How a repeal of the Affordable Care Act will affect Blacks

By Glenn Ellis, Health columnist

acasigning President Barack Obama, Vice President Biden, members of Congress and guests before the signing of the ACA on March 23, 2010. PHOTO: The White House

( – Racism has historically had a significant, negative impact on the health care of Blacks and other people of color in the United States. The Affordable Care Act (ACA) is truly the first time that African-Americans have, collectively, had significant access to health care. It is noteworthy that America’s first African-American president is chiefly responsible for this access.

Improved access to care; Medicaid expansion; prevention medicine; and lifting of barriers for pre-existing conditions, are all aspects of the ACA that have been of great benefit to Blacks. But there is a thick air of uncertainty on the horizon.

In a few weeks, Donald John Trump will become the 45th president of the United States. It is unclear how quickly, or when, Trump’s vow to repeal and replace Obamacare will play out. But make no mistake, just like the adage, “when white folks catch a cold, black folks get pneumonia!”, a repeal of the ACA would disproportionately hurt blacks.

Republicans in Congress have put out their plans: to repeal most of the ACA without replacing it; doubling the number of uninsured people – from roughly 29 million to 59 million – and leave the nation with an even higher uninsured rate than before the ACA.

Let me point out a few ways that Blacks have, specifically, benefitted from the ACA, what many now call “Obamacare”. Given the low incomes of uninsured Blacks, nearly all (94 percent) are in the income range to qualify for the Medicaid expansion or premium tax credits. Nearly two thirds (62 percent) of uninsured Blacks have incomes at or below the Medicaid expansion limit, while an additional 31 percent are income-eligible for tax subsidies to help cover the cost of buying health insurance through the exchange marketplaces. Under the new law, insurance companies are banned from denying coverage because of a pre-existing condition, such as cancer and having been pregnant.

Importantly, for people living with HIV there also new protections in the law that make access to health coverage more equitable including the expansion of Medicaid and in the private market, prohibition on rate setting tied to health status, elimination of preexisting condition exclusions, and an end to lifetime and annual caps. The passage of the Affordable Care Act (ACA) in March 2010 provided new opportunities for expanding health care access, prevention, and treatment services for millions of people in the U.S., including many people with, or at risk for, HIV.

Safety net hospitals play a critical role in the nation’s health care system by serving low-income, uninsured and medically and socially vulnerable patients regardless of their ability to pay. Also, in agreeing to lower payments, hospitals in the 31 states that expanded Medicaid under the law, have made up that revenue in part through the Medicaid expansion.

These places are critical to the health of Black communities, and in the poorest neighborhoods. They have been among the loudest voices against repeal of the health law, as they could lose billions if the 20 million people lose the insurance they gained under the law. This could bring about widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.

Under the ACA, these hospitals have received subsidies (or credits) to provide care based on a patients’ income levels. Should this change, community hospitals may have more difficulty weathering the storm of an increase in the number of uninsured.

Admittedly, there are some real problems with the ACA as we have come to know it; not the least being steady increases in premiums (midrange plans increased 22 percent nationally in 2016, with the average premium set to rise 25 percent in 2017); nearly 70 percent of all ACA plan provider networks are narrower than promised; and the high-deductibles and co-pays. Perhaps the most universal complaint is the “individual mandate”, that requires everyone in the United States to have insurance, or face a financial penalty.

Republicans are dead set on repealing the Affordable Care Act. Congress will likely pass significant modifications to the Affordable Care Act this month, which will be signed by incoming President Trump. The plans they have proposed so far would leave millions of people without insurance and make it harder for sicker, older Americans to access coverage. No version of a Republican plan would keep the Medicaid expansion as Obamacare envisions it.

Donald Trump’s presidency absolutely puts the future of the Affordable Care Act (ACA) in jeopardy. A full repeal is unlikely, but major changes through the budget reconciliation process (which cannot be filibustered) are nearly certain.

But let me be clear; changes are needed in the ACA, but the idea of dismantling it remains a troubling prospect for Blacks.

Moral March for Higher Ground unveils ‘Healthcare Justice Quilt’ on the steps of the Capitol in Montgomery



On Monday, September 12 a group of a hundred or more clergy and lay leaders marched from the Dexter Avenue Baptist Church to the State Capitol steps in Montgomery, Alabama.
The group carried a letter to Governor Bentley entitled “Higher Ground Moral Declaration” signed by more than 10,000 Alabama citizens and unfurled a quilt with a thousand pieces representing people in Alabama who had died because they did not have health insurance. Governor Bentley has not extended Medicaid to reach people up to 138% of the poverty level. There are 250,000 people in this gap between Medicaid coverage for the very poor and working poor people who do not make enough to qualify for insurance subsidies under the Affordable Care Act. The actions in Montgomery were coordinated with demonstrations in more than twenty states by Rev. William Barber, North Carolina NAACP leader and head of the “Moral Monday Movement” to raise moral concerns about the future direction of America.
In the Higher Ground Moral Declaration it states, “Following moral traditions rooted in our faith and the Constitution, we are called to stand up for justice and tell the truth. We challenge the position that the preeminent moral issues today are about prayer in public schools, abortion, and homosexuality. Instead, we declare the deepest public concerns of our faith traditions are how our society treats the poor, those on the margins, the least of these, women, children, workers, immigrants and the sick; equality and representation under the law; and the desire for peace, love and harmony within and among nations.”
“This Higher Ground Moral Declaration provides a moral agenda for our nation on issues including: democracy and voting rights; poverty and economic justice; workers’ rights; education; healthcare; environmental justice; immigrant rights and challenging xenophobia; criminal justice; LGBTQ rights; and war-mongering and the military. For each issue area, an individual moral and constitutional foundation is established. The positions are neither left nor right, nor conservative or liberal. Rather, they are morally defensible, constitutionally consistent, and economically sound. Most importantly, they represent, as Dr. King urged, a revolution in values.”
At the Capitol steps, the persons who unveiled the Healthcare Justice Quilt made this statement, “The quilt has 1000 squares. We chose this figure to represent the minimum 1000 lives prematurely lost every year in Alabama, due to lack of health insurance. The quilt is also intended to remember additional lives lost due to inability to afford co-pays and deductibles, hospital closures, and all financial barriers to healthcare.
“We would like to recognize quilters around the state who have contributed to this project, including Mopsy Forsee, Linda Harman, Katherine Weathers, Pippa Abston, and the members of Project Linus in Huntsville.
“Our plan for the quilt is to write names of those who have died prematurely because of financial barriers to healthcare in our state. This is not restricted by year. We have pens here for any of you who wish to contribute names today. We will use this quilt as both a memorial for those named and unnamed, and as a call to action.
“We plan to have it at events in the state and to take it to government officials, so they have a visual reminder of the consequences of their policy decisions. Please contact us if you want to set up a meeting with your legislator or other government official or if you have an event in mind.
We will initially focus our efforts on the Medicaid Expansion. Even the expansion, however, will not bring health insurance to everyone; and full health insurance coverage that includes co-pays and deductibles will not make quality healthcare affordable to everyone. So this quilt will be used as long as it is needed—as long as there is anyone whose healthcare is limited due to money. We hope that one day, it will live in a museum, as a remembrance of what we did before we learned better.
“Our quilt is made of many different fabrics and by many hands, and it was stitched with love. Notice how the different fabrics, brought together, create a new and beautiful whole! We in Alabama are also of many colors, textures and patterns, all connected with the common thread of our humanity. When we come together, we are as beautiful as this quilt. We commit ourselves today to the love and care of all human beings!”