The “Undeserving Poor,” Racial Bias, and Medicaid Coverage of African Americans

Abstract

The Affordable Care Act’s Medicaid expansion increased coverage especially for the “undeserving poor”—nondisabled, nonelderly adults, who disproportionately are African American. However, African Americans benefited comparably less than other groups from Medicaid expansion because they disproportionately reside in states that rejected Medicaid expansion. Psychological and other social science research establishes that disapproval of providing “welfare” to “undeserving poor” is closely aligned with racial bias, and that these sentiments partly motivate public disapproval of policies such as Medicaid for nondisabled, nonelderly adults. It is important to clarify and acknowledge this barrier for a realistic perspective on obstacles to keeping and expanding Medicaid coverage.