By Janelle Ross
As Americans across the country click their way through HealthCare.gov in search of a bargain, information or perhaps just some sense of clarity about what theÂ Affordable Care Act does and does not do health economistsÂ and public health analysts concerned about the welfare of minorities will be watching closely.
A fullÂ 48 percentÂ of theÂ 24 million people expected to gain health insurance coverage as the major components of the Affordable Care Act — better known as Obamacare –Â become real are blackÂ orÂ Latino,Â according to a 2012Â Urban InstituteÂ analysis.
In 2010, Latinos under age 65 were nearly three times more likely to be uninsured, and black Americans nearly two times more likely to be uninsured, than white Americans of the same age, according to the May Urban Institute analysis. (After age 65 these health insurance coverage disparities nearly disappear because senior citizens are eligible for Medicare.)
The Urban Institute is a Washington, D.C.-based nonprofit think tank.
The Affordable Care Act is designed to offer the largest discounts and free or low cost coverage to Americans with low to moderate incomes. It is expected to bring nearly half of the nationâ€™s estimated 50 million uninsured onto health insurance rolls.
The law could have such a large potential impact on the share of people of color living without health insurance that some researchers anticipate that early, self-reported, measures of health such as the sense that one can see a doctor when one needs to and handle medical costs will improve quickly. And, over time, long-running racial health disparities may narrow.
Why?Massive gaps in health insurance coverage between the nationâ€™s white population and minorities have long been identified as one of several root causes of lower life expectancy rates, more frequent serious complications from disease and more deaths from treatable conditions among minority groups, according to aÂ March Kaiser Family Foundation report.
The Foundation is a California-based nonprofit health research organization.
And, given that people of color will soon comprise a majority of the nationâ€™s population, Â expanding health insurance coverage among these populations could prove critical in improving Americaâ€™s overall health
Lisa Clemans-Cope, a health economist at The Urban Instituteâ€™s Health Policy Center, is so excited about the short and long term possibilities of the Affordable Care Act that sheâ€™s loathe to talk about a significant glitch created by Republican-dominated state governments in a few key states.
When the Supreme Court upheld the constitutionality of the Affordable Care Act it ruled that the federal government did have the authority to regulate and in some ways shape the market for health insurance but barred the federal government from forcing sates to expand existing Medicaid programs to cover a larger group of the very sick and very poor.
Simply put, under the Affordable Care Act, subsidies offered through state or federally-administered health care exchanges will become available for individuals living in households that earn up to 400 percent more than theÂ federal poverty line. Thatâ€™s the feature of the law rolling out today.
And, families earning up to 138 percent more than the federal poverty line will be eligible for and expanded Medicaid program. Until now, enrollment has been limited to the very poor and the critically or chronically ill.
The federal government has set up exchanges offering subsidies in nearly two dozen states where Republican-dominated legislatures have refused to do so. But, the Supreme Courtâ€™s ruling means the federal government will have to stand down when it comes to those too poor to afford the exchange but earning too much to qualify for old-fashioned, unexplained Medicaid.
â€œUnfortunately, there are going to be some people who are essentially, stuck in the middle, unable to qualify for subsidies offered on the exchanges or Medicaid in their state,â€ Clemans-Cope said.
As of mid September, 22 states turned down theÂ Medicaid expansion citing concernsÂ about future costs and growing government involvement in the health care market. The federal government will cover the full cost of the expansion for three years a minimum of 90 percent of costs thereafter, according to the terms of the Affordable Care Act. (http://www.cbpp.org/cms/?fa=view&id=3801)
Those decisions could shape the lives of nearly 6 million people. Thatâ€™s right, state governments in 22 states which are collectively home to 6 million people who can not afford their own insurance but do not qualify for the old, unexpanded Medicaid program for the very poor, could be left out of any benefits of the Affordable Care Act that may materialize.
And since the states opting out of the Medicaideâ€™s include Texas Florida, Georgia, North Carolina and Louisiana, places with significant black and Latino uninsured populations, minority health gains could be stymied.
The situation would be even worse if states like New York and California had not announced plans to opt into the Medicaid expansion.
â€œCall me an optimist,â€ said Clemans-Cope. â€œBut healthcare is so essential that Iâ€™m these people are not permanently restricted from getting the coverage they need, that this is Â a temporary kink that can be worked out. I think these states are going to see that coverage for their residents is probably a good thing and will allow the expansion in the future.â€