Racial Bias and Medicaid Spending


Since 1965, all states and the District of Columbia have offered Medicaid, a government program designed to ensure that low-income individuals have access to healthcare. 

Though providing healthcare would seemingly be something most people could get behind, Medicaid is highly politicized. Opponents of the program point to reliance on the government and wastefulness. The criticisms are intensified because of Medicaid’s association with the opioid crisis and suggestions of rampant false claims. 

As a result, there is considerable state-level variability in Medicaid expenditures, especially when it comes to disability-related spending. 

Recently, Jordan Leitner, of Cal-Berkeley, and his colleagues examined the role of racial bias in state-level Medicaid spending. The authors note that Blacks disproportionately benefit from Medicaid; thus, efforts to cut that spending could be related, at least partially, to state-level racial bias. 

To examine this possibility, they analyzed the responses from over 1.76 million people. The participants completed information about their explicit racial bias, or that bias which is deliberately maintained, and their implicit bias, or unconscious bias that is expressed by some otherwise well-meaning individuals. 

The researchers also took into account other factors that could influence the results, such as income levels, conservatism, and so on. 

Results indicate that as racial bias increased, that state’s spending per disabled Medicaid enrollee decreased. This was true for both implicit and explicit racial bias.

Income and political attitudes also influenced the relationship.  The researchers noted, “the results suggest that racial bias might play a role in Medicaid disability expenditures in places where Whites have lower economic advantage or there is a culture of conservatism.”