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Blacks Gain Most from Obamacare When Medicaid Expanded

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FILE - This Nov. 29, 2013, file photo shows a part of the HealthCare.gov website, photographed in Washington. If you have health insurance on your job, you probably don't give much thought to each year's renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises. Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts.  (AP Photo/Jon Elswick, File)

This Nov. 29, 2013, file photo shows a part of the HealthCare.gov website, photographed in Washington. (AP Photo/Jon Elswick, File)

By Freddie Allen
NNPA Senior Washington Correspondent

WASHINGTON (NNPA) – As families prepare to choose health insurance coverage during the open enrollment period, a recent report by the Urban Institute shows that Blacks have the most to gain from the Patient Protection and Affordable Care Act (ACA) if the states they live in expand Medicaid under the law.

The Urban Institute, a nonprofit research group focused on social and economic policy, estimated that Blacks will experience, “the largest decreases in uninsurance rates under full Medicaid expansion: a drop from 11.3 percent (projected with current expansion decisions) to 7.2 percent” and the uninsurance rate gap between Blacks and Whites will fall from 6.5 percent under current Medicaid expansion to 2.6 percent with full expansion.

However, the gap between Black and White uninsurance rates will remain closer to 7 percent, at least for the near future, because most Blacks live in states that have refused to expand Medicaid under the ACA.

The original law, passed in 2010, mandated Medicaid expansion nationwide, but the United States Supreme Court 2012 decision in the National Federation of Independent Business v. Sebelius case reversed that provision, leaving it to the states to decide whether they want to take additional Medicaid funding under the ACA.

According to the Urban Institute, “As of December 2014, 27 states and the District of Columbia had expanded Medicaid or planned to expand by January 2015.”

The Urban Institute projected that Blacks would comprise 12.8 percent of all coverage gains under current Medicaid expansion policies and 2.9 million Blacks would get health insurance. The uninsurance rate for Blacks would fall from 19.6 percent to 11.3 percent.

More than half of all Blacks live in states, primarily in the South and led by Republican governors, that didn’t expand Medicaid after the ACA was passed in 2010.

When states refused to expand Medicaid, the move trapped Blacks in a “coverage gap,” because many of them don’t meet the income-based requirements to qualify for Medicaid under their own state rules or to receive subsidies through the ACA marketplace.

About 1.4 million Blacks fall into this category, accounting for more than 23 percent of the uninsured non-elderly adult Blacks. For example, in Florida, Georgia, Texas and North Carolina, the uninsured rates for Blacks would plummet roughly 30 percent compared to current rates, if those states expanded Medicaid coverage under the ACA.

“For blacks, however, the difference between their uninsurance rates and whites’ rates is projected to narrow under the ACA with current Medicaid expansion decisions only in Medicaid expansion states,” the report said. “Across all states, the difference in uninsurance rates between blacks and whites is projected to stay approximately the same both under the ACA with current Medicaid expansion decisions and without the ACA.”

In August 2014, researchers with the Urban Institute said that 6.7 million residents would still remain uninsured in 2016 in the states that continued to block Medicaid expansion through the ACA.

“These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, which will lessen economic activity and job growth,” the August 2014 report said. “Hospitals in these 24 states are also slated to lose a $167.8 billion (31 percent) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.”

The report continued: “For every $1 a state invests in Medicaid expansion, $13.41 in federal funds will flow into the state.”

The Council of Economic Advisers (CEA), a small group that offers the president domestic and foreign economic advice, predicted that, Medicaid expansion would have added, in nonexpanding states, nearly 79,000 jobs in 2014, “172,400 jobs in 2015, and 98,200 jobs in 2016.”

The August 2014 report also noted that that the rate of uninsured in the states that expanded Medicaid fell by nearly 40 percent, since September 2013, the number of uninsured in the non-expansion states fell by less than 10 percent.

The technical difficulties that plagued the rollout of HealthCare.gov last year have faded from headlines, and the benefits of Medicaid expansion under the Affordable Care Act become harder for governors and state legislators to dismiss.

In December, Republican Tennessee Gov. Bill Haslam moved to expand Medicaid under the ACA, leaving less than two dozen states to weigh providing health care for their poorest residents against future costs associated with Medicaid.

The Urban Institute report on uninsurance rates under the ACA said that improving health literacy, translation services, outreach through ethnic media and working with trusted members of the community can also aid in driving down the levels of uninsured.

According to a recent report by the Department of Health and Human Services (HHS), 87 percent of the people who selected health insurance plans through HealthCare.gov were eligible for financial assistance, a 7 percent increase over last year’s numbers.

