Why blacks will suffer the most from Republicans' Obamacare opposition

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A New York Times analysis today showed that more than 60 percent of African-Americans live in states that will not expand Medicaid under “Obamacare,” meaning that tens of thousands of low-income blacks will not benefit from the new health care law.

Twenty-six states, including nearly all of the South, where a disproportionate number of blacks live, are opting against expanding Medicaid to all of their low-income residents, as the law originally called for. (A Supreme Court decision last year allowed states to opt out of the Medicaid program if they like.) What that means is that the poorest people in these states, particularly low-income childless adults, won’t be eligible for Medicaid under the law and also can’t get the subsidized health insurance that Obamacare offers for people with higher incomes.

This coverage gap will affect more than eight million Americans, including two-thirds of poor blacks, according to the Times data.

“A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance,” the Times concluded.

Obama administration officials have urged these states to reconsider this decision. But some states in the South argue it will cost their governments too much money, since they will eventually have to pay about 10 percent of the bill for these new Medicaid recipients. (The federal government will pay the rest.) But 25 of the 26 states have Republican governors,  illustrating the political and ideological element of these decisions to reject Medicaid spending. Texas Gov. Rick Perry has been among the Republicans who have said he opposes expanding Medicaid on principle, while other Republican governors have adopted this position under political pressure from conservatives in their states.

Earlier this year, Kathleen Sebelius, head of the Department of Health and Human Services, argued that these Republicans governors would cave eventually, under pressure from doctors and hospitals in their states.

“It not only would bring more people into the health care system, but it would dramatically reduce unpaid medical costs,” Sebelius told USA Today.

But her confidence ignored the intensity of conservative opposition to the overall health care law. Declining the Medicaid expansion has become one of the easiest ways for conservatives to express their discontent with Obamacare and also a way to position themselves for a potential presidential run or avoid a Republican primary for re-election as governor.

Of the Republican governors who have said they will participate in the Medicaid program, nearly all are from states Obama won in 2012. And even getting the governor’s support is often not enough: after Florida Gov. Rick Scott, a Republican, suggested he would accept the Medicaid money, Republican state legislators there blocked him from doing so.

To be sure, millions of blacks live in places like California and New York that are embracing the health care law. But the center of the Republican Party, and therefore opposition to Obamacare, is the South. And there, a band of states with large black populations is opposing the law and its Medicaid expansion: Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee and Texas.

In Mississippi, for example, more than 180,000 people of all races would gain insurance under the Medicaid provision of the law, according to the Urban Institute. Thirty-seven percent of the people in Mississippi are black. African-Americans are disproportionately low income. So it’s likely upwards of 90,000 blacks in that state alone are being denied insurance, although the states have not released these figures.