Trapped in the Medicaid Ghetto

Published September 7, 2010

During the legislative battle over President Barack Obama’s health care law, there were many stories left untold about the true ramifications of the measure. We learned recently that allies of the White House have been circulating a presentation advising supporters to stop claiming the law will lower costs or reduce the deficit — now they tell us! But perhaps the most disturbing of the untold stories is how the new law’s expansion of Medicaid will burden African-Americans.

The evidence for this unsettling conclusion is solid and data-driven. According to a Congressional oversight report released by the Senate’s two serving physicians, Dr. Tom Coburn (R-OK) and Dr. John Barrasso (R-WY), the president’s choice to expand Medicaid services dramatically will have a disproportionate impact on the health of the poor—and as a side effect it will trap a significant percentage of African-Americans in a ghetto of poor medical care.

Academic studies have repeatedly confirmed Medicaid patients experience poorer health outcomes and higher infant mortality rates. In July a new report from the University of Virginia found even worse performance: surgical patients on Medicaid actually fare worse than the uninsured. They are 13 percent more likely to die than those who have no insurance and 97 percent more likely to die than patients with private insurance.

Yes, you read that right — having no coverage at all is statistically better than being covered by Medicaid.

Those patients who do survive are virtually guaranteed lengthy and expensive time in the hospital. Even after the study authors controlled for “age, gender, income, geographic region, operation, and 30 comorbid conditions,” they found “Medicaid payer status was associated with the longest length of stay and highest total costs.” The stays were 42 percent longer than for those covered by insurance, and the costs were 26 percent higher.

Although much of the focus on Capitol Hill has been on how the new regime affects those on Medicare—coincidentally, a political constituency more likely to vote—the consequences for those on Medicaid are far more serious. The system is already fraught with problems, including delays in access to care that multiply costs and in some sad cases cause perfectly avoidable deaths. Now Obama’s law will jam 16 to 18 million more Americans into it.

The racial divide that this policy precipitates is particularly disgusting. A much higher proportion of the African-American population is in the program than any other major ethnic group. According to the most recent statistics, from 2008, it’s more than 30 percent.

Before the passage of Obama’s law, I and other critics voiced concerns that his reform approach would make a reality of former Sen. John Edwards’ claim that there are two Americas. The law creates a tiered system dividing those on government coverage from anyone else, deepening the economic chasm between rich and poor.

Several supporters of the legislation cited racial disparities in health care, but they did not bother to examine which health care system is inflicting this damage on minorities. Instead they passed a law mandating Americans below 133 percent of the federal poverty level will be eligible only for Medicaid. Low-income families and minorities don’t deserve to be forced into a government program that denies them access to 40 percent of the nation’s physicians and has higher infant mortality rates and a guaranteed pattern of atrocious outcomes.

During the push to reform the nation’s welfare laws in the 1990s, political leaders on both sides of the aisle acknowledged the point of government programs like these is to integrate minority and poor populations into the mainstream, to provide a safety net until people can get back on their feet, not imprison them in a destructive system. We need this type of bipartisan solution on health care to solve the disastrous, growing Medicaid problem.

Low-income people need access to equitable treatment with proven results, perhaps through a voucher-based approach that trusts adults to make decisions for themselves. But that would be a solution built on data and facts, not on political games and false promises. And that is exactly the kind of answer Washington’s current leadership seems determined to avoid.

Benjamin Domenech is a research fellow at The Heartland Institute, managing editor of Health Care News, and editor of The New Ledger.