Racial and ethnic health disparities persist in our nation and health care system. Compared to their white counterparts, people of color are more likely to be without health insurance. They often receive poor quality care and experience worse health outcomes. The causes of these disparities are complex and interrelated, and include social and economic determinants (such as income level, education, and living conditions in homes and neighborhoods) as well as racial biases and structural racism within the health care system and society. The Affordable Care Act (ACA) included a number of provisions to address health disparities including anti-discrimination requirements, essential health benefits and essential community providers—all aimed at more equitably providing coverage and access to needed care, but it did not eliminate all disparities. We still have far to go in eliminating health disparities but the GOP replacement plan, the American Health Care Act (AHCA) would be a giant step in the wrong direction that would further harm vulnerable populations.
Despite the growing fears and mounting opposition from many communities across the country to the dismantling of the ACA, the Trump administration and Republicans in Congress are determined to push through their vision of health care. The AHCA will undo the extraordinary progress we have made over the past six years. As Richard (RJ) Eskow, Contributor to the Huffington Post, rightly puts it, this bill is “an assault on people of color,” as it would “cut programs that disproportionately help people of color while providing tax cuts for the wealthy that disproportionately help white people.” According to the analysis released by the Congressional Budget Office (CBO) on March 13, as many as 24 million people would lose their health care coverage by 2026, and people of color would be among the hardest hit. Below are three ways the AHCA harms people of color.
1. Massive cuts in Medicaid would cause millions of people of color to lose coverage
Medicaid plays an important role helping to fill some of the gaps in private coverage, as people of color are more likely than whites to be in low-income, low-wage jobs that provide limited access to employer sponsored insurance (or if offered, require employee premium contributions that are too expensive and beyond their reach). However, one of the most outrageous aspects of the House Republican repeal bill is its deep cut of 880 billion dollar cut in federal funding for Medicaid over ten years. This is due to the reduction in federal funding for Medicaid expansion and conversion of the program to a per capita cap. Such a significant reduction in funding would put at least 14 million low-income Medicaid enrollees at serious risk of becoming uninsured and losing access to the care they need.
A rollback of Medicaid expansion would cause, for instance, as many as 1.5 million Blacks to lose coverage; similarly at least 440,000 American Indians and Alaska Natives would become uninsured; and the vast majority – 3.3 million – of women of color would be at risk of losing Medicaid expansion coverage and access to reproductive care services. Many people of color who face serious physical and/or mental health problems, including being overweight or obese, having diabetes or cardiovascular disease and experiencing frequent mental distress or substance use disorders would have efforts to treat and prevent these conditions undermined by the loss of coverage. For children of color, capping Medicaid means denying them access to important preventive services (including but not limited to preventive and developmental screenings and chronic care management for health conditions such as diabetes or asthma) provided at school-based clinics. A Medicaid per capita cap would exacerbate disparities in health outcomes between white children and children of color. Capping Medicaid funding will result in lower provider rates, reduced access to care predominately in communities of color and low-income communities, and separate and unequal health care systems.
2. Marketplace coverage will cost people more as subsidies and cost-sharing benefits decrease dramatically
In addition to Medicaid coverage loss, approximately 12.2 million people – 30 percent of those are people of color – who are currently enrolled in the marketplace would find coverage unaffordable and would see their out-of-pocket costs significantly increase due to a decrease in financial assistance. According to the Center for American Progress, virtually everyone would experience an average cost increase of $3,174 in 2020 if the House Republican repeal bill passed into law; those with income below 250 percent of the federal poverty line would see their costs increase by $4,815; and the impact would be severe for older individuals age 55 through 64 as they would be forced to pay five times more than younger adults. People of color, especially Blacks and Latinos, would more likely fall into the lower-income range than their white counterparts. This financial impact would erode their financial stability – many of them have already struggled with medical bills. Facing financial burdens, many would forego needed treatments or medications, which would further deteriorate their health outcomes.
3. Eliminating the Prevention and Public Health Fund Would Cut Supports to Low-income and Vulnerable Communities
Furthermore, the House Republican repeal bill would eliminate the Prevention and Public Health Fund (PPHF), which would directly affect everyday Americans and their families. On average, people of color experience shorter life spans, higher infant mortality rates and higher prevalence of many chronic conditions compared to whites. Much of the PPHF have granted to low-income and vulnerable communities, like West Bronx in New York as well as many other communities across the country, to expand preventive health programs such as diabetes awareness classes, infectious disease research, toxic lead eradication, mental health and vaccination efforts, and community bike plans. According to the Centers for Disease Control and Prevention, PPHF dollars have proven successful improving physical activity and childhood immunizations, lowered hospitalizations for preventable conditions, and increased prenatal care visits in their target communities. Eliminating PPHF would make the fight to close the racial health gap even harder.
We must continue to be loud and united!
Community Catalyst and the Health Equity Leadership and Exchange Network recently hosted a webinar in which Daniel Dawes, author of 150 Years of ObamaCare, and Dara Taylor of Community Catalyst discussed the impact of the AHCA on health equity and strategies we can use to protect our care and combat health disparities. The presentation can be found here. Some of the strategies shared were that, first and foremost, it is essential for us to work toward addressing systemic racism and to explicitly name it as “a cause of poor health.” Secondly, data collection is an effective tool to identify health disparities. We should work with state and local government agencies across sectors, health care providers and community leaders to collect as much health data as possible. In addition to race, ethnicity, sex, language and disability status, we should collect information related to gender identity, sexual orientation and income level to help answer research questions, test hypotheses and evaluate outcomes that lead to reducing and eliminating health inequities. Lastly but not least, whenever possible, let’s make sure to elevate the voices of the people who will be affected in communities of color. Nothing is more powerful than hearing stories of how the ACA has positively improved health outcomes and provided financial security for millions of Americans. We must continue to work together in advocating against Republican repeal efforts that threaten to strip coverage away from millions of people and fails to advance health equity.