Health Justice CT

Health Justice CT Blog

What Difference Expansion Makes: A Tale of Two States

Connecticut continues to be a leader on the national stage for health equity. Since the implementation of the Affordable Care Act (ACA), 27 states and the District of Columbia have expanded Medicaid and three are considering expansion. This means 20 states have not expanded eligibility for Medicaid.



When you consider Medicaid is income-based health insurance coverage and people of color disproportionately experience poverty, this becomes not only an access to care and health equity issue but also a civil rights issue. As my colleague Georica Gholson pointed out in her recent blog, institutional racism matters. From the Tuskogee experiments to the theft of Henrietta Lacks cancer cells, the relationship between people of color and the health care system has been fraught with turmoil, deceit and mistrust. The burden of centuries of institutional racism could be lessened a little by simply allowing those without health insurance a chance to get coverage and access to health care.

For example, legislators of  the state of Oklahoma, voted against expanding Medicaid coverage, denying 144,000 adults health insurance coverage who would have been eligible to receive it if expansion was implemented. Currently, adults without children or a disability are not eligible for Medicaid in Oklahoma. This denial of access has a disproportionate impact on communities of color in the state.

Recent  US Census data shows that 75% of Oklahomans are white, 7.7% are black, and 9.6% are Hispanic or Latino.  According to a report by the Kaiser Family Foundation (KFF), in 2013, White people comprise 10% of the people living at or below Federal Poverty Level (FPL); this number increases nearly three times for Black Oklahomans at 29%, two times for Latinos at 21% and two times for “other” at 21%. Those numbers are disheartening, but truly reveal health inequities and barriers to access to care for people of color, particularly in Oklahoma.

The picture looks bleak for Medicaid expansion in Oklahoma, despite a new state objective to reduce the number of uninsured from 17% to 9.5% by 2019. Lawmakers still consider even the discussion of the ACA “politically toxic.”

This story has a much happier ending in Connecticut, a Medicaid expansion state. Here in Connecticut in 2013, White people comprised 8% of the population living at or below the FPL; black people and Latinos make up nearly triple that of white people at 22% and 25% respectively. Enrollment for Medicaid increased by 129,588, with 78,933 new single adults. A survey by Access Health CT(AHCT) indicates 55% of these enrollees were previously uninsured. In the second round of enrollment,  AHCT reports 39,000 new enrollees as of December 2014. But the good news doesn’t stop there.

The fear that Primary Care Providers (PCP) would opt out of Medicaid because of the ACA mandates was unsubstantiated. In Connecticut, Medicaid saw an increase in provider participation, which increases access to care for Medicaid recipients. The number of participating PCPs increased 21.3% from 2,370 in January 2013 to 3,458 by the end of July 2014. The number of participating Specialists increased 23.3% to 22,562 providers. Additionally, 97.4% of PCPs are still accepting new Medicaid patients.

While the implementation and enrollment in the ACA has had some hiccups, the good clearly outweighs the bad, especially here in Connecticut. Imagine where we would be if Connecticut chose not to expand Medicaid?


Image credit: Kaiser Family Foundation

About Tonya Wiley

Writer, trainer and consultant Tonya Wiley taps into her inner Wonder Woman by fighting for health equity for all. Find her on Twitter nerding out on pop culture and engaging in varied conversations. Learn more about Tonya here.

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