Eligible Uninsured African Americans: 6 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid or CHIP

ASPE ISSUE BRIEF

By: Emily R. Gee

Abstract

Approximately 6 in 10 eligible uninsured African Americans in the United States could obtain Health Insurance Marketplace tax credits, Medicaid, or the Children’s Health Insurance Program (CHIP). This ASPE Issue Brief discusses the demographics of the eligible uninsured African American population and new health insurance coverage options available to them under the Affordable Care Act. There are 6.8 million eligible uninsured African Americans nationwide, according to data from the 2011 American Community Survey Public Use Microdata Sample, and one-sixth of all eligible uninsured in the United States are African American. Under the Affordable Care Act, 2.2 million uninsured African Americans may be eligible for Marketplace tax credits and 2 million for Medicaid or CHIP coverage.

Under the Affordable Care Act, 6.8 million eligible uninsured African Americans will have access to new options for health care coverage starting January 1, 2014.¹ Six in ten, or 4.2 million, of these eligible uninsured African Americans may qualify either for tax credits to purchase coverage in the Health Insurance Marketplace (2.2 million) or for Medicaid or the Children’s Health Insurance Program (CHIP) (2.0 million). If all states were to expand Medicaid, 95 percent of all eligible uninsured African Americans would be eligible for Marketplace tax credits, Medicaid, or CHIP.

Of the 41.3 million uninsured nonelderly U.S. citizens and others lawfully residing in the United States (a group referred to as “eligible uninsured” in this brief), 6.8 million people or one in six (16 percent) are African American. African Americans are uninsured at a higher rate than the U.S. population overall; 16 percent of all nonelderly U.S. citizens and others lawfully residing are uninsured, while the comparable proportion among eligible African Americans is 20 percent.

Location — The five states with the greatest number of eligible uninsured African Americans are:

• Florida                       677,000 (10 percent of all eligible uninsured African Americans),
• Georgia                      631,000 (9 percent),
• Texas                          617,000 (9 percent),
• North Carolina           380,000 (6 percent), and
• New York                   354,000 (5 percent).

The greater Atlanta, New York, Chicago, Dallas, Houston, and Detroit metropolitan areas are home to one-fifth (21 percent) of eligible uninsured African Americans (see Table 4). Approximately 15 percent of eligible uninsured African Americans live outside a metropolitan area, a lower proportion than among the eligible uninsured population overall (19 percent).

Gender — More men than women are uninsured in the United States. This is also the case for African Americans. Among eligible uninsured African Americans, less than half, or 44 percent (3.0 million) are women.

Age — Young adults are a disproportionately large share of the uninsured relative to their share of the general population. They are the age group most likely to be without health insurance coverage in the U.S.² The same is true among young African Americans: young adults ages 18 to 35 account for nearly half (3.2 million; 47 percent) of the African American eligible uninsured but only 30 percent of the eligible African American population overall. Of the 3.2 million eligible uninsured African Americans ages 18 to 35, 1.3 million (41 percent) are women and 1.9 million (59 percent) are men.

Employment — Most (73 percent) of eligible uninsured Americans live in households with at least one full-time worker. Similarly, six in ten (61 percent) eligible uninsured African Americans have at least one full-time worker in the family.

Education — About one-fifth (19 percent) of eligible uninsured African Americans did not earn a high school diploma, 71 percent have a high school diploma, and an additional 9 percent hold a college degree. Among all eligible uninsured Americans nationwide (41.3 million), 20 percent do not have a high school diploma, 68 percent have a high school diploma, and 12 percent hold a college degree.

Language — Nearly all (97 percent) of eligible uninsured African Americans report that they speak English as a first language or at least “very well” as a second language. Among those who do not, the most common language is French Creole, which is spoken by 1 percent of eligible uninsured African Americans.

Income — More than half (3.8 million; 55 percent) of all eligible uninsured African Americans have family incomes³ below 100 percent of the Federal Poverty Level (FPL), and nearly two-thirds of these people (2.4 million) live in states that are not expanding Medicaid. This means that more than one in three eligible uninsured African Americans may not gain access to affordable coverage through Medicaid in 2014 because their state declined to take the federally funded option to expand Medicaid eligibility.

Approximately 4.4 million eligible uninsured African Americans have family incomes at or below 138 percent of the FPL, the threshold for qualifying for Medicaid in expansion states. Of these 4.4 million, 1.5 million live in Medicaid expansion states.⁴