Threats to Obamacare could deal a new blow to communities of color that have been disproportionately ravaged by the coronavirus pandemic as the nation is reckoning with generations of inequity.
The Affordable Care Act’s insurance subsidies, its expansions of Medicaid eligibility and its protections for preexisting conditions have especially helped Americans of color, narrowing historic disparities in access to health insurance and affordable care. The coverage gains are among the most significant since the passage of Medicare and Medicaid and the desegregation of American hospitals more than 50 years ago.
Now, President Donald Trump is again threatening to replace the law if he’s reelected. And exactly one week after the election, the Supreme Court, with its new 6-3 conservative majority, will hear oral arguments in a case brought by conservative states seeking to overturn the entire Affordable Care Act. If the law is dismantled, the communities it aided the most stand to lose the most.
“Health care could be ripped away from millions and the numbers of uninsured Americans of color could skyrocket—aggravating the health care disparities that already exist in this country,” said Sen. Tammy Duckworth (D-Ill.). “It’s especially infuriating that this is happening in the middle of a deadly pandemic that is disproportionately devastating so many seniors, Black, Brown and Native Americans and those with pre-existing conditions.”
Between 2013, the year before the Obamacare markets opened and Medicaid expansion began, and 2018, the rate of Latinx adults without health insurance plummeted from 40 percent to 25. The uninsured rate for Black adults fell from 24 percent to 14. For white adults, it dropped from 15 percent to 9, according to the Commonwealth Fund.
“There is no doubt that the Affordable Care Act, though it left millions uninsured, narrowed the racial gap in health insurance coverage and that’s a good thing,” said Mary Bassett, the former New York City health commissioner who is now a professor at Harvard’s School of Public Health. “Having millions suddenly lose their health insurance seems very likely to have an adverse impact.”
If the health law disappeared, the Urban Institute estimated that the gaps would widen once again, almost back to 2013 levels. And that assessment was in 2019 — before the devastation wrought by the coronavirus which is exacerbating inequality, in both health and the economy overall.
Especially affected would be people of color living in one of the 38 states that expanded Medicaid, the joint federal-state health program for low-income people. Without health coverage, many would lose access to much-needed care for chronic health conditions — and become more vulnerable to serious complications from Covid-19.
Trump says he wants a health system that will give people more choice, at less cost. “It’s in court, because Obamacare is no good,” he said at his second and last debate with Democratic challenger Joe Biden.
Even the Affordable Care Act’s backers admit it was not a panacea. Health inequities, some driven by generations of systemic racism, persist. Private insurance remains out of reach