Early this year, the National Center for Health Statistics reported the steepest decline in life expectancy since World War II, and a three-year drop — the largest of any group — for Latinos. The decline was due primarily to increases in mortality connected to the COVID-19 pandemic.
The disproportionate impact of COVID-19 on racial and ethnic populations was, in turn, fueled by long-standing structural inequality and the effects of discrimination throughout our health system. As congressional leaders build consensus on a massive human infrastructure bill, closing gaps in the health care system is imperative, in no small part because it could make a difference in life expectancy for Latinos and Blacks.
The moment for this change is now. The vision for the Affordable Care Act (ACA) more than a decade ago was a health system that provided a minimum of basic coverage for the most vulnerable Americans. The unfortunate reality is that many Americans continue to be shortchanged based on the state in which they live. Critically, Congress has an opportunity — even a responsibility — to change that in the days ahead.
A 2012 Supreme Court decision undermined the ACA’s original vision, instead of allowing states to choose whether to expand Medicaid to include more low-income adults. Since that time, 38 states and Washington, D.C., expanded coverage, and substantial evidence shows that those who gained coverage are healthier and more financially stable. But 12 states continue to refuse expansion — although a majority of people living in these states support it — leaving more than 2 million uninsured Americans, including more than 600,000 Latinos, in a coverage gap with no real option for affordable, quality health coverage.
There’s a lot at stake here, especially for Latinos. A large share of the Latino population is concentrated in states that refuse to expand Medicaid — particularly Texas and Florida. Nearly 30 percent of people in the coverage gap are Latino, including 420,000 in Texas alone, and the number of uninsured Latino parents and children continues to rise, particularly in non-expansion states. In addition, the COVID-19 pandemic exposed the shortcomings of our health system and disproportionately impacted Latinos, making them more than twice as likely to be hospitalized or die from COVID-19 as non-Hispanic whites.
The reconciliation package now up for debate provides a critical opportunity for policymakers to close this gap. The disproportionate adverse effect of the pandemic on Latinos, many of whom are essential workers keeping the economy afloat, has made it imperative that equity is at the center of any additional federal investments in our health system.
Closing the gap requires a meaningful, permanent alternative to the quality coverage available through Medicaid. Any short-term solution, as is currently being considered, would be too difficult to set up quickly and could expire before achieving its goals. Any new policy should also eliminate premiums for low-income individuals and families and control costs for those covered.
Congress should also allow year-round enrollment, to ensure that people can access coverage when they need it. Just this summer, the Biden administration recognized the importance of ongoing enrollment, and any alternative to Medicaid expansion should follow this example.
Whether done transitionally through the Marketplace, or by long-term enrollment through a federal Medicaid alternative, it’s important that nothing is left on the cutting room floor that would be needed to successfully integrate uninsured Americans into the health system. Navigating the health care system can be complex, and Latinos are more likely than others to seek out assistance enrolling in new coverage.
With a new federal option in place, Latinos would represent nearly a third of newly eligible individuals and should receive a proportional investment towards educating and facilitating enrollment. The creation of any federal program will also require sufficient resources for states and the Department of Health and Human Services to facilitate coordination between a new federal coverage option and state-administered public benefits and services.
But even a well-designed federal alternative to Medicaid expansion may never be a perfect substitute for the ACA’s original vision. Congress should further incentivize state adoption by restoring the full federal share of the costs associated with Medicaid expansion for late-adopting states.
When the COVID-19 federal emergency declaration expires, hundreds of thousands of individuals already enrolled in Medicaid could be at risk of losing coverage when states revert to pre-pandemic Medicaid eligibility rules. Congress and the White House have reached a critical crossroads with respect to health equity. One road could see a continuation of dramatic declines in life expectancy for all low-income Americans, including Latino and Black households. Another road could help advance the original vision of the ACA and make a meaningful contribution to health equity. Congress cannot miss this opportunity to close the Medicaid coverage gap.
Matthew Snider is a senior health policy analyst at UnidosUS, formerly the National Council of La Raza, a Latino civil rights and advocacy organization.