Medicaid expansion is making progress. As TPM reported yesterday, even states as conservative as Wyoming are coming around. Others like Indiana and Pennsylvania are making progress as well. But a handful remain hardened in their opposition. They are largely contained to the South, and that means that the people being left out of Obamacare’s safety-net expansion are disproportionately poor blacks.
Nelson Lichtnestein, director of the University of California-Santa-Barbara’s Center for the Study of Work, Labor and Democracy, flagged the ongoing disparity in an email to TPM on Monday, responding to the Wyoming story. “There is a large elephant that escapes your notice,” he said. “Republican governors in North and West are indeed climbing aboard, but not those in the South.”
And it’s true. A map of Medicaid expansion leaves out the five states that, at least by the standard definition, comprise the Deep South. You can tack on two huge adjoining states — Florida and Texas — and go by the “original Confederate States” definition. Arkansas and Kentucky are the most Southern states so far to expand, and both are led by Democrats. GOP-led Tennessee is working on it.
In a June op-ed for Reuters, Lichtenstein used the South’s obstruction of Medicaid expansion as “Exhibit A” in his argument that the region was reverting to the “New South,” formerly the description of the period between the Civil War (or Reconstruction, more precisely) and civil rights.
“A ruling white caste (is) now putting in place policies likely to create a vast economic and social gap between most Southern states and those in the North, upper Midwest and Pacific region,” he wrote. “Of course, such regressive social policies… are supported by a fierce white partisanship.”
It’s a reality that has been noted by others, like The New Republic’s Brian Beutler, with the recent news that other (whiter) GOP-controlled states like Pennsylvania and Wyoming are moving toward Medicaid expansion.
GOP-controlled Medicaid expansion states are pretty white, relative to GOP-controlled, non-expansion states http://t.co/tU5avi5KMU
— Brian Beutler (@brianbeutler) September 2, 2014
And it’s a reality borne out by demographic analysis of the so-called Medicaid expansion gap, which has left more than 4 million people in more than 20 states without coverage in the first year of Obamacare as GOP-led states seized on the Supreme Court ruling that made Medicaid expansion optional.
The Kaiser Family Foundation reported in December on the Medicaid gap’s demographics, and it has likely become more skewed considering it has been states like New Hampshire and Iowa that have since changed their minds and expanded the program.
Back then, 79 percent of the nearly 5 million people being cut out of Medicaid lived in the South. And more than them were black (27 percent) or Hispanic (21 percent) than white (47 percent). They were also young (50 percent between 18 and 34).
So while it appears that the poor residents of Indiana and Wyoming can soon look forward to health coverage under Obamacare, Southern blacks are being left behind.
Lead image: Renee Walker, from Orlando, holds a sign during the kickoff for “Moral Monday” March 3, 2014 at the Florida State Capitol.