^rd.

So as the U.S. Supreme Court grappled with a failure in language clarity in the ACA, the undercurrents remain clear: where access to healthcare is open and available, where the ACA has received full state cooperation, vs states that oppose the ACA federal mandate, people are uniformly healthier and live longer. Strange that healthcare unkindness is strongest where Christian values are touted the most.

I’m Peter Dekom, and caring about your fellow neighbors is something that the United States could use a whole lot more of.