Expiring Obamacare Subsidies Could Put Chiropractic Care Out of Reach for Black Minnesotans
As Affordable Care Act tax subsidies near expiration, health care providers warn that rising insurance costs could once again widen racial disparities in access to care. Chiropractic services, often used by Black patients for pain management and mobility, are among the services most at risk. Minnesota providers say the loss of subsidies could force thousands of Black residents to forgo care or turn to emergency rooms instead.
Racial disparities among Black Americans in the health care system are unfortunately not new. Still, the Affordable Care Act, known as Obamacare, has slowly tried to close the gap since its introduction in 2010. However, with the program’s tax subsidies set to expire at the end of this year, it threatens to significantly raise insurance premiums for Minnesotans, making certain health care out of reach for many.
One of the benefits that could be substantially affected is chiropractic care, which many Black patients use for pain management. It has historically been a “luxury” many couldn’t afford until Obamacare came into effect.
The tax subsidies, which will expire at the end of this year, were created in 2021 during the Covid-19 pandemic under former President Joe Biden. The subsidies were extended until the end of 2025, but Congress has yet to reach a deal to continue them into 2026.
Since the enactment of Obamacare and the additional subsidies in 2021, the number of uninsured Americans has slowly decreased, with the Minnesota Budget Project reporting that “Since February 2020 (just before the pandemic hit our state), the number of Minnesotans enrolled in Medicaid managed care has increased by over 19%.”
One branch of care that was made more accessible to Black patients was chiropractic care, often used for pain management, physical therapy, and more. The percentage of Americans seeking chiropractic care has increased significantly since the Affordable Care Act was introduced, rising from 15.8% in 2010 to 17.9% by 2018.
This same data shows a disparity between white and Black patients, with only 9.9% of Black patients seeking chiropractic care, compared to the national average. However, that gap will only grow when Obamacare’s tax subsidies expire.
“I think it’s gonna be a big barrier to a lot of patients, unfortunately,” said Dr. Jasmine Hanson of Pure Health Chiropractic, located in downtown Minneapolis. According to Hanson, while they see a diverse amount of patients, she says, “About 25-30%” are Black. The number of these patients has gone up in recent years, Dr. Hanson said, but now that her office has been told it can no longer accept Medicare, she fears many patients will lose care.
“It will affect a good portion of our patients, and it will affect patients of color. It would affect some white patients as well, but not as many,” Dr Hanson said. “The only recommendation that Medicare has given us is that they can ‘pay out of pocket.’ Of course, patients who are on Medicare can’t afford the health care, so they are not able to afford care.”
Dr. Hanson says of her Black patients, 25% of them are on Medicaid, which means at least a quarter of those patients would have to pay out of pocket come the new year.
From 2019 to 2023 alone, the number of uninsured Black Minnesotans has gone from 10% to 6.5%, with data showing that 41.9% of Black patients are insured through Medicaid. If the Obamacare subsidies were to expire in Congress, that would leave around 138,497 Black Minnesotans who rely on Medicaid unable to afford the out-of-pocket fees.
“We have some patients that we are the only resource they can easily get to, and so it’s gonna affect a lot of their pain, a lot of their mobility, and now there’s just gonna be a lot more of a barrier,” Dr. Hanson said.
While patients may still need to see an MD for physical therapy, which requires a referral, chiropractors in Minnesota are considered primary care providers, making the process easier. Chiropractors primarily focus on diagnosing and treating musculoskeletal and nervous system disorders and performing manual adjustments.
“I think a lot more patients will end up going to urgent care and the ER for pain issues,” Dr. Hanson said. “This could lead to more issues with hospitals becoming overbooked, and then it could lead to more patients being on pain medication because the ER or the urgent care isn’t really set up to manage pain or musculoskeletal issues like a chiropractor office is.”
Despite this threat looming over the heads of thousands of patients around the country, a deal still has not been reached, with the latest news being that lawmakers in the House want to introduce legislation for Republicans to vote on as early as next week, according to Deseret News. However, nothing concrete has been introduced yet.
“As a health care provider, we obviously go into this health care field to help people, and now we have to look at the people that I feel I get the most purpose from helping, and tell them ‘Oh, I can’t help you and there’s actually nowhere for you to go … I’m really dreading that conversation with patients,” Dr. Hanson said.
Izzy Canizares welcomes reader responses at icanizares@spokesman-recorder.com.