“That includes more than 3.4 million people who selected a plan in the 37 states that are using the HealthCare.gov platform for 2015, and more than 600,000 consumers who selected plans in the 14 states that are operating their own Marketplace platform for 2015,” stated a press release on the report.

A more detailed view of enrollment data collected from November 15 to December 26 showed that roughly 6.5 million people either selected plans or were automatically reenrolled.

HHS Secretary Sylvia Burwell said that the vast majority of people who signed up for health insurance coverage through HealthCare.gov were able to lower their costs using tax credits.

“Interest in the Marketplace has been strong during the first month of open enrollment,” Burwell said in a recent press release about the enrollment report. “We still have a ways to go and a lot of work to do before February 15, but this is an encouraging start.”

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Returning to Its Roots, the Oakland Black-Eyed Pea Festival Partners with the Freedom Farmers Market Sept. 12

POST NEWS GROUP — Freedom Farmers’ Market (FFM) vendors sell produce and promote wellness and nutrition through organic herbs, massage, and other gift items from July through October on the second and fourth Saturdays at a dozen canopies in the last block of Shattuck Avenue, where it merges with Telegraph Avenue.

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Elaine Smith, executive director of Farms to Grow, Inc., holds T-shirt for Ki’Ara LaFitte, winner of the Freedom Farmers’ Market Watermelon-Eating Contest at the season opening on July 11. Courtesy photo.

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The Oakland Black-Eyed Pea Festival (BEPF), a celebration of African American traditional music, food and art, will return to its roots through a partnership with Farms to Grow, Inc., the hosts of the Freedom Farmers’ Market on Sept. 12.

Now in its 11th year, the downsized festival sponsored by Omnira Institute will open with presentations by Wakan Wiya Two-Spirit Drum, a drum invocation for the ancestors by Awon Ohun Omnira, a performance by Andre Thierry of Accordion Soul, and most importantly, fresh black-eyed peas for sale.

Freedom Farmers’ Market (FFM) vendors sell produce and promote wellness and nutrition through organic herbs, massage, and other gift items from July through October on the second and fourth Saturdays at a dozen canopies in the last block of Shattuck Avenue, where it merges with Telegraph Avenue.

Over the years, FFM vendors have appeared at the Black-Eyed Pea Festival and vice versa, so this collaboration is like a family reunion.

Farms to Grow, Inc. Executive Director Elaine Smith said the collaboration with Omnira Institute was an opportunity she couldn’t refuse. “People talk about community and unity for Black people – I always want to be an example of what has to be done,” Smith said. “Anyway that we can partner with our people, we want to do that.”

Charlotte Jackson, a longtime vendor with FFM and the festival, had been known for her jellies, jams and chow-chow through Pots n’ Jars. For the last several years, she hasn’t been able to find a commercial kitchen she can afford, so she began selling vegan soap and skin care products that her son and his partner produce under the name Lather and More.

“It’s been a blessing,” said Jackson, who will tell her customers that although they can order the wares from the website, there’s no such thing as ‘smell-avision.” From her table, she encourages passers-by to take a sniff of the soaps, then directs them to the nearby booths.

Jackson functions as a sort of ‘town crier’ of ‘buying Black,’ never failing to encourage Black people to take their mule or Pontiac or Chevrolet and steer it toward Black businesses like Mandela Market.

Likewise, the Black-Eyed Pea Festival was established to encourage Black entrepreneurship by providing a space for Black creatives to sell their handmade or original designs and products without competing with commercially produced goods.

It also served as a way to both commemorate and invigorate memory of the once-thriving Black community of West/North Oakland before it was divided by highways, BART, and then ravaged by the crack cocaine epidemic.

“For one day, I wanted to invoke the success of that community through the sound of music, the taste of soul food and black-eyed peas and the beauty of our art,” Ravernell said.

Once deciding to follow through on the idea of holding a festival celebrating African American traditions, Ravernell settled on using the black-eyed pea as its symbol because of its pride of place in Black people’s consciousness on New Year’s Day and because the peas were originally cultivated in Africa.

Learning that Fresno farmer Wil Scott, former president of the California African American Farmers Association, grew black-eyed peas as well as other legacy crops that are the foundation of a soul food menu, Ravernell was intent on ensuring Scott’s presence at the first festival in 2014. Whenever he could, and whenever the weather yielded a bountiful crop, Scott would bring his black-eyed peas to the festival, shelled or on the pods.

Originally cultivated in Africa, the black-eyed pea is believed to have been brought to the U.S. hidden in the hair of African captives brought to the Western Hemisphere during the holocaust of the Atlantic Slave Trade.

