REPORTS

The State of Healthcare Access in Black America

The national health care debate that has unfolded in Washington D.C. has generated anxiety from one end of America to the other. Thus far, efforts to repeal and/or replace the Affordable Care Act have foundered on Capitol Hill, and Senate and House leaders have moved on to the other issues. But the threat to the ACA – and to the program's vision of universal health coverage – is not over. The peril facing the ACA is only dormant and almost certain to return. Indeed, the Trump Administration, regardless of whether Congress takes action or not, has the potential to severely weaken the insurance market through regulatory decisions, effectively undermining the ACA even if the repeal of Obamacare lacks the votes in Congress

Of all racial and ethnic groups in the United States, none has benefited from the ACA more than Black America. The proportion of Black Americans without health insurance has been cut almost in half as a result of the ACA, and the insurance coverage gap between Black and white Americans, once yawning, has been radically reduced. The ACA is helping continue and quicken the reduction in disparities in life expectancy between Black and white Americans. As a result of expanded access to care under the ACA, Black America now has the means to more effectively manage health problems that have disproportionately affected Black communities, such as HIV, hypertension, certain cancers, diabetes and infant mortality. The ACA represents an important step in our country's still-incomplete journey towards the vision of equal opportunity for all enshrined in our Constitution.

This report speaks to Black America. It encourages vigilance in the face of continuing threats to the ACA. The voices of diverse communities – so pivotal thus far in the fight to save the ACA – need to be amplified in the coming months. And as the Trump Administration's ambivalence about the ACA diminishes the efforts of the federal government to attract new ACA enrollees, Black communities need to step into the breach, educating fellow community members about health coverage available under the ACA and developing community-centered strategies to facilitate enrollment.

But the failure thus far of ACA repeal efforts also presents critical new opportunities, and this report addresses these as well. In particular, states that have thus far refused to expand Medicaid may now be willing to reconsider, especially as the federal government foots the vast majority of expansion costs. This opportunity is especially important in the South, where only two states have expanded Medicaid under the ACA.

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