African American Uninsured Rate Dropped by More Than a Third Under Affordable Care Act
Repealing ACA and Cutting Medicaid Would Undercut Progress
End Notes
[1] Robin A. Cohen, Emily P. Zammitti, and Michael E. Martinez., “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2016,” National Center for Health Statistics, May 2017, https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201705.pdf.
[2] The National Health Interview Survey data are the most recent health insurance coverage estimates available and reflect preliminary survey results for 2016. We use this source for national-level estimates in this paper. The Census Bureau’s Current Population Survey (CPS) shows a similar reduction in the uninsured rate among non-elderly African Americans, from 17 percent in 2013 to 12 percent in 2015.
[3] Kaiser Family Foundation, “Percent of Adults Reporting Fair or Poor Health Status, by Race/Ethnicity,” 2015, http://kff.org/other/state-indicator/percent-of-adults-reporting-fair-or-poor-health-status-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
[4] Centers for Disease Control and Prevention, “African American Health: Creating Equal Opportunities for Health,” May 2017, https://www.cdc.gov/vitalsigns/pdf/2017-05-vitalsigns.pdf.
[5] CBPP analysis of American Community Survey data for 2015, United States Census Bureau.
[6] Congressional Budget Office, “H.R. 1628: American Health Care Act,” May 24, 2017, https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf.
[7] For more on per capita caps, see Edwin Park, “Medicaid Per Capita Cap Would Shift Costs and Risks to States and Harm Millions of Beneficiaries,” Center on Budget and Policy Priorities, February 27, 2017, https://www.cbpp.org/research/health/medicaid-per-capita-cap-would-shift-costs-and-risks-to-states-and-harm-millions-of.
[8] Congressional Budget Office, “H.R. 1628.”
[9] CBPP analysis of Medicaid Budget & Expenditure System administrative data and American Community Survey data. For total number of Medicaid enrollees: Centers for Medicare & Medicaid Services, “Total Medicaid Enrollees – VIII Group Break Out Report,” December 2016, https://www.medicaid.gov/medicaid/program-information/downloads/cms-64-enrollment-report-jan-mar-2016.pdf. For proportion of enrollees who are non-Hispanic African American (20 percent in 2015), CBPP analysis of 2015 American Community Survey public use file.
[10] Census Bureau, “Quick Facts, United States,” https://www.census.gov/quickfacts/table/PST045216/00#headnote-js-a; Kaiser Family Foundation, “Distribution of the Nonelderly with Medicaid by Race/Ethnicity,” http://kff.org/medicaid/state-indicator/distribution-by-raceethnicity-4/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D .
[11] HHS Secretary Tom Price and CMS Administrator Seema Verma letter to governors, March 14, 2017, https://www.hhs.gov/sites/default/files/sec-price-admin-verma-ltr.pdf.
[12] Center on Budget and Policy Priorities, “Sabotage Watch: Tracking Efforts to Undermine the ACA,” https://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca.
[13] Centers for Medicare & Medicaid Services, “Health Insurance Marketplace 2017 Open Enrollment Period Final Enrollment Report: November 1, 2016 – January 31, 2017,” March 31, 2017, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-03-15.html.
[14] Kaiser Family Foundation, “Key Facts about the Uninsured Population,” September 29, 2016, http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.
[15] Samantha Artiga et al., “Key Facts on Health and Health Care by Race and Ethnicity,” Kaiser Family Foundation, June 2016, http://files.kff.org/attachment/Chartpack-Key-Facts-on-Health-and-Health-Care-by-Race-and-Ethnicity.
[16] James Kirby and Jessica Vistnes, “Access to Care Improved for People Who Gained Medicaid or Marketplace Coverage in 2014,” Health Affairs, October 2016, pp. 1830-1834.
[17] Sarah Miller and Laura Wherry, “Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions,” New England Journal of Medicine, March 2017, pp. 947-956; Kosali Simon, Aparna Soni, and John Cawley, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions,” Journal of Policy Analysis and Management, 2017, pp. 390-417; Benjamin Sommers et al., “Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act,” Journal of the American Medical Association, July 2015, pp. 366-374.
[18] Annual Update to the HHS Poverty Guidelines, 82 Fed. Reg. 19 (2017).
[19] Rachel Garfield and Anthony Damico, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid,” Kaiser Family Foundation, October 19, 2016, http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.
[20] CBPP analysis of American Community Survey data for 2015, United States Census Bureau.
