Politics, Pandemic, and Racial Justice Through the Lens of Medicaid

Michener, Jamila

doi:10.2105/ajph.2020.306126

Cited by 22 publications

(21 citation statements)

References 11 publications

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“…Medicaid is at a crossroads in fulfilling its mandate to insure large populations amid conflicting fiscal and political pressures. The COVID-19 pandemic and racial justice movements spurred initiatives to reduce racial and ethnic disparities in Medicaid . Race has been a central factor shaping the design, implementation, and outcomes of the Medicaid program .…”

Section: Introductionmentioning

confidence: 99%

The US Medicaid Program

Donohue

Cole

James³

et al. 2022

JAMA

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ImportanceMedicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending.ObjectiveTo describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity.Evidence ReviewAnalyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included.FindingsMedicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity.Conclusions and RelevanceMedicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.

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Section: Introductionmentioning

confidence: 99%

The US Medicaid Program

Donohue

Cole

James³

et al. 2022

JAMA

Self Cite

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“…For example, scholars who study immigration have identified critical linkages between politics, processes of racialization, and health (Kline 2019;LeBrón et al 2018;Lopez 2019;Pedraza 2018a, 2018b;Pedraza, Cruz Nichols, and LeBrón 2017;Novak, Geronimus, and Martinez-Cardoso 2017;Young, Beltrán-Sánchez, and Wallace 2020). Similarly, a small but burgeoning literature on Medicaid policy has amplified the tripartite significance of racism, health and politics in that arena (Franklin 2017;Grogan and Park 2017;Quadagno 2016, 2021;Leitner, Hehman, and Snowden 2018;Michener 2018Michener , 2020Michener , 2021Snowden and Graaf 2019).…”

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confidence: 99%

Racism, Health, and Politics: Advancing Interdisciplinary Knowledge

Michener

LeBrón

2021

Journal of Health Politics, Policy and Law

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Racism and health predominated political agendas across (and beyond) the United States in the spring of 2020. The simultaneous calamities of the COVID-19 pandemic and the murder of George Floyd by a police officer underscored the urgency and interconnectedness of racism and health. Even as COVID-19 was disproportionately devastating Black, Latina/o/x/e, Pacific Islander, and Native communities, people across the United States were participating in massive, historic protests against racialized state violence (

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“…28,29 Jamila Michener writes: "Medicaid is racialized, despite being facially colorblind, because race has been a central factor in shaping policies, discourse, design, implementation, and perceptions of it." 30 Thus, an antiracist-not a color-blind-approach to payment reform is imperative for meaningful change.…”

Section: Implementing Antiracist Payment Reformmentioning

confidence: 99%

What Should Antiracist Payment Reform Look Like?

Singletary

Chin

2023

AMA Journal of Ethics

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Racism reduces eligibility for health insurance and access to high-quality care for people of color in the United States, and current payment structures exacerbate the resultant de facto racial segregation. Payers and health plans do not adequately support and incentivize clinicians and health care delivery organizations to meet the health needs of minoritized communities. This article describes foundational work needed to create an antiracist culture of equity; the Roadmap to Advance Health Equity; and specific, actionable antiracist payment reform strategies, including increasing access to and the scope of health insurance coverage, antiracism accountability in managed-care contracts, support for the safety-net system, strengthened nonprofit hospital tax status requirements, and payment incentives to advance health equity. Antiracist payment reforms have great potential to desegregate health care systems and to ensure that everyone has a fair opportunity to receive good health services and optimize their health.

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Politics, Pandemic, and Racial Justice Through the Lens of Medicaid

Cited by 22 publications

References 11 publications

The US Medicaid Program

The US Medicaid Program

Racism, Health, and Politics: Advancing Interdisciplinary Knowledge

What Should Antiracist Payment Reform Look Like?

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