Insurance coverage

‘The job isn’t done’: More black Americans need health insurance coverage

A health insurance survey released by the Commonwealth Fund reveals continued coverage needs for black people, despite recent federal intervention. (Credit: Klaus Nielsen/Pexels)

by Alexa Spencer

The number of Americans living without health insurance has reached record highs during the pandemic due to government pressure for coverage, but experts like Sara Collins – a senior fellow at the Commonwealth Fund – say that despite these victories, “the work is not done”.

A recent Commonwealth survey reveals that while more Americans than ever have coverage, many are struggling to afford the care they need or are not covered at all.

“Millions of people are still uninsured,” Collins told Word In Black in a phone interview. “A lot of people have unstable coverage, so they have gaps in their insurance.”

Nearly half of American workers have access to health insurance through their employer, but – according to the survey – 29% of those covered by the employer say that the plans do not meet their needs.

Collins says it has a lot to do with cost, that programs “can have very high deductibles, high spending limits, and that leaves people very exposed to health costs when they receive care.”

What are the health consequences of being underinsured?

Not being able to afford insurance can cause people to avoid health care. 42% of survey respondents said they skipped or postponed care due to cost.

“Underinsured people report high rates of care delays, not receiving care when they need it,” she says. “And those who receive care report high rates of problems paying their medical bills.”

And when these bills go unpaid, they turn into debts that can affect a person’s livelihood.

The medical debt crisis is particularly hard on the black community. 27% of black households have medical debt, compared to 17.2% of white households, for example.

And according to the Commonwealth survey, these unpaid bills are more likely to be sent to a collection agency. This can affect a person’s credit scores and prevent them from making purchases, such as buying a house.

Earlier this year, the Biden-Harris administration announced a plan to reduce the impact of unpaid medical bills on credit and eliminate it as a factor in the mortgage approval process.

Why are so many black people uninsured?

Even though Medicaid’s expansion of the Affordable Care Act has allowed more people to get coverage, black adults are still more likely than others to be uninsured.

Since the expansion process began in 2014, 38 states and the District of Columbia have opted for federal funding.

However, 12 states — mostly Southern states with the nation’s largest black populations — have yet to expand public medical coverage for its residents.

Among them are Mississippi, Alabama and Georgia — states where black mothers die at disproportionately high rates and where strokes are a leading cause of death.

“If these states grew, you would see a big increase in coverage rates among black adults,” Collins says.

How can more black people get coverage?

The Commonwealth Fund suggests several policy recommendations that could address the coverage needs of the black community, including allowing states to maintain continued Medicaid eligibility without having to seek a federal waiver.

Additionally, the organization suggests that Congress provide a federal “fallback” option for Medicaid-eligible residents living in non-expanded states. That could lower uninsured rates for blacks in those states by 27%, according to the Urban Institute.

Collins says, “These are really minor tweaks that could really have significant effects, especially for black adults and children.”