We have reached a critical point for the future of American health care and the fate of the Affordable Care Act (ACA). On June 25th, Trump’s Department of Justice (DOJ) and Republican-led states submitted their briefs in support of California v. Texas, the lawsuit seeking to strike down the ACA. If President Trump and Republicans have their way, more than 20 million Americans will lose their insurance coverage, 135 million Americans with pre-existing conditions will be stripped of their protections, and costs will go up for millions. The consequences of the lawsuit for America’s health care are particularly devastating at a time the country is gripped by the coronavirus crisis which threatens the health and safety of the entire nation.

No action would be more damaging to Americans’ health and safety than if the Trump administration achieves their desired goal of overturning the ACA in its entirety during this crisis. When the court hears this case, there will likely be no vaccine and no viable treatment for the virus. When millions of Americans have already lost health insurance due to the pandemic, it’s absurd that President Trump is arguing in court that 20 million more Americans should lose their health care. And when millions of Americans who contract the coronavirus join the 135 million Americans with a pre-existing condition, President Trump will also be arguing in court to allow insurance companies to deny them coverage or charge them more. The submission of these briefs from Republican states will put the Trump administration’s politically-motivated lawsuit on full display for the American people in front of the highest court.

Days of Action: Day 9 of 12 focuses on health care for Black Americans. To learn more about our Days of Action, visit our website.

What’s At Stake: Coverage for Black Americans

The ACA helped reduce longstanding racial disparities in coverage rates, improving health care access for communities of color across the board. Destroying the ACA would be especially harmful as the country is still reeling from the coronavirus pandemic, which has disproportionately devastated Black communities nationwide. 

The ACA Helped Lower The Uninsured Rate For African Americans By More Than One Third. Before the passage of the ACA, more than 16 percent of the nearly 50 million Americans lacking health insurance were African Americans. According to the Center on Budget and Policy Priorities, the ACA helped lower the uninsured rate for nonelderly African Americans by more than one third between 2013 and 2016 from 18.9 percent to 11.7 percent. 

Medicaid Expansion Played A Key Role In Increasing Coverage Rates For Black Communities. After the implementation of the ACA, gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. Today, a Black person living in an expansion state is more likely to be insured than a white person residing in a state that rejected Medicaid expansion. Per the Commonwealth Fund: “Five years after the ACA’s implementation, black adults living in states that expanded Medicaid report coverage rates and access to care measures as good as or better than what white adults in nonexpansion states report.”

Research Confirms That The ACA Improved Health Care Access For Black Americans: 

Commonwealth Fund Study Found That The ACA’s Medicaid Expansion Has Been Key To Improving Racial Equity In Health Insurance Coverage And Access To Care. “Uninsured rates for blacks, Hispanics, and whites declined in both expansion and nonexpansion states between 2013 and 2018. In addition, disparities in coverage between whites and blacks and Hispanics also narrowed over that time period in both sets of states… People living in Medicaid expansion states benefited the most in terms of coverage gains. All three groups reported lower uninsured rates in expansion states compared to nonexpansion states, and larger coverage improvements between 2013 and 2018. Coverage disparities in expansion states narrowed the most over the period, even though the disparities were smaller to begin with. The black–white coverage gap in those states dropped from 8.4 percentage points to 3.7 points, while the difference between Hispanic and white uninsured rates fell from 23.2 points to 12.7 points.” [Commonwealth Fund, 1/16/20

  • Commonwealth Fund: The Black-White Disparity In Cost-Related Access Problems Shrank From 8.1 Percentage Points In 2013 To 4.7 Points In 2018. “Twenty-three percent of black adults reported avoiding care because of cost in 2013, compared to 17.6 percent in 2018…As a result, differences narrowed between white adults and black and Hispanic adults in cost-related access problems. The black–white disparity shrank from 8.1 percentage points in 2013 to 4.7 points in 2018, while the Hispanic–white difference fell from 12.7 points to 8.3 points.”  [Commonwealth Fund, 1/16/20

Washington Post: ACA Linked To Reduced Racial Disparities, Earlier Diagnosis And Treatment In Cancer Care. “Proponents of the embattled Affordable Care Act got additional ammunition Sunday: New research links the law to a reduction in racial disparities in the care of cancer patients and to earlier diagnoses and treatment of ovarian cancer, one of the most dangerous malignancies. According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis. But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said. Another study showed that after implementation of the law, ovarian cancer was diagnosed at earlier stages and that more women began treatment within a month. The speedier diagnoses and treatment were likely to have increased patients’ chances of survival, the researchers said.” [Washington Post, 6/2/19]

Georgetown University Center For Children And Families: “…Medicaid Expansion Is An Important Means of Addressing Persistent Racial Disparities In Maternal Health And Maternal Mortality.” “New research shows states that expand Medicaid improve the health of women of childbearing age: increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates. While more must be done, Medicaid expansion is an important means of addressing persistent racial disparities in maternal health and maternal mortality. The uninsured rate for women of childbearing age is nearly twice as high in states that have not expanded Medicaid compared to those that have expanded Medicaid (16 percent v. 9 percent).” [Georgetown University Center for Children and Families, May 2019]

JAMA: Medicaid Expansion Tied To Positive Gains For Black Babies. “A major part of the Affordable Care Act — the expansion of the Medicaid program — may play a role in shrinking the gap in premature birth and low birth weight between black and white infants born in the United States, according to a new study…Black infants are about twice as likely to be born at low birth weight and 1.5 times as likely to be born prematurely than white infants. Yet the new study finds that Medicaid expansion was linked with closing that gap. Between 2011 and 2016, this expansion was associated with significant improvements in disparities among black and white infants, according to the study, published Tuesday in the medical journal JAMA.” [CNN, 4/23/19]

Black Women Were More Likely To Receive Care Because Of The ACA. “There has been an increase in the share of black women with a ‘usual source of care’—meaning a particular doctor’s office, clinic, or health center. In 2010, 83 percent of black women had a usual source of care. By 2014, the share had risen to 88.1 percent. Furthermore, black women have experienced a reduction among those who delayed or went without care due to cost. In 2010, 18.6 percent of black women ‘who had to delay or forgo care because of cost’; by 2014, only 15.1 percent of black women did so.” [Center for American Progress, 2/28/17

If The ACA Is Overturned, The Black Uninsured Rate Would Nearly Double: 

The Black Uninsured Rate Would Spike To 20 Percent. “Everything would go: protections for preexisting conditions, subsidies that help people purchase insurance, the Medicaid expansion…States that expanded Medicaid would get the worst of it: Urban projected their uninsured rates would nearly double if the law were overturned. The uninsured rate for black Americans would increase from 11 percent today to 20 percent without Obamacare; there would also be a dramatic spike in uninsurance among Hispanics.” [Vox, 3/2/20

Bottom Line: “Health coverage is especially important for African Americans and other racial and ethnic minorities because they often have worse health status than their white counterparts,” according to the Center on Budget and Policy Priorities. Coverage losses incurred by overturning the ACA would be devastating for Black Americans and reverse the significant gains in health care access made by the law.