The Limits of the Affordable Care Act and the Impact on Minorities

By: Chris Pine
Blog Category: Race & Healthcare

State refusals to expand Medicaid through the Affordable Care Act leaves millions without coverage, particularly African-Americans. The Supreme Court’s decision to strike down the ACA’s mandatory Medicaid expansion has left the question of expansion up to the states.  To encourage expansion, the federal government will carry the entire cost of each state’s Medicaid expansion for the first three years.  After 2016, the federal government will continue to cover a minimum of 90% of the costs.

Nonetheless, 26 states have declined to expand Medicaid coverage.  Some of these states have prohibited Medicaid expansion without first gaining legislative approval.  Others have delayed a decision by tasking committees to further study the impact of expansion on their state.  In Maine, the governor vetoed Medicaid expansion. Republican governors and GOP controlled legislatures have been the common denominator among anti-expansion states.

The result is that many poor will find themselves in the void between those who qualify under that state’s current Medicaid standards and those in higher income brackets, who qualify for subsidies.  A disproportionate number of African-Americans will find themselves in this no-man’s-land of ineligibility.  This particularly the case in the Deep South, in states like Mississippi, Alabama, and Georgia, with Arkansas as the loan exception.

The opinions expressed herein are strictly those of the author and do not necessarily reflect the opinions of the Widener Journal of Law, Economics & Race.


Sabrina Tavernise & Robert Gebeloff, Millions of Poor Are Left Uncovered by Health Law, New York Times (Oct. 2, 2013), available at

Status of State Action on the Medicaid Expansion Decision, as of September 30, 2013, The Henry J. Kaiser Family Foundation (Oct. 10, 2013),

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