The Ongoing Racial Paradox of the Medicaid Program

Executive Summary

This article originally appeared in the May edition of the Journal of Health and Life Sciences Law, published by the American Health Law Association 

Medicaid, the largest public health insurance program for low-income people, has since 1965 extended health coverage to millions of people, including people of color. At the same time, it has perpetuated disparities based on race. Central in the paradox of Medicaid is that racism is “baked into the program,” yet it has transformed opportunities for health care and decreased racial disparities in coverage and access. It includes features that, with attention and creativity, can make significant contributions to reducing inequities in the health care system.

In this article, Jane Perkins and Sarah Somers review Medicaid’s history, from its birth during the civil rights era to the present day, including the significant changes wrought by the Affordable Care Act. Most notably, this includes the Medicaid expansion that has brought coverage for the first time to millions of adults, many of those people of color. They discuss the racism woven through its history and the ways in which the program has perpetuated racial inequity. Finally, they conclude by describing Medicaid’s potential to address systemic racism in health care, including innovations in care delivery and management, and full implementation of the expansion.

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