[21] Congressional Budget Office, “Detail of Spending and Enrollment for Medicaid for CBO’s January 2017 Baseline,” January 2017, https://www.cbo.gov/sites/default/files/recurringdata/51301-2017-01-medicaid.pdf.
[22] Congressional Budget Office, “H.R. 1628.”
[23] Edwin Park, Judith Solomon, and Hannah Katch, “Updated House ACA Repeal Bill Deepens Damaging Medicaid Cuts for Low-Income Individuals and Families,” Center on Budget and Policy Priorities, March 21, 2017, https://www.cbpp.org/research/health/updated-house-aca-repeal-bill-deepens-damaging-medicaid-cuts-for-low-income.
[24] Associated Press, “Arkansas governor signs new Medicaid plan restrictions,” KATV (ABC), May 4, 2017, http://katv.com/news/local/arkansas-governor-signs-new-medicaid-plan-restrictions; Hannah Katch et al., “Are Medicaid Incentives an Effective Way to Improve Health Outcomes?,” Center on Budget and Policy Priorities, January 24, 2017, https://www.cbpp.org/research/health/are-medicaid-incentives-an-effective-way-to-improve-health-outcomes.; Judith Solomon, “Wisconsin Medicaid Proposals Don’t Merit Federal Approval,” Center on Budget and Policy Priorities, April 25, 2017, https://www.cbpp.org/blog/wisconsin-medicaid-proposals-dont-merit-federal-approval
[25] LaDonna Pavetti, “Work Requirements Don’t Cut Poverty, Evidence Shows,” Center on Budget and Policy Priorities, June 2016, https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows.
[26] Kaiser Family Foundation, “Premiums and Cost-Sharing in Medicaid: A Review of Research Findings,” February 2013, https://kaiserfamilyfoundation.files.wordpress.com/2013/02/8417-premiums-and-cost-sharing-in-medicaid.pdf.
[27] Wisconsin Department of Health Services, “Section 1115 Demonstration Waiver-BadgerCare Reform,” April 25, 2017, https://www.dhs.wisconsin.gov/badgercareplus/waivers-cla.htm
[28] Bryce Covert, “What 7 states discovered after spending more than $1 million drug testing welfare recipients,” ThinkProgress, February 26, 2015, https://thinkprogress.org/what-7-states-discovered-after-spending-more-than-1-million-drug-testing-welfare-recipients-c346e0b4305d.
[29] Department of Health & Human Services Office of the Assistant Secretary for Planning and Evaluation, “Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies,” October 2011, https://aspe.hhs.gov/basic-report/drug-testing-welfare-recipients-recent-proposals-and-continuing-controversies#inherent.
[30] CBPP analysis of Medicaid Budget & Expenditure System administrative data and American Community Survey data. For total number of Medicaid enrollees: Centers for Medicare & Medicaid Services, “Total Medicaid Enrollees —VIII Group Break Out Report.” For proportion of enrollees who are non-Hispanic African American (20 percent in 2015), CBPP analysis of 2015 American Community Survey public use file.
[31] Census Bureau, “Quick Facts, United States”; Kaiser Family Foundation, “Distribution of the Nonelderly with Medicaid by Race/Ethnicity.”
[32] Judith Solomon, “Indiana’s Medicaid Waiver Evaluation Shows Why Kentucky’s Medicaid Proposal Shouldn’t Be Approved,” Center on Budget and Policy Priorities, August 1, 2016, https://www.cbpp.org/sites/default/files/atoms/files/8-1-16health.pdf.
[33] State of Indiana, “Healthy Indiana Plan Demonstration Annual Report.” April 29, 2016, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-annl-rpt-feb-jan-2016-04292016.pdf.
[34] Centers for Medicare & Medicaid Services, “Health Insurance Marketplace 2017 Open Enrollment Period Final Enrollment Report: November 1, 2016 – January 31, 2017.” March 31, 2017.
[35] Paul Guerio and Cara James, “Race, Ethnicity, and Language Preference in the Health Insurance Marketplaces 2017 Open Enrollment Period,” Center for Medicare & Medicaid Services, April 2017, https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Data-Highlight-Race-Ethnicity-and-Language-Preference-Marketplace.pdf.
[36] Center on Budget and Policy Priorities, “The House-Passed Health Bill Can’t Be Fixed,” May 10, 2017. https://www.cbpp.org/sites/default/files/atoms/files/5-9-17health.pdf.
[37] Center on Budget and Policy Priorities, “Sabotage Watch.”