October 11, 2023  – As our nation grapples with historical disparities, a recent study in Health Affairs has shown that Medicaid expansion could play a pivotal role in rectifying health inequities in historically redlined districts.

Historically, redlined districts, deemed “hazardous” based on the Home Owners’ Loan Corporation grading system from the 1930s, were deprived of investments due to the presence of non-White, lower-income residents. Such discrimination, which persisted till the late 1960s, resulted in economic disparities rooted in race and class that resonate even today. These areas, unfortunately, are characterized by lower homeownership rates, restricted healthcare access, suboptimal health outcomes, and elevated mortality rates.

The study accentuates the significance of understanding health disparities on not just the individual level but also considering the overarching context or community dynamics and how they are intertwined with various forms of racial discrimination.

The research team tapped into the American Community Survey (ACS) data spanning from 2009-2013 and 2015-2019. This was complemented by Medicaid expansion data from KFF and redlined appraisal records from the Mapping Inequality initiative.

From a pool of over 11,640 census tracts that the study analyzed, a notable division emerged between regions that experienced Medicaid expansion and those that didn’t. Before Medicaid’s expansion in 2014, districts with a prominent history of redlining observed higher rates of uninsurance. This landscape, however, underwent a notable transformation post-expansion.

Following the expansion, a significant decline in uninsurance rates was witnessed in redlined areas of both categories—expansion and non-expansion states. For areas with the most historical redlining in states that adopted Medicaid expansion, uninsurance plummeted by 6.2 percentage points.

One of the most notable observations from the research was the large difference in uninsurance decline between expansion and non-expansion states. Hispanic adults residing in the most redlined areas of expansion states saw the most dramatic reduction in uninsurance rates, 7.9 percentage points higher than their counterparts in non-expansion states.

While the study offers valuable insights, it also has its limitations. It couldn’t delve into the nuances of data within specific census tracts or extend its findings to certain districts, such as Washington, DC.

Researchers concluded that, “By reducing uninsurance rates in the most heavily redlined census tracts, Medicaid expansion may have helped reduce the burden of historical racial segregation. This benefit has not yet been realized in the most heavily redlined communities in nonexpansion states,” the researchers concluded. “The gap is especially detrimental for the pursuit of health equity in these states.”

Subsequent research underscores the transformative impact of Medicaid expansion on extending coverage and reducing uninsurance, particularly among marginalized demographics.

Read the full study from Health Affairs by clicking here.