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Analysis: Healthcare for All: The Unfinished Business of a Nation

Perhaps the Affordable Care Act's greatest legacy has been its impact on racial inequality in America.
Supreme Court Hears Case Challenging Obama's Affordable Health Care Act
Supporters of the Affordable Care Act gather in front of the U.S Supreme Court during a rally March 4, 2015 in Washington, DC.Alex Wong / Getty Images

Amid all of the partisan debate around the Affordable Care Act (ACA), it’s easy to lose sight of the facts: more than 20 million Americans have access to health care coverage because of the Affordable Care Act. Insurance companies can no longer deny coverage because of a pre-existing condition, put limits on the amount of care you can receive, or charge women more simply because of gender. But perhaps the ACA’s greatest legacy has been its impact on racial inequality in America.

For too long, healthcare was seen as a privilege for those with “good jobs” or large bank accounts. While the creation of Medicaid and Medicare in 1965 provided access to some care for low-income individuals, there remained huge gaps in coverage for many Americans. The passage of the ACA made access to healthcare a right for all Americans.

Prior to the enactment of the ACA, over 50 million Americans were uninsured, including 20 percent of African Americans and 40 percent of Latinos. Uninsured Americans were more likely to use the emergency room rather than see a primary care physician, which led to improper diagnoses and lack of consistent treatment for chronic diseases like cancer, heart disease, and obesity. Burdened by higher rates of poverty and employment discrimination, African Americans and Latinos faced significant barriers to affordable and quality healthcare.

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Take the story of Tonya Fisher, a middle school teacher in Dallas. She woke up one morning to find that the right side of her face had gone numb. When Tonya finally saw a doctor, she was diagnosed with a brain tumor. Without insurance, Tonya simply could not afford the brain surgery needed to save her life. But with the passage of the ACA, she underwent two operations that put her on a path to recovery. “I had a long and painful road ahead of me,” she said, “but I did not have to put my family in debt along the way.”

Tonya’s story is not unique. The ACA has already started to reduce racial and ethnic disparities in coverage across the country. By 2011, three years before the law was fully implemented, 14.3 million people of color made up the majority of the 25.4 million uninsured Americans who were at or below 138 percent of the federal poverty line. Of the 14.3 million, 8.9 million were Latinos, 4.2 million were African Americans, and 1.2 million were Asians.

The ACA has expanded coverage in a number of ways. First, uninsured Americans can now purchase health insurance regardless of their health status, and lower and moderate income Americans receive financial help to make insurance affordable.

Second, states can elect to expand Medicaid to all individuals with incomes up to 138 percent of the federal poverty level with the federal government covering 90 percent of the cost. The District of Columbia and 31 states have already embraced the expansion, and there is growing pressure for reluctant states to take action.

Third, the law also provided $11 million to community health centers, which are essential to reaching communities of color. Thirty-two percent of patients in community health centers are Latino and 22 percent are African American. This additional investment in health centers will provide more options for these communities and help address the language and cultural barriers to health access.

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These reforms have resulted in a dramatic decline in the uninsured rate for African Americans. Among African-American adults, the uninsured rate fell by 41 percent, resulting in 2.3 million more individuals covered. In addition, it’s not only the uninsured who have benefited. Right now, 7.8 million African Americans who already had private insurance now have access to expanded preventative services, and an additional 500,000 young African Americans (19-26) are now covered. The ACA has also increased health care access in the Latino community, providing coverage to an additional 4.2 million Latino Americans.

But these are more than just statistics. They represent the success stories we hear every day. It’s the story of the 60-year-old immigrant from El Salvador, who no longer has to choose between buying groceries and getting treatment for her kidney stones. It’s the story of the 51-year-old street vendor, who can finally afford a prosthetic replacement for the leg he lost to untreated diabetes. “Now I don’t worry,” he said. “It’s a security, a comfort that I feel.” It’s the story of Tonya Fisher, who is back in the classroom with the students that are counting on her.

This essay is part of the 2016 State of Black America Report. The rest can be found at

2016 State of Black America "Locked Out" report.
2016 State of Black America "Locked Out" report.Courtesy SOBA