Known to grow plentifully even in poor soil, the pea was associated with abundance in Africa and later, in the U.S., with good luck.

She also learned that black-eyed peas nourish poor soil, that they are a very good source of nutrition, and that they probably contributed to the longevity of the enslaved.

“I thought the black-eyed pea, its story and its significance for Black people made it a great symbol to represent Black culture,” she said. In spite of everything they endured, Black people emerged from slavery and Jim Crow as masters of making a lot from a little, creating a culture that would be emulated and imitated at home and abroad.

Feeling that many people know only the most recent iterations of Black music – Hip Hop and R&B – she created the festival to promote the music of earlier eras, which reflect the thoughts and feelings of Black people over time.

That’s why the festival highlights straight-ahead jazz, gospel, zydeco and the Second Line of the New Orleans jazz funeral.

“It’s not enough to remember,” Ravernell said. “We need to actively nourish the roots of our culture.”

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Business

NPRC Scores First Advocacy Victory: David Shaw Finally Gets His Wish to ‘Go Home’

POST NEWS GROUP — The National Probate Reform Coalition (NPRC), formed by the Post Newspaper Group in January following years of reporting on alleged abuses within the probate court system, helped Beverly secure the return of her husband, along with the couple’s property and assets.

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Beverly and David Shaw were separated by a hospital after Beverly took David there to treat his dehydration. The hospital determined Beverly was not caring for David property and placed him under their guardianship. Courtesy photo.

For nearly four years, Beverly Shaw fought to bring her husband home.

She watched as David Shaw moved through three nursing homes, became increasingly sedated and repeatedly expressed his desire to return to his wife. Last week, that finally happened.

The National Probate Reform Coalition (NPRC), formed by the Post Newspaper Group in January following years of reporting on alleged abuses within the probate court system, helped Beverly secure the return of her husband, along with the couple’s property and assets.

For NPRC, the Shaw case represents its first major advocacy victory. For David, it means something much simpler: He finally got to go home.

In a letter to the court, Beverly raised serious concerns about her husband’s care at Riverview at the Park Nursing Home.

She alleged that David was frequently heavily sedated and questioned whether his medications were properly documented. She said an aide told her medications were sometimes administered without proper charting, although she acknowledged she had not independently verified that information.

Shaw also said she was unable to obtain David’s medical records and questioned medications he was receiving despite previous medical instructions following his 2023 stroke.

“I believe David has been subjected to abuse, neglect, and unnecessary chemical restraint,” Shaw wrote.

The allegations are Shaw’s account and have not been independently established. But they raise questions central to NPRC’s mission: Who is watching when a vulnerable person becomes subject to guardianship? Who is accountable when family members say they are ignored? And who makes sure the person under guardianship, not the professionals surrounding them, remains the priority?

“Please let me go home”

Perhaps the most compelling part of Shaw’s case was David’s own voice. Shaw told the court she possesses recordings in which David repeatedly expressed his desire to return home.

After 45 years of marriage and four years apart, Beverly argued that David deserved the opportunity to spend his remaining years at home with his wife, receiving individualized care.

NPRC responded with a “Request for Compassion” letter-writing campaign to Judge Thomas Inman, Associate Circuit judge for Ste. Genevieve County, Missouri. The coalition also helped Shaw pursue appropriate legal filings and engaged with her attorney to press for action.

The court ultimately returned David to Beverly’s custody and restored the couple’s property and assets.

“What we have here is the power of coalition,” said Alee Carrino, an NPRC planning committee member. “We applied pressure from all sides, and it worked.”

The victory comes during NPRC’s eighth month of organizing for probate reform. The coalition advocates for greater judicial and governmental oversight, court ombudsmen, mandatory mediation, transparency in probate billing and stronger protections for elders and disabled people.

The Shaw case sends a powerful message: Guardianship is supposed to protect vulnerable people, not permanently separate them from those who love and care for them.

David Shaw asked to go home. His wife fought to bring him home. NPRC supported her every step of the way, and this time, the system listened.

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Commentary

ESSAY: California Can Close Its Colorectal Cancer Gap

POST NEWS GROUP — The numbers are stark. From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 Black Californians, compared with 35.8 among non-Hispanic White Californians. The mortality rate was 25.3 deaths per 100,000 among Black Californians and 17.7 among White Californians—a 43% difference.

