Bubbling Up

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It took more than a decade of work from countless organizations and dedicated individuals to make it a reality, but on July 22, the Missouri Supreme Court reaffirmed the will of the state’s voters by unanimously declaring that Medicaid expansion is the law of the land. Having only moved to Missouri and joined the Foundation in May, I made it just in time to see this amazing culmination of so much effort. Those who are newly eligible can’t enroll just yet, but it will happen, and soon*. When it does, an estimated 275,000 Missourians will gain access to affordable, quality health care and the state will see numerous economic benefits; truly a win-win for our region.

(*Editor’s Note: A judge ruled today that Medicaid expansion must move forward immediately.)

It is my hope that the remaining 12 states who have yet to expand Medicaid are ready to show up and remain steadfast in their fight toward achieving health equity, because ultimately, that’s what this is about – health equity and racial equity.

Now is the time to move forward with Medicaid expansion throughout the country. Now is the time to move further toward more equitable health care systems. And while we know that this is just one stop on America’s health equity journey, expansion needs to be realized if we’re serious about creating a more just, vibrant future.

We know that the effects of structural racism, racial discrimination, and chronic exposure to racism negatively affects health outcomes. We also know that people who feel that they will be discriminated against are less likely to seek out health care services. Further, the history of racism in our country has led to other health-related disparities, including Black and Latino Americans experiencing much higher rates of uninsurance when compared to whites. In fact, before the implementation of the Affordable Care Act, 33% of Latinos and 20% of Black Americans were uninsured, compared to 12.5% of white Americans. In the 38 states (and the District of Columbia) that have implemented expansion, the data clearly show that this disparity in insurance coverage among people of color is drastically reduced. We are confident that we will see the same impact in Missouri as expansion moves forward.

The big picture says a lot. Expanding Medicaid in the remaining states would provide coverage for about 2.2 million lower-income people, the vast majority of whom are working full time, but either can’t afford or are not offered insurance through their employer. Those without insurance in these 12 states are disproportionately people of color, including 28% who are Black and 28% who are Latino. Medicaid coverage in these states would be a huge step toward a more racially unbiased system of insurance coverage.

We could point to just about any health challenge we’ve faced in recent years, including the opioid epidemic and increases in behavioral health conditions, and make a case for righting the massive inequities in health care access. COVID-19 simply made these disparities more real for all of us who struggled to recognize the faulty systems that Black and Brown communities have long been made to rely on and navigate through, while also remaining oppressed. COVID came hard and fast, and for many communities of color, just being Black, Latino, or Indigenous proved to be a preexisting condition for infections and the economic downturn tied to the pandemic. The loss of jobs due to COVID hit Black and Brown folks the hardest, and for many of those that reside in non-Medicaid expansion states, there is no health coverage available.

Now is the time to move forward with Medicaid expansion throughout the country. Now is the time to move further toward more equitable health care systems. And while we know that this is just one stop on America’s health equity journey, expansion needs to be realized if we’re serious about creating a more just, vibrant future.

The U.S. Constitution was established on the belief that all people were created equal and afforded the rights of life, liberty, and the pursuit of happiness. Those rights mean nothing if certain Americans are being denied health and well-being. Medicaid expansion is about racial equity! We hope the remaining 12 states are inspired by Missouri’s efforts to expand Medicaid through a vote, just as we were watching the wins of those 38 states before us.