House Republicans’ “Pledge to America” contains one particularly specific public policy proposal worth worrying about—the pledge to repeal the Affordable Care Act of 2009. This comprehensive health reform law, designed to fix our broken health care system over the coming decade, in particular provides a unique opportunity to address the health care disparities that African Americans experience from birth to death in the form of higher infant mortality, higher rates of disease and disability, and shortened life expectancy.
The "Pledge to America" would replace health care reform with a grab bag of isolated measures that mostly benefit those who already have health care coverage. These piecemeal measures will do nothing to address the hurdles such as lack of health insurance, lack of access to preventive care, and other barriers that black families face in getting access to the care they need. Let’s take a closer look at their pledge to understand just how devastating their proposals would be to blacks.
The pledge will not improve access to health insurance coverage for African Americans
Twenty-one percent of African Americans, including 11.5 percent of children, were uninsured in 2009, the last year for which complete data is available. This represents an increase of 818,000 people without insurance over the figures for the previous year. What’s more, African Americans are the least likely to be able to afford insurance. Of all racial and ethnic groups in the United States, they are most likely to be poor—26 percent live in poverty—and the median annual income of an African-American household is $17,000 less than that of the average American household.
Conservatives who want to repeal the Affordable Care Act have no plan to expand coverage to help those who cannot afford health insurance. They want to repeal Medicaid expansions, repeal financial help to small businesses struggling with the costs of employee coverage, and repeal the tax subsidies that will help working families purchase coverage through health insurance exchanges.
Their pledge does contain a claim that Republicans will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a preexisting condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick. They never mention, however, that all of these protections are already enacted in the Affordable Care Act.
The pledge will not rein in the excesses of the health insurance industry to protect African Americans
Nor will their pledge rein in the excesses of the health insurance industry to protect African Americans—and indeed all Americans—from the excesses of the health insurance industry, which ACA will deal with effectively and fairly in the coming years. Specifically, conservative proposals do nothing to rein in the discriminatory practices and price-gouging behavior of the health insurance industry, such as those that recently saw one insurer, Anthem Blue Cross of California, attempt to increase premiums by 39 percent in the insurance marketplace for individual insurance policies.
What’s more, the pledge would do nothing to ensure that health insurance plans spend premium dollars on health care. In contrast, the Affordable Care Act requires that at least 80 percent of premium costs are returned in benefits.
The pledge will not improve access to primary care for African Americans
More than a quarter of African Americans do not have a regular doctor, compared with only one-fifth of white Americans. Twenty-two percent of African Americans report having little or no choice in where to seek care, and many of these people end up—inappropriately—in hospital emergency rooms. A primary care provider and a facility where a person receives regular care substantially improve the health of Americans with access to such care. The Affordable Care Act’s emphasis on primary care will particularly benefit people of color, especially those who live in areas that are currently medically underserved.
Conservatives have no plan to improve primary care or increase the primary care workforce. They want to repeal the provisions in the new law that will boost primary care capacity, establish more school-based clinics and more community health centers targeted to the needs of the communities they serve, and develop and expand the so-called medical home model for Medicare and Medicaid patients. Medical homes—health care settings that provide patients with timely, well-organized care and enhanced access to providers—are associated with a reduction in health care disparities for adults and better access to preventive services.
The pledge will not provide better preventive health services for African Americans
Chronic diseases, many of them preventable, place a high burden on African-American communities, where 48 percent of adults suffer from a chronic disease compared to 39 percent of the general population. Obesity is debilitating and is often a catalyst to chronic disease. Seven out of 10 African Americans ages 18 to 64 are obese or overweight. As a consequence they are twice as likely to be diagnosed with diabetes as whites.
In addition, they are more likely to suffer complications from diabetes, such as end-stage renal disease and lower extremity amputations. African Americans experienced 29 percent higher death rates from cardiovascular disease than white adults, and 40 percent higher death rates from stroke. Their age-adjusted death rate for cancer is approximately 25 percent higher than for white Americans, primarily due to late diagnosis.
Black women are less likely to receive prenatal care in the first months of pregnancy and older African Americans are far less likely to receive pneumonia or flu shots. African Americans face the most severe burden of HIV in the United States.
Better access to prevention and early interventions would help keep the African-American population healthier throughout their lives. Yet conservatives would repeal the provisions in the Affordable Care Act that will enhance preventive care and remove the co-payments and deductibles for approved preventive services such as immunizations, screening for colorectal cancer and diabetes, and mammograms. Among the programs that Republicans want to repeal are demonstration projects to develop comprehensive models for reducing childhood obesity, and increased funding for a nurse home-visiting program to help improve the health and well-being of mothers and their children.
The pledge will not improve the lower health quality and health care disparities that African Americans experience
African Americans are less likely than white Americans to get timely access to care and good quality care, and may face some inherent biases within the health care system. Defining and measuring health care disparities is a prerequisite for understanding and addressing them.
If the Republicans repeal the new health care law, they will repeal requirements that federally funded programs collect and report data on race, ethnicity, socioeconomic status, health literacy, and primary language, using methodologies that will ensure health care disparities can be measured. They will also undo the provisions that establish the Office of Minority Health at the Department of Health and Human Services and a network of minority health offices located within HHS that elevate the Office of Minority Health at the National Institutes of Health directly into the Office of the Secretary of Health and Human Services.
The Affordable Care Act makes significant advances for African Americans’ health coverage, quality of care, and access to health care services. It represents an important milestone toward the ultimate goal of eradicating racial and ethnic disparities in health and health care in the United States. House Republicans’ "Pledge to America" represents a devastating rollback of much-needed changes to our nation’s health care system—a step backward that will ensure that African Americans continue to receive poorer care and live in poorer health than the rest of the nation.