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Dr. Gracie Ann Dinkins, left, and Sydney Y.K. Brown, MA

Every breakthrough in cancer care carries a promise: earlier detection, better treatment and longer life. California has helped deliver that promise through world-class cancer centers, a statewide cancer registry and major public-health investments. Yet colorectal cancer still exposes a painful divide: Black Californians are more likely to develop the disease and far more likely to die from it than their White neighbors.

The numbers are stark. From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 Black Californians, compared with 35.8 among non-Hispanic White Californians. The mortality rate was 25.3 deaths per 100,000 among Black Californians and 17.7 among White Californians—a 43% difference. 

A later state analysis showed that the incidence gap remained in 2021, at 39.0 versus 35.0 cases per 100,000.

These differences should not be treated as an inevitable consequence of biology. The more revealing explanation lies in what happens—or fails to happen—across the cancer-care continuum: prevention, screening, diagnostic follow-up, treatment and surveillance after treatment.

Colorectal cancer is one of the few cancers that screening can sometimes prevent. Colonoscopy can find and remove precancerous polyps, while stool-based tests can identify people who need further evaluation. The U.S. Preventive Services Task Force recommends screening for average-risk adults from ages 45 through 75, with several acceptable options. But a screening test saves no one if it is never offered, never completed or not followed by a timely colonoscopy after an abnormal result.

California’s cancer-burden report shows both the urgency of the problem and a troubling data gap. Nearly six in 10 colorectal cancers were diagnosed at a regional or distant stage among both Black and White patients from 2009 through 2018. The racial difference in stage was not statistically significant. Yet, the registry report did not include screening information, so it could not show who was offered a test, who completed it or who received the necessary colonoscopy afterward. It also did not assess whether survivors completed recommended follow-up. California can count cancers and deaths, but it cannot yet see every missed opportunity that produced them.

The disparities become clearer after diagnosis. A California Cancer Registry study of nearly 27,000 people with stage I through III colorectal cancer found that Black patients had 39% higher odds of receiving less than guideline-recommended treatment and 78% higher odds of waiting more than 60 days for treatment than White patients. Neighborhood socioeconomic disadvantage explained part of the substandard treatment, but racial differences persisted even after researchers accounted for where patients lived.

Survival reflects the accumulation of these missed opportunities. Among Californians diagnosed from 2009 through 2013, five-year relative survival was 58.8% for Black patients and 65.1% for White patients. After researchers adjusted for age, insurance, neighborhood income, stage, chronic illness and other factors, the survival difference was no longer statistically significant. That does not make the gap less serious. It identifies much of it as potentially preventable: when access, timing and health conditions are unequal, survival will be unequal too.

California already has proof that a better system can work. Kaiser Permanente Northern California built an organized program that identified eligible patients, mailed annual home stool tests to those overdue, offered colonoscopy as an alternative, and tracked abnormal results through follow-up. Screening among Black members rose from about 40% in 2009 to 80% in 2019. Over the same period, their colorectal cancer death rate fell from 54.2 to 20.9 per 100,000, essentially eliminating the Black-White mortality gap within that health system.

The lesson is not that every Californian must join one health plan. It is that equity requires organized care rather than reliance on chance encounters. Mailed screening outreach, patient navigation and guaranteed follow-up colonoscopy should become standard across Medi-Cal, county health systems and community clinics. Health systems should publicly report screening completion; time from a positive stool test to colonoscopy; time from diagnosis to treatment; receipt of guideline-concordant therapy; and completion of post-treatment surveillance—each stratified by race, insurance, and neighborhood.

Transportation, paid time off, bowel-preparation costs, childcare and distrust are not side issues; they determine whether patients can complete care. Community organizations, churches, clinicians and public hospitals should help design outreach from the beginning, not merely deliver messages created elsewhere. Survivors should leave treatment with a clear surveillance plan, navigation support and reminders that do not disappear when active therapy ends.

Closing California’s colorectal cancer gap is achievable. The state has the tests, specialists, data systems and proof of concept. What it needs is the will to connect them. Success should be measured not only by how many cancers we treat, but by how many we prevent, how quickly we act and whether every Californian has an equal opportunity to survive.

About the Authors 

Gracie Ann E. Dinkins, MD, FACS, is a Clinical Assistant Professor of Surgery and Surgery Clerkship Director at the Charles R. Drew University College of Medicine, Department of Surgery. Her mission is to help realize the CDU vision: Excellent health and wellness for all in a world without health disparities.

Sydney Y. K. Brown, MA, is a medical student at the Charles R. Drew University College of Medicine whose work focuses on clinical research, community engagement, and health equity. She is committed to advancing equitable access to high-quality care and improving health outcomes in underserved communities.

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