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How a repeal of the ACA will affect Blacks, health

GLENN ELLIS | 1/9/2017, 9:02 a.m.
Racism has historically had a significant, negative impact on the health care of Blacks and other people of color in ...
Earl Charles Williams Sr., 59, talks about the medication he must take for his diabetes. He was uninsured for about a year before signing up for care under the Affordable Care Act. Christian K. Lee

Strategies for Well-Being

Racism has historically had a significant, negative impact on the health care of Blacks and other people of color in the United States. The Affordable Care Act is truly the first time that African Americans have, collectively, had significant access to health care. It is noteworthy that America’s first African American president is chiefly responsible for this access.

Improved access to care; Medicaid expansion; prevention medicine; and lifting of barriers for pre-existing conditions are all aspects of the ACA that have been of great benefit to Blacks. But there is a thick air of uncertainty on the horizon.

In a few weeks, Donald John Trump will become the 45th president of the United States.

It is unclear how quickly, or when, Trump’s vow to repeal and replace Obamacare will play out. But make no mistake, just like the adage, “When White folks catch a cold, Black folks get pneumonia,” a repeal of the ACA would disproportionately hurt Blacks.

Republicans in Congress have put out their plans: to repeal most of the ACA without replacing it; doubling the number of uninsured people – from roughly 29 million to 59 million – and leave the nation with an even higher uninsured rate than before the ACA.

Let me point out a few ways that Blacks have specifically benefitted from the ACA. Given the low incomes of uninsured Blacks, nearly all [94 percent] are in the income range to qualify for the Medicaid expansion or premium tax credits. Nearly two thirds [62 percent] of uninsured Blacks have incomes at or below the Medicaid expansion limit, while an additional 31 percent are income-eligible for tax subsidies to help cover the cost of buying health insurance through the exchange marketplaces. Under the new law, insurance companies are banned from denying coverage because of a pre-existing condition, such as cancer and having been pregnant.

Importantly, for people living with HIV, there are also new protections in the law that make access to health coverage more equitable, including the expansion of Medicaid and in the private market, a prohibition on rate-setting tied to health status, elimination of preexisting condition exclusions and an end to lifetime and annual caps. The passage of the ACA in March 2010 provided new opportunities for expanding health care access, prevention, and treatment services for millions of people in the U.S., including many people with, or at risk for, HIV.

Safety net hospitals play a critical role in the nation’s health care system by serving low-income, uninsured and medically and socially vulnerable patients regardless of their ability to pay. Also, in agreeing to lower payments, hospitals in the 31 states that expanded Medicaid under the law have made up that revenue in part through the Medicaid expansion.

These places are critical to the health of Black communities and those living in the poorest neighborhoods. They have been among the loudest voices against repeal of the health law, as they could lose billions if the 20 million people lose the insurance they gained under the law. This could bring about widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.