Who's getting a bigger piece of the pie?: Simulating health policy outcomes for the African-American uninsured

Background: The current proposals for expanded health insurance coverage raise difficult questions of distributive equity across populations. The effects of the proposals, i.e. public health insurance expansions, non-group credits, and incentives to increase employer-provided insurance, on minority populations are of particular interest given the disproportionately large percentage of minority uninsured. Methods: I decompose the uninsured African-American population and contrast it with the non-Hispanic white population, using data from the 2007 Current Population Survey. The numbers of the uninsured in the two populations are compared across family income, income-to-poverty ratio, and work status. I apply Gruber's 2008 micro-simulation of the effects of the three aforementioned policies specifically to the African-American population, and calculate the total number of beneficiaries from each policy. Results: If public health insurance is expanded to cover everyone up to 100% of the poverty threshold, all of the uninsured below this threshold, including 2.4 million African-Americans, would become newly insured. If income-tiered non-group tax credits are offered to families making less than $60,000 per year, 1.9 million African-Americans will receive these benefits, with those between 100 and 200% of poverty receiving 45% of federal benefits and those below 100% of poverty receiving 27% of benefits. Increasing employer-provided insurance will result in potentially 3.2 million newly insured African-Americans. Conclusions: The different policies proposed have varying impacts on the both different racial groups as well as groups with different work status and income levels. Public policymakers should understand these varying redistributive implications when crafting a health policy to expand coverage.