The COVID-19 pandemic has both underscored and exacerbated Black Americans’ health disparities across the United States. While this pattern has garnered national attention, West Virginia has been less successful in identifying and quantifying similar patterns, in part because Black West Virginians comprise less than 4 percent of the population, or roughly 64,500 people — well below the national average of 13 percent.
However, the most recent data from before the pandemic indicates longstanding inequities, with 10.1 percent of Black West Virginians uninsured, compared to just 8.1 percent of their white counterparts. This discrepancy means Black residents are more vulnerable to the virus and health inequities as health care remains out of reach.
In several counties, including Boone, Marshall, and Wyoming Counties, the uninsured rate for Black residents exceeded 20 percent. Experimental data from the US Census Bureau’s Household Pulse Survey estimates that West Virginia’s statewide Black uninsured rate has jumped to approximately 16 percent over the course of the public health crisis. Addressing the gap between Black and white insurance rates benefits not only Black West Virginians, but everyone, ensuring wellness through the pandemic and beyond.
A 10 percent average rate of uninsured non-elderly Black West Virginians represents about 4,700 people. Despite being relatively high, Black uninsured rates remain lower than in the years before the Affordable Care Act’s (ACA) implementation, which occurred between 2010 and 2014, as well as West Virginia’s 2014 Medicaid expansion. The ACA included measures that proved critical to West Virginia, which has the highest proportion of non-elderly individuals with pre-existing conditions in the country. Benefits include protecting people with certain pre-existing conditions, allowing young adults to stay on their parents’ insurance until they turn 26, eliminating lifetime limits on insurance coverage, and more. The Medicaid expansion increased the number of people eligible up to 138 percent of the Federal Poverty Line. Both the original ACA implementation and West Virginia’s Medicaid expansion allowed more people to receive affordable health insurance coverage.
Medicaid has been of particular importance for Black West Virginians. Representing about 3.6 percent of West Virginia’s population, Black individuals comprise 5 percent of overall Medicaid recipients. Nearly half of Black individuals in West Virginia receive Medicaid, compared with under one-third of white individuals. Furthermore, they are less likely to have private insurance, typically provided by employers or subsidized by the individual exchange marketplace, than white West Virginians.
These data indicate a couple phenomena: first, Black West Virginians, overrepresented in Medicaid coverage despite overall lower health insurance rates, have less income than their white counterparts. Recent data found that the racial income gap equaled 27 percent, or $7,151, in 2018. Observing the gap between private insurance coverage reinforces this notion, indicating that Black West Virginians are also less likely to work in jobs that offer private insurance. The second implication is that existing health policy, including Medicaid, has yet to address race-driven disparities. One study found stigma to be a notable factor driving down insurance coverage rates — and interactions with the healthcare system — among populations of color.
These data provide insights that West Virginia can use to execute policies that will benefit Black West Virginians, as well as the rest of the population. Addressing the racial income gap can reduce the number of uninsured Black West Virginians. Increasing the minimum wage would benefit several thousand workers in the state, especially Black workers. More directly, removing barriers to coverage requires robust investigation, and the state should not only collect but publish data on subpopulations to better inform advocates. Raising public awareness has also proven useful to increase health care enrollment and can potentially address stigma, too. Making programs more affordable through increased subsidies, a public option, and other means will increase the number of insured Black West Virginians.
