The expansion of the federal low-income health program to cover more people hasn’t benefited Latinos as much as other racial and ethnic groups, according to a recent report by UCLA researchers.
The Affordable Care Act expanded the program, called Medicaid, and it has allowed millions of previously uninsured people to qualify for government-funded health care. Thirty-two states, including California, and the District of Columbia have implemented the expansion.
In California, where Medicaid is known as Medi-Cal, almost 4 million people gained coverage after the program’s expansion in 2014.
Yet Latinos, who in California make up almost 40 percent of the population, haven’t enjoyed the same increases in health care coverage, access and affordability as non-Hispanic whites and blacks, the UCLA study found.
“We were a little bit surprised about the finding,” said researcher Dahai Yue.
Researchers found that, prior to the ACA, Latinos had “the lowest insurance coverage rate,” Yue said. “Why would (they) benefit the least from Medicaid expansion?”
The researchers analyzed data from a nationwide health survey conducted by the Centers for Disease Control and Prevention prior to Medicaid expansion, in 2013, and afterward, in 2015.
Focusing on respondents whose income level would make them eligible for Medicaid, the study authors tallied how many people reported having health insurance coverage, a personal doctor and being able to afford care. They compared the results for states that expanded Medicaid and those that didn’t. The researchers also examined differences among racial and ethnic populations within expansion states.
Overall, people living in states that expanded Medicaid enjoyed higher increases in health insurance coverage, access to personal doctors and the ability to afford a doctor’s visit following the ACA, compared to people living in states that didn’t expand the program. Yet these benefits accrued largely for non-Hispanic whites and blacks—not for Latinos, the researchers discovered.
While whites in states that expanded Medicaid enjoyed an 11 percent gain in health insurance coverage, and blacks an 8 percent gain, coverage rates for Hispanics actually went down about 1 percent, according to the findings. Hispanics also saw the lowest increase in access to a personal doctor, with just a 5 percent increase—compared to a 13 percent increase for blacks and a 6 percent increase for whites.
Meanwhile, the number of Hispanics who said they couldn’t afford to see a doctor rose by 3 percent following expansion, while whites and blacks were 4 percent and 8 percent less likely to report this problem, respectively, the researchers found.
Yue said language barriers and immigration concerns may help explain the disparities for Latinos. Those with limited English language skills may have a harder time accessing care, he explained. And people with undocumented family members are often wary of divulging personal information to the government in order to qualify for Medicaid, he said.
Efforts to increase Medicaid enrollment among minority populations may have improved coverage and accessibility for Hispanics since 2015, co-author Petra Rasmussen wrote in an email. However, she anticipated that immigration fears would likely continue to discourage enrollment among some Latinos, including those in California.
“It would be really interesting to see the study repeated looking only at California,” she wrote in an email. “The state has made great efforts to reach the Latino population and help them get enrolled in coverage,” Rasmussen said.
But, “there are still serious immigration concerns which may chill a willingness on the part of immigrants or family members of immigrants to enroll in any government program.”