5 Things You Need to Know About the Affordable Care Act and African Americans

People wait to sign up for the Affordable Care Act at Swope Health Services in Kansas City, Missouri, on March 31, 2014.

This column contains a correction. 

Prior to the passage of the Patient Protection and Affordable Care Act, or ACA, quality affordable health care was out of reach for millions of Americans—many of whom are society’s most vulnerable. In the time before the ACA, nearly 50 million Americans lacked health insurance; more than 16 percent of these individuals were African Americans.* As a result of the ACA, nearly 20 million Americans who did not have coverage now do. Millions of young adults are able to remain on their parent’s insurance until age 26, and health insurance companies can no longer refuse to cover those with pre-existing conditions. The passage of the ACA has done a great deal for many Americans. If efforts to repeal it are successful, however, many Americans have a lot to lose, particularly African Americans.

  1. Since the opening of the health insurance marketplaces in 2013, the share of uninsured black individuals has been significantly reduced. According to a Center for Disease Control and Prevention survey, the share of non-Hispanic black adults ages 18–64 who lacked health insurance coverage fell from 24.9 percent in 2013 to 15.1 percent between January and September 2016.
  1. Black women in particular have received a number of benefits because of the implementation 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. Lastly, 55.6 million women who are enrolled in private insurance are able to get preventive care without paying out-of-pocket costs.
  1. Partial repeal of the ACA through the reconciliation process will cause the uninsured rate among black individuals to rise significantly by 2019. According to research, partial repeal of the ACA through reconciliation would result in the uninsured rate among non-Hispanic black populations to increase to 20 percent from a projected 11 percent under the ACA.
  1. Despite the significant gains in coverage under the ACA, many black individuals still remain uninsured. As of 2015, there were 28.5 million uninsured people in the United States—15 percent of whom were black. In states that have refused to expand Medicaid under the ACA, 31 percent of uninsured black individuals fall into what is known as the coverage gap, which includes people who have incomes above Medicaid eligibility but below the lower bound for tax credits for health insurance marketplace premiums. A lack of insurance for these Americans is a direct result of states failing to expand Medicaid. Given the demographic makeup of the states that refused to expand Medicaid, this decision has disproportionately affected communities of color, particularly African Americans. In states that did not expand Medicaid, 16 percent of black individuals are uninsured, while the uninsured rate for black individuals in states that did expand Medicaid is only 9 percent, which is similar across the board for all races in those states.
  1. Millions of uninsured black individuals are not aware of health insurance marketplaces. The ACA could be helping significantly more people—especially communities of color. According to a survey conducted by the Commonwealth Fund from February to April 2016, approximately 42 percent of uninsured black people were unaware of the marketplaces compared with only 21 percent of uninsured white adults who were unaware.

If conservatives in Congress and the White House follow through on their calls to repeal the ACA, millions of families will be left out in the cold. With lower incomes and higher unemployment rates than other demographic groups, African Americans are particularly vulnerable to the impacts of ACA repeal.

* Correction, February 28, 2017: This column incorrectly stated the share of African Americans who lacked health insurance before the ACA. The correct amount is more than 16 percent.