One of the key Initiatives of The Scott Family Foundation Intl. in the U.S. is health care reform and initiatives the will increase health awareness and health care coverage in the African American Community. Studies show that healthy Americans live longer than unhealthy ones. Unfortunately, due to lack of access and knowledge, African Americans have significantly less healthcare coverage and as a result, significantly more health concerns and problems with Diabetes, High Blood Pressure, Gout and the transmission of Sexually Transmitted Diseases than any other racial demographic in the country.
One of the key goals of the ACA is to reduce the number of uninsured through an expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income individuals purchase coverage.
As of 2011, 37 million individuals living in the United States identified as African Americans or African American. African Americans currently comprise the third largest racial or ethnic group in the United States after non-Hispanic Whites and Hispanics (Figure 1).
While it is projected that the nation will become increasingly diverse and the African Americans population will grow over the next few decades, African Americans are anticipated to maintain a consistent share of the population. The Affordable Care Act (ACA) has important implications for African Americans as they face longstanding and persistent disparities in health and health care.
As of 2011, there are over 7 million uninsured nonelderly African Americans, who make up about 15% of the total nonelderly uninsured population. Over five in six (84%) uninsured African Americans are adults, while the remaining one million are children age 18 or younger. More than two-thirds are in a working family, including half who have at least one full-time worker in the family. However, the majority have low incomes (below 138% of poverty), including over a third who have very low-incomes below half the poverty level. Many uninsured African Americans could benefit from these new pathways to coverage, which would help increase their access to care and promote greater equity in health care.
Coverage for African Americans Under the ACA Coverage Expansions
As noted, one of the key goals of the ACA is to reduce the number of uninsured. Beginning in 2014, Medicaid eligibility will expand to adults with incomes up to 138% of poverty ($26,951 for family of three in 2013), in states that implement the ACA’s Medicaid expansion. In addition, beginning in 2014, new health insurance marketplaces will become available through which individuals will be able to purchase coverage, and premium tax credit subsidies will be available to help moderate income individuals without access to affordable employer coverage pay for coverage offered through these marketplaces.
Given the low incomes of uninsured African Americans, nearly all (94%) would be in the income range to qualify for the Medicaid expansion or premium tax credits. Nearly two thirds (62%) of uninsured African Americans have incomes at or below the Medicaid expansion limit of 138% FPL, while an additional 31% would be income-eligible for tax subsidies to help cover the cost of buying health insurance through the exchange marketplaces (Figure 7). Uninsured African Americans have high stakes in state decisions to expand Medicaid.While the ACA intended for the Medicaid expansion to occur nationwide, the June 2012 Supreme Court decision on the ACA effectively made this expansion a state option. Given that the majority of uninsured African Americans have incomes below the Medicaid expansion limit, they will be significantly impacted by state decisions to expand Medicaid. In the absence of the expansion, poor uninsured adults will not gain a new coverage option and likely remain uninsured. Other analysis finds that African Americans are at highest risk of continuing to face coverage gaps due to state decisions not to expand at this time, with nearly six in ten (59%) uninsured African Americans with incomes below the Medicaid expansion limit residing in states that were not planning to expand Medicaid as of late June 2013.
Today, African Americans remain significantly more likely to be uninsured compared to Whites. This disparity, in large part, reflects that many African Americans do not have access to employer-sponsored insurance and cannot afford to purchase private coverage on the individual market due to their low incomes. Given limited access to private coverage and low incomes, Medicaid is an important source of coverage for 9.4 million African Americans, many of whom would otherwise go uninsured. However, Medicaid eligibility levels for adults remain limited in most states today, particularly in the South, where African Americans are more likely to live. As such, over 7 million African Americans remain uninsured, the majority of whom are adults.
The ACA coverage expansions provide an important opportunity to increase health coverage and access to care for uninsured African Americans. Given that most uninsured African Americans are in low-income families, the majority would be in the income range to qualify for the ACA coverage expansions, particularly the Medicaid expansion. As such, state decisions to implement the ACA Medicaid expansion have particularly important implications for African Americans. If a state does not implement the expansion, poor uninsured adults will not gain a new coverage option and will likely remain uninsured. Currently, African Americans are at the highest risk of continuing to face coverage gaps due to state expansion decisions. Even with the coverage expansions, targeted outreach and enrollment assistance will be important for ensuring eligible individuals enroll in coverage. The ACA will help address many historical procedural barriers to enrollment through new streamlined, data-driven enrollment processes that will go in place in 2014. However, targeted outreach and one-on-one application assistance from trusted individuals within the community will remain key for facilitating enrollment of eligible individuals.
Increasing health insurance coverage may significantly reduce disparities in access to care and health outcomes for African Americans. Widespread research shows that uninsured individuals experience worse access to care and poorer health outcomes. Moreover, evidence suggests that African Americans face wide and persistent disparities in health and health care. For example, infant mortality rates are significantly higher for African Americans infants and African Americans males of all ages have the shortest life expectancy compared to all other groups. Several chronic conditions affect a greater percentage of African Americans compared to non-Hispanic Whites, including diabetes and obesity. In addition, African Americans are less likely to have a usual source of care, compared to Whites. Increasing health coverage rates among African Americans could significantly increase access to care and eventually contribute to improved health outcomes as well as greater equity in health and health care. Conversely, coverage gaps, especially in states that do not move forward with the Medicaid expansion, may lead to widening disparities in coverage and care over time.
It is clear than, that we at The Scott Family Foundation Intl. must focus on first educating the community on how to become and remain healthy by providing education in the following areas:
- Healthy eating habits
- Cost effective ways to eat healthy
- The importance of regular exercise
We must also provide resources to the community that enable them to gain better access to quality health care providers and encourage regular interaction with qualified medical professionals that can monitor health conditions and provide advice to the community on how best to implement sound health habits
Finally, we seek to partner with organizations such as The Henry J Kissinger foundation to raise health care awareness in the community and bring sustainable programs to the community that will provide an immediate impact and overall benefit to the long term health of the African American Community.
*background information provided by the Henry J Kissinger Foundation. Further information can be found at: https://www.kff.org/disparities-policy/fact-sheet/health-coverage-for-the-black-population-today-and-under-the-affordable-care-act/