Much is at stake for minorities in Medicaid debate

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As Pennsylvania decides whether to expand its Medicaid program, a new study says the decision will have a major impact on the state's racial and ethnic minorities.

A Kaiser Family Foundation analysis found that 15 percent of African Americans in Pennsylvania are without health insurance and nearly two-thirds of them would qualify for coverage under federal poverty level criteria set out by the Affordable Care Act if Medicaid were expanded.

That equates to 73,000 of the more than 114,000 African Americans in the state who are uninsured, according to the study. More than 20 percent of the 90,000 uninsured Latinos also would qualify.

"It hasn't gotten a lot of attention and it is a key issue," said Julie Donohue, associate professor in the University of Pittsburgh's Department of Health Policy and Management. She recently co-authored a Rand report on Medicaid expansion.

While African Americans make up about 20 percent of the state's population, they comprise 38 percent of uninsured Pennsylvanians, she said, so people of color "are more likely to benefit from the Medicaid expansion."

Pennsylvania is one of six states -- along with Indiana, Michigan, New Hampshire, Ohio and Tennessee -- still debating whether to expand the Medicaid program.

Despite the law's provision that federal money would pay nearly the entire cost of expansion the first few years, Gov. Tom Corbett has balked at signing on over concerns about the long-term costs and questions about whether federal officials will allow Pennsylvania to make changes in the program. Earlier this summer, the Pennsylvania Senate approved legislation that would have compelled expansion, but a House committee removed that language from a budget-related bill. The issue is expected to be revisited in the fall.

"We are continuing discussions with the federal government around Medicaid reform," said Christine Cronkright, spokeswoman for the governor's office. "Gov. Corbett is interested in instituting common sense reforms into the Medicaid program, such as a work search requirement that will help better integrate our job training and public assistance programs and reasonable copays for able-bodied Pennsylvanians.

"He's also still pursuing whether we can leverage federal dollars to help qualified individuals purchase insurance on the exchange, something that's being considered in other states as well. If we can achieve some of these things, we believe we can increase access to health care options for more Pennsylvanians, which is the ultimate goal."

It should be no surprise that African Americans and Latinos are more likely to be uninsured, said Antoinette Kraus, director of the Harrisburg-based Pennsylvania Health Access Network. "African Americans and Latinos tend to work in low wage jobs that often do not come with health insurance."

Yet arguably no groups are in greater need, said Patricia Document, scientific director of the Center for Health Equity at Pitt, because African Americans have higher rates of diabetes, heart disease, some cancers and other medical conditions than other ethnicities.

Those without health insurance are more likely to delay care, so an untreated infection for a diabetic may necessitate an amputation, or untreated heart disease escalates until major surgery is required, she noted.

"In the end, we all pay for this. It comes from all of us," she said. "There's a lot to be gained for them to be insured because they are more likely to be in preventive programs and problems are less likely to escalate."

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Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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