Vice President for Housing Policy
Running for President, President Trump asked African Americans, “What do you have to lose by trying something new like Trump?” As it turns out, one answer is health insurance.
With the Congressional Budget Office (CBO) estimating that the House Republican health plan would cause 24 million people to lose health insurance, African Americans have particular reason for concern due to existing health disparities and related financial burdens.
The Affordable Care Act (ACA) boosted the African American insured rate by 5 percentage points, to 88 percent, slightly below the 91 percent national figure. The House Republican plan, by contrast, would cause large numbers of African Americans to lose coverage. About 15 million of the nearly 40 million African Americans get coverage through Medicaid, which the House plan would cut by $880 billion over ten years; about 1.5 million of them are covered through the ACA’s Medicaid expansion, which the House plan would effectively eliminate. Many other African Americans have private insurance through the ACA’s marketplaces, where coverage would become less affordable for many consumers under the House plan (due partly to its much weaker premium tax credits to help them buy coverage).
In 2015, African Americans under 65 were likelier than whites, Asian Americans, and Hispanics to report difficulty paying medical bills in the past year, the Centers for Disease Control and Prevention (CDC) reports. Losing health insurance would further erode African Americans’ financial stability. It also would likely widen the already significant health disparities between African Americans and other races. African Americans’ death rates due to diabetes, heart disease, and cancer significantly exceed whites’ and generally exceed all other races.
Even more striking is the disparity in HIV rates: 60 per 100,000 African Americans have been diagnosed with HIV, compared to 7 per 100,000 whites, the CDC reports; the African American diagnosis rate is almost triple that of the next highest group (Hispanics). There’s also a wide disparity in death rates among people diagnosed with HIV: 24 per 100,000 for African Americans, compared to 7 or fewer per 100,000 for all other races.
Health insurance is key to reducing these disparities by making care affordable. The ACA’s Medicaid expansion has improved enrollees’ access to a doctor or clinic and led to improved self-reported health status among enrollees. For example, in Ohio — where African Americans make up almost one-quarter of the Medicaid expansion population — expansion enrollees with chronic conditions reported that Medicaid coverage improved their access to care and management of their conditions. And 48 percent of Ohio’s Medicaid expansion enrollees reported feeling better since gaining health insurance.
Policymakers considering the House Republican plan need to understand that health insurance for African Americans is, in fact, a lot to lose.