Disparities in Care for Safety-net Populations
How will the current global pandemic, longstanding health disparities, and the future of health and healthcare affect Medicaid and the most vulnerable populations served?
Adaptation Health responds:
Health Disparities Across Racial Groups:
COVID-19 Health Disparities and Impact on Medicaid
As a result of poor and inequitable social determinants of health and disparate access to care and services, communities of color experience higher rates of chronic diseases, death and infant mortality, than their white peers. These conditions include cardiovascular disease, obesity, diabetes, cancer and HIV/AIDS, among others. Access to care can vary according to geographic location, race/ethnicity, culture, and socioeconomic status. Healthcare access has improved with Medicaid expansion across 39 states and the District of Columbia, with over 12 million uninsured adults having received health insurance coverage. Expansion has not only improved access to care but also racial and ethnic health equity, as displayed by reductions in chronic disease burden in expansion states.
However, racial health disparities persist, and, amid the COVID-19 pandemic, these disparities have been exacerbated. Higher rates of underlying health conditions and overrepresentation in low-wage, higher-risk jobs within communities of color, has driven greater prevalence of COVID-19 related deaths within these populations. Thus, Medicaid spending and enrollment is projected to be higher than pre-pandemic estimates. Furthermore, persons with comorbidities face new challenges of disease management and health care and service access, especially when factoring in technology barriers. Impacts to care utilization, including lower virtual visits, child vaccinations, and important in-person health screenings and procedures, could lead to widened gaps in health equity for those most vulnerable.
The pandemic has catalyzed a national conversation, spurred collaborations, and launched new initiatives with missions to address not only the effects of COVID-19 on communities of color but also the root social health inequities that paved the way for such outcomes. Medicaid can be at the forefront of making history in the fight to address health disparities in care and outcomes. As the insurance provider to those disproportionately impacted by the pandemic, Medicaid is uniquely positioned to lead sustainable change that shifts the trajectory of health inequity in the United States.
1 Cross-Call, Jesse. “Medicaid Expansion Has Helped Narrow Racial Disparities in Health Coverage and Access to Care.” Center on Budget and Policy Priorities, 21 Oct. 2020, www.cbpp.org/research/health/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage-and.
2 Artiga, Samantha, et al. Disparities in Health and Health CARE: Five Key Questions and Answers. 1 Apr. 2020, www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/.
3 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2021, January 20). HIV and African American People. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html.
4 Brown, Elizabeth J., et al. “Racial Disparities In Geographic Access To Primary Care In Philadelphia: Health Affairs Journal.” Health Affairs, 1 Aug. 2016, www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1612.
5 Cross-Call, Jesse. “Medicaid Expansion Has Helped Narrow Racial Disparities in Health Coverage and Access to Care.” Center on Budget and Policy Priorities, 21 Oct. 2020,
6 Eliason, Erica L. “Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality.” Women's Health Issues , vol. 30, no. 3, pp. 147–152., doi:https://doi.org/10.1016/j.whi.2020.01.005. Accessed 6 Feb. 2021.
7 Cross-Call, Jesse. “Medicaid Expansion Has Helped Narrow Racial Disparities in Health Coverage and Access to Care.” Center on Budget and Policy Priorities, 21 Oct. 2020, www.cbpp.org/research/health/medicaid-expansion-has-helped-narrow-racial-disparities-in-health-coverage-and.
8 National Center for Health Statistics. “Health, United States Spotlight Racial and Ethnic Disparities in Heart Disease .” Centers for Disease Control and Prevention, 23 Apr. 2019, www.cdc.gov/nchs/hus/spotlight/2019-heart-disease-disparities.htm.
9 Thebault, Reis, et al. “The Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate.” Washington Post, 7 Apr. 2020, www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/?arc404=true.
10 Abdelmalek, Mark, and Lucien Bruggeman. “Dramatic Drop in Cancer Diagnoses amid COVID Pandemic Is Cause for Concern, Doctors Say.” ABC News, ABC News Network, 14 May 2020, abcnews.go.com/Health/drop-cancer-diagnoses-concern-doctors/story?id=70682238.
11 Rudowitz, 2020
12 Artiga, Samantha, and Wyatt Koma. “Low-Income and Communities of Color at Higher Risk of Serious Illness If Infected with Coronavirus.” KFF, 7 May 2020, www.kff.org/coronavirus-covid-19/issue-brief/low-income-and-communities-of-color-at-higher-risk-of-serious-illness-if-infected-with-coronavirus/.
13 Mehrotra, Ateev. “The Impact of the COVID-19 Pandemic on Outpatient Care: Visits Return to Prepandemic Levels, but Not for All Providers and Patients.” Commonwealth Fund, 15 Oct. 2020, www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-outpatient-care-visits-return-prepandemic-levels.