During the development of the Affordable Care Act, the Obama administration included a provision that allowed states to broaden their Medicaid eligibility requirements, with federal support. The intent was to extend coverage to millions of Americans who previously did not qualify. Sounds promising, right? However, following a 2012 Supreme Court decision, Medicaid expansion became optional for states.
As a result, each year, several states opt out of this expansion. According to the Henry J. Kaiser Family Foundation, as of March 2019, 14 states—including Texas, Florida, Georgia, and North Carolina—chose not to broaden Medicaid access for their residents. This decision effectively left around 2 million people in a “coverage gap,” meaning they earn too much to qualify for Medicaid but not enough to afford health insurance through the ACA marketplace.
This situation is infuriating because it’s about real individuals and families who often find themselves without health insurance due to financial constraints. For instance, a family of three earning more than $8,935 annually would not qualify for Medicaid. This reality is unacceptable. Medicaid is designed to assist those who are struggling, and by not expanding it, states send a message that the well-being of poorer residents is unimportant.
The consequences of this negligence are particularly severe for our most vulnerable population—infants. A 2018 study published in the American Journal of Public Health revealed that states that expanded Medicaid experienced a decrease in infant mortality rates, while those that did not saw an increase. Researchers analyzed data from 2010 to 2016 and discovered that in states with expanded Medicaid, the infant mortality rate fell from 5.9 to 5.6 deaths per 100,000 infants. Conversely, in states that opted out, the rate increased from 6.4 to 6.5 deaths per 100,000 infants.
Health insurance is a lifesaver. There’s no denying that. States that consciously decide against providing their citizens with the maximum coverage are demonstrating an alarming disregard for human life. It’s noteworthy that many of these same states are implementing measures to restrict abortion access, revealing a troubling inconsistency in their concern for infants.
Moreover, the study highlights a concerning trend where the lack of Medicaid expansion disproportionately impacts people of color. In states that expanded Medicaid, black infants saw a 14.5% decline in mortality, compared to only a 6.6% decline in states that did not. This disparity is unacceptable.
The U.S. has one of the highest infant mortality rates among developed nations, and this rate is significantly higher for black infants. Contributing factors include insufficient access to prenatal care, systemic racism in healthcare, and even potential epigenetic changes resulting from past traumas that leave black mothers and their babies at a higher risk for health complications.
Ensuring that black infants receive the best healthcare possible should be a priority. Encouragingly, expanding Medicaid has been shown to effectively address these disparities. A 2019 study published in JAMA analyzed over 15 million births from 2011 to 2016 and found that states that expanded Medicaid showed improvements in low birth weight and preterm birth rates, particularly among black infants.
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 their white counterparts. This study highlights the vital role that Medicaid expansion plays in improving health outcomes for families of color.
As J. Mick Tilford, the study’s senior author, stated, “These findings should be considered in policymakers’ calculus of whether to expand Medicaid or not.” It’s crucial that state policymakers heed the advice of researchers and healthcare professionals regarding what truly matters for the health of their communities.
Health insurance saves lives, and everyone—regardless of race, income, or state—deserves an equal opportunity for health and wellness. Not tomorrow, not next year, but right now.
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In summary, the decision not to expand Medicaid in certain states has severe implications for infant mortality rates, particularly among black infants. Understanding the importance of Medicaid expansion and its effects on vulnerable populations is essential for building a healthier society.