Minorities make up nearly three-quarters of the uninsured adults in the “coverage gap” created when Texas declined to expand Medicaid eligibility under the Affordable Care Act, according to new reports released Tuesday by the Kaiser Family Foundation.

Hispanics make up the largest uninsured minority group in the coverage gap, accounting for more than half of Texas’ 1 million uninsured adults in the gap — the highest total in the country among states that chose not to expand Medicaid.

“These continued coverage gaps and their varied impacts across groups will result in millions of poor adults remaining uninsured and likely lead to widening racial and ethnic as well as geographic disparities in coverage and access to care,” one of the two new Kaiser Family Foundation reports states.

In addition to requiring that most individuals purchase health insurance, the ACA required all states to expand Medicaid coverage to adults with incomes less than 138 percent of the federal poverty line — $15,856 for an individual or $32,499 for a family of four. But the U.S. Supreme Court ruled that provision unconstitutional, creating the coverage gap consisting of individuals who make too much money to qualify for Medicaid but not enough to qualify for tax credits to purchase coverage through state or federal health insurance marketplaces.

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In states that have approved Medicaid expansion and have a large Hispanic population, uninsured Hispanic adults are less likely to fall into the coverage gap, according to one of the Kaiser reports. Texas is among the 23 states that chose not to expand Medicaid eligibility under the Affordable Care Act, which is commonly known as Obamacare.

More than a fifth of all people in the coverage gap live in Texas. Additionally, 59 percent of the nation’s 1 million uninsured Hispanic adults in the coverage gap reside in Texas.

In other states that opted not to expand Medicaid, particularly in the South, uninsured black adults make up the minority group more likely to be left without a new health coverage option, according to the Kaiser reports. But in Texas, uninsured black adults only make up 15 percent of the state’s uninsured adults who fall in the coverage gap.

Still, 12 percent of the nation’s 1.3 million uninsured black adults in the coverage gap live in Texas.

Overall, Texas has the highest rate of uninsured individuals, with nearly a quarter of the population living without health insurance, according to census data.

According to the Kaiser reports, states that chose to not expand Medicaid are hindering efforts to address long-standing disparities in health coverage rates and outcomes among minorities that the expansion could significantly improve.

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“Last, the population in the coverage gap shows that, as a result of state decisions not to expand their Medicaid programs, many remaining uninsured under the ACA will reflect the legacy of the system linking Medicaid coverage to only certain categories of people,” one of the reports states. “The ACA Medicaid expansion was designed to end categorical eligibility for Medicaid, but in states not implementing the expansion, the vestiges of categorical eligibility will remain."

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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