Guest Post: Bob Cohen, Policy Director at Public Policy and Education Fund and Citizen Action – New York, and Peter Scatena, Intern at Public Policy and Education Fund
The Affordable Care Act has resulted in the enrollment of an impressive 20 million people nationwide, but we still have a long way to end health disparities, according to a new report by the Alliance for a Just Society (AJS), a national advocacy organization.
The report, Breaking Barriers: Improving Health Insurance Enrollment and Access to Health Care, based on a year-long survey of over a thousand low-income Americans in ten states (New York is not included), found numerous obstacles to enrollment of racial minorities and rural residents. The largest of these obstacles is the failure of four of the ten states in the study to expand Medicaid, an important ACA provision. In the four states that expanded Medicaid there was a 4.1% decline in the number of uninsured residents, as compared with 2.9% for the six non-expansion states. The report found other obstacles to enrollment for low-income communities and communities of color, including cost, technology, language barriers, and difficulty understanding their new coverage.
While New York is doing well in enrollment compared to some states, this report has some lessons for our state. Medicaid enrollment is a plus in New York: within the first two years of the NY State of Health’s implementation, more than 1.5 million New Yorkers have enrolled in Medicaid, in part due to the state’s decision to expand Medicaid. While it’s hard to make definitive conclusions about enrollment disparities based on race, as roughly one-quarter of applicants to NY State of Health opted not to state their race and demographic data is only available for the first year of enrollment, here too, the available data is positive: 15% of New Yorkers are African-American and 15% of those newly enrolled stated indicated they were African-American. However, areas of concern remain in New York. Those reporting that their preferred written language was Korean, Russian, French, French Creole, or Italian were almost completely absent from those enrolled in the first year, despite the fact that substantial numbers of New Yorkers speak these languages.
As in the states covered by the Breaking Barriers report, New York also places barriers on enrollment for those whose language is not English. To this day, the NY State of Health web page only is translated into Spanish. And certainly, New Yorkers who are low-income, immigrants, and live in rural areas also face barriers like lack of equal access to the Internet and gaps in their understanding of health coverage, as do their counterparts in other states. Some of the solutions to addressing health disparities in New York were outlined in a report issued last year by the Public Policy and Education Fund, AJS and Make the Road New York.