The nation is in the midst of twin public health and economic crises: More than 8.2 million Americans have contracted COVID-19 and more than 220,000 have died from it, and the United States has lost 10 million jobs since March. Both the public health and economic crises are disproportionately affecting communities of color, and repealing the Affordable Care Act (ACA) would only further compound that inequity. More than 100,000 small businesses have closed their doors since the beginning of the pandemic, and wealth inequality continues to persist. According to the latest Federal Reserve data, white families had almost eight times the median wealth of Black families in 2019—$189,100 compared with $24,100. While this may seem like a small improvement from the 2016 numbers of $181,871 and $18,240, respectively, it is important to note that the impact of COVID-19 is not reflected in them. The current recession will likely contribute to a renewed widening of the gap and other economic inequalities.
During a time of national crisis, congressional action to provide aid and support to U.S. communities is critical—yet the Trump administration and Republican members of Congress have failed to act. Instead of focusing on what the American public needs right now—safe, reliable, and affordable health care, and economic stimulus—the administration and its allies in Congress are focused on rushing through the recent nomination of Amy Coney Barrett to the U.S. Supreme Court.
While the nomination of Barrett is concerning for several reasons, people of color should be especially concerned about the state of health care if she is confirmed to the Supreme Court. President Trump has pledged to only appoint Supreme Court justices who would act to strike down the ACA—and Barrett has repeatedly voiced her opposition to the major decisions that upheld the health care law. Less than one month from now, the court will hear arguments in yet another lawsuit, California v. Texas, that seeks to dismantle the ACA. A single decision from a Supreme Court stacked with Trump’s nominees could spell the end of affordable, accessible health care for tens of millions of Americans, many of whom are people of color.
The ACA increased health care coverage for people of color
Today, the United States remains one of the only states in the Organization for Economic Cooperation and Development that lacks universal coverage; it is ahead only of Mexico. The passage of the ACA was not easily won, but it was a critical policy change that needed to be made for the health and safety of the nation. As the country continues to fight the coronavirus, the American public has seen firsthand why access to and quality of health care are essential. Prior to the passage of the ACA, many Americans—especially people of color and low-income people—lacked health coverage. They were denied coverage or faced sky-high premiums due to having one or more preexisting conditions; similarly, annual or lifetime caps on care could spell bankruptcy for individuals or families facing chronic conditions.
People of color were disproportionately uninsured at high rates. In 2010, 32.6 percent of the Hispanic and 32 of the American Indian/Alaska Native (AI/AN) nonelderly population lacked insurance coverage, compared with only 13 percent of the white nonelderly population. Following the ACA’s passage, and after the law’s major coverage expansions were implemented in 2014, the uninsured rates among these groups dropped significantly. By 2016, the Black uninsured rate had dropped to 10.7 percent from 19.9 percent in 2010. For Asian Americans, the uninsured rate went from 16.7 percent in 2010 to 7.1 percent in 2017. The ACA lawsuit threatens to reverse this progress: At least 9.47 million people of color could become uninsured if the law is repealed. (see Table 1)
Increasing health care coverage through the ACA was the first step in overhauling a health care system that failed to protect Americans, especially people of color. As the nation continues to battle the COVID-19 pandemic, repealing the first step toward improving health care access would be chaotic and devastating. COVID-19 has spotlighted so many inequalities in the health care system for people of color. According to a Center for American Progress analysis, 21 million working-age people of color have a medical condition that puts them at higher risk for severe illness due to COVID-19. People of color are also more likely to be front-line workers in the pandemic. Ensuring that these workers have access to health care is critical to the safety and prosperity of the nation. Overall, CAP estimates that about 54 million people of color have a preexisting condition, based on population data from the 2019 American Community Survey and a 2017 report by the U.S. Department of Health and Human Services. If the ACA is repealed, these conditions could lead to them being charged more, having benefits excluded, or being denied access to coverage in the individual market for health insurance, and millions more will likely have a preexisting condition due to COVID-19. While the passage of the ACA was critical in improving coverage and addressing some inequalities in the health care system, there are still critical steps that policymakers must take to ensure people of color have access to quality, affordable, and comprehensive health care.
