HEALTHCARE FOR ALL: THE UNFINISHED BUSINESS OF A NATION
BY NEERA TANDEN AND DANYELLE SOLOMON

Amid all of the partisan debate around the Affordable Care Act (ACA), it’s easy to lose sight of the facts: more than 20 million Americans have access to health care coverage because of the Affordable Care Act. Insurance companies can no longer deny coverage because of a pre-existing condition, put limits on the amount of care you can receive, or charge women more simply because of gender. But perhaps the ACA’s greatest legacy has been its impact on racial inequality in America.  

For too long, healthcare was seen as a privilege for those with “good jobs” or large bank accounts.  While the creation of Medicaid and Medicare in 1965 provided access to some care for low-income individuals, there remained huge gaps in coverage for many Americans. The passage of the ACA made access to healthcare a right for all Americans.

Prior to the enactment of the ACA, over 50 million Americans were uninsured, including 20 percent of African Americans and 40 percent of Latinos.  Uninsured Americans were more likely to use the emergency room rather than see a primary care physician, which led to improper diagnoses and lack of consistent treatment for chronic diseases like cancer, heart disease, and obesity.  Burdened by higher rates of poverty and employment discrimination, African Americans and Latinos faced significant barriers to affordable and quality healthcare.

Take the story of Tonya Fisher, a middle school teacher in Dallas. She woke up one morning to find that the right side of her face had gone numb. When Tonya finally saw a doctor, she was diagnosed with a brain tumor. Without insurance, Tonya simply could not afford the brain surgery needed to save her life. But with the passage of the ACA, she underwent two operations that put her on a path to recovery. “I had a long and painful road ahead of me,” she said, “but I did not have to put my family in debt along the way.”

Tonya’s story is not unique. The ACA has already started to reduce racial and ethnic disparities in coverage across the country. By 2011, three years before the law was fully implemented, 14.3 million people of color made up the majority of the 25.4 million uninsured Americans who were at or below 138 percent of the federal poverty line.  Of the 14.3 million, 8.9 million were Latinos, 4.2 million were African Americans, and 1.2 million were Asians.

The ACA has expanded coverage in a number of ways.  First, uninsured Americans can now purchase health insurance regardless of their health status, and lower and moderate income Americans receive financial help to make insurance affordable.

Second, states can elect to expand Medicaid to all individuals with incomes up to 138 percent of the federal poverty level with the federal government covering 90 percent of the cost. The District of Columbia and 31 states have already embraced the expansion, and there is growing pressure for reluctant states to take action.

Third, the law also provided $11 million to community health centers, which are essential to reaching communities of color.  Thirty-two percent of patients in community health centers are Latino and 22 percent are African American.  This additional investment in health centers will provide more options for these communities and help address the language and cultural barriers to health access.

These reforms have resulted in a dramatic decline in the uninsured rate for African Americans.  Among African-American adults, the uninsured rate fell by 41 percent, resulting in 2.3 million more individuals covered. In addition, it’s not only the uninsured who have benefited. Right now, 7.8 million African Americans who already had private insurance now have access to expanded preventative services, and an additional 500,000 young African Americans (19-26) are now covered.   The ACA has also increased health care access in the Latino community, providing coverage to an additional 4.2 million Latino Americans.

But these are more than just statistics. They represent the success stories we hear every day. It’s the story of the 60-year-old immigrant from El Salvador, who no longer has to choose between buying groceries and getting treatment for her kidney stones. It’s the story of the 51-year-old street vendor, who can finally afford a prosthetic replacement for the leg he lost to untreated diabetes. “Now I don’t worry,” he said. “It’s a security, a comfort that I feel.” It’s the story of Tonya Fisher, who is back in the classroom with the students that are counting on her.

This is what progress looks like. Unfortunately, not every community has been able to reap the full benefits of the ACA. Republican governors across the country have done everything in their power to block the expansion of health care access, hurting their states’ residents and their families. Currently there are 19 states that have not expanded Medicaid, locking out nearly 4.3 million low-income people from access to coverage – including 1.7 million adults of color.  Many of the states failing to adopt Medicaid expansion are in the south, where there are large African-American populations. Even worse, leading candidates for the Republican presidential nomination have promised to repeal the ACA entirely if they are elected, stripping insurance from millions of Americans.

Our country simply cannot afford to turn back the tide of progress. Looking forward, we must continue to reduce the overall cost of health care in this country; we must expand coverage in states that have denied Medicaid to their residents; and we must elect leaders who are committed to protecting every word of the Affordable Care Act.

The United States is undergoing significant demographic changes, and these shifts must inform our public policy decisions – especially when it comes to health care.