This study investigates the intersection of Medicaid expansion and historical redlining practices, illuminating the impact of structural racism on health insurance disparities. Analyzing data from the Mapping Inequality project and American Community Survey, the research reveals that Medicaid expansion significantly reduces uninsurance rates in areas marked by severe redlining. Crucially, this effect remains consistent across racial and ethnic lines within each redline category. The findings underscore the vital role of contextual factors, urging policymakers to address structural racism in healthcare policies. Strategic Medicaid expansion emerges as a potent tool in mitigating historical discrimination’s consequences.
This study explores the persistent structural racism in the United States that leads to enduring disparities in health insurance coverage, with a focus on the profound impact of discriminatory practices on marginalized communities. Even with advancements, people from racial and ethnic minority groups still face obstacles in accessing healthcare resources. The research delves into the intricate interplay between Medicaid expansion and historical redlining practices, highlighting how strategic policy measures can help bridge these gaps. Understanding the influence of structural racism is crucial in creating inclusive healthcare policies and promoting equal access to health services.
Abstract
This study delves into the intricate relationship between Medicaid expansion and structural racism’s impact on health insurance disparities among nonelderly adults. Utilizing data from the Mapping Inequality project on historical residential redlining and the American Community Survey on uninsurance rates, our research investigates whether Medicaid expansion differentially reduced uninsurance rates among nonelderly adults exposed to historical redlining. Through a comprehensive difference-in-differences analysis, we discovered that Medicaid expansion significantly lowered uninsurance rates in census tracts marked by severe historical redlining. Remarkably, within each redline category, there were no significant disparities in the impact of Medicaid expansion across racial and ethnic lines. These findings underscore the critical importance of considering contextual factors, specifically structural racism when evaluating the effectiveness of health policies. States opting to expand Medicaid play a pivotal role in mitigating the consequences of historical discrimination in redlined communities, thereby advancing health equity.
Introduction
Despite strides made since the Civil Rights movement, structural racism’s enduring impact on the United States persists, perpetuating racial disparities across various sectors, including healthcare. This study focuses on health insurance coverage disparities, highlighting the multifaceted influence of structural racism on these disparities. Structural racism, characterized by discriminatory systems in housing, education, employment, and healthcare, profoundly affects minoritized racial and ethnic groups’ access to resources necessary for health and well-being.
Medicaid Expansion and Racial Disparities
The Affordable Care Act (ACA) introduced Medicaid expansion as a pivotal mechanism to enhance healthcare coverage. By 2016, Medicaid expansion had reduced nationwide uninsurance rates by 7%. Notably, it significantly narrowed racial and ethnic disparities in health insurance coverage, particularly among nonelderly adults. However, existing research predominantly relies on self-reported individual race and ethnicity data, overlooking the underlying influence of structural racism.
Historical Redlining: A Measure of Structural Racism
This study focused on residential redlining as a tangible manifestation of structural racism. In the 1930s, the Home Owners’ Loan Corporation (HOLC) implemented appraisals explicitly biased against communities inhabited by minoritized racial and ethnic groups. Redlined neighborhoods faced systemic disinvestment, limiting access to crucial resources and perpetuating generational disparities.
Methodology
Our research employed a robust difference-in-differences analysis, utilizing data from the American Community Survey and verified historical redlining records. By categorizing census tracts based on redlining severity, we explored Medicaid expansion’s impact on uninsurance rates within these categories and across racial and ethnic groups.
Findings and Implications
Medicaid expansion demonstrated its most significant impact in communities historically subjected to severe redlining. Remarkably, within each redline category, the effect of Medicaid expansion on uninsurance rates was consistent across racial and ethnic lines. This suggests that Medicaid expansion, when strategically implemented, can mitigate the adverse consequences of structural racism. Policymakers and healthcare reform advocates must recognize the pivotal role of contextual factors such as structural racism in shaping healthcare disparities. By addressing both individual-level and systemic factors, comprehensive health policy reforms can pave the way toward equitable healthcare access for all.