Structural barriers to health care still exist
Although the ACA expanded coverage, it did not remove all the structural barriers people of color face in the health care system. Discrimination, language access, and cost still affect the ability of people of color to fully access quality health care. COVID-19 has further exposed many of those challenges and is a call to action for lawmakers to build upon the Affordable Care Act—not strike it out of existence.
COVID-19 has shed light on the lack of access to care across the country. Access is not only about having a facility that provides necessary health care services but also about the facility being accessible and affordable for people and their families. The ACA drastically increased support for federally qualified health centers, which are the largest source of comprehensive primary health care for medically underserved communities. Any attempt to remove funding or limit access to care will be detrimental for people of color receiving care. Furthermore, according to CAP analysis of data from the Centers for Disease Control and Prevention, “16 percent of Black people, 20 percent of Hispanic people, 19 percent of AI/AN people, and 18 percent of Asian Americans were unable to see a doctor in 2018 due to cost. By contrast, just 10 percent of white Americans were unable to see a doctor due to cost.” Despite the positive impacts of the ACA in reducing costs of premiums and co-pays, people of color are still reporting cost as a barrier. Repealing the ACA would only increase costs and further limit the ability of people of color to access health care.
How COVID-19 has exacerbated barriers to health care for communities of color
The federal government’s historical failure to uphold its trust and treaty agreements placed tribal communities in harm’s way when COVID-19 struck. COVID-19 has devastated tribal communities. In New Mexico, AI/AN people represent one-tenth of the state population but make up more than 55 percent of the COVID-19 cases. Lost revenue from casino closings has caused business closures and lost jobs. Any attempts to thwart the limited health services currently available will be detrimental. The Indian Health Service (IHS) is not adequately supported. According to the IHS’ fiscal year 2022 budget, funding is about one-eighth of what is actually required. Therefore, programs such as Medicaid are “critical” to sustaining operations. The federal government’s historical failures combined with COVID-19 have put the health of AI/AN people in significant jeopardy.
Black Americans have also been devastated by COVID-19. Black Americans are twice as likely to die from the disease as their white counterparts, and the unemployment rate for Black Americans is currently twice as high as that of their white counterparts. Despite the gains in coverage under the ACA, COVID-19 has spotlighted other barriers that still need to be addressed. During the beginning of the pandemic, there were multiple reports of Black Americans being turned away from care and care being unavailable in communities predominately populated by Black people.
Latinx people have faced enormous damage to their communities in the fallout from COVID-19. For example, despite being only 39 percent of California’s population, Latinx people represent more than 100,000 more cases than all other racial or ethnic groups in the state combined. Latinx workers are overrepresented in service-sector jobs, which place them at increased risk of exposure to COVID-19. In addition, these jobs typically pay less and have poor benefits. For example, nearly 1 in 4 employed Latinx workers don’t have employer-based health insurance.
Health care discrimination persists for people of color
Discrimination in the health care system continues to block access to comprehensive health care. According to a June 2020 poll by the Kaiser Family Foundation, Black adults were more than three times as likely as white adults to report that they had experienced discrimination while receiving health care in the past 12 months. And according to the U.S. Department of Health and Human Services, one of the primary barriers to care for Asian Americans is language access. Despite possessing a legal right to have health care information provided in the language of their choice, millions of Americans are prevented from getting quality care due to language barriers. The Affordable Care Act helped reduce some of the racial and ethnic disparities seen in coverage and quality of care. As policymakers work to protect the ACA, they must also ensure they build upon on it to ensure no person is discriminated against when trying to access services. Any attempt to repeal the law will worsen health disparities for communities of color.
The Affordable Care Act was the first step in reforming and improving America’s health care system. Despite the gains made, there is more work to be done—and this is especially true in the wake of COVID-19. Communities of color have been on the front lines of this pandemic, and any attempt to repeal health care coverage would be detrimental to their health and lives. This is not the time to rush through a Supreme Court nominee who is likely to dismantle the health care law; instead, it is time to do more to protect Americans—especially people of color.
Danyelle Solomon is the vice president of Race and Ethnicity Policy at the Center for American Progress. Richard Figueroa is the research assistant for Race and Ethnicity Policy at the Center.