As the debate between Trumpcare and Obamacare continues in Washington D.C., there has been one glaring omission ― the devastating impact that Trump’s healthcare plan would have on Black people. The combination of severe racial disparities in health outcomes and the ever-widening wealth gap means that Black people will be hit first and hardest by Trump’s proposed “reform.” Let me be perfectly clear with you; none of this is by accident.
The people pushing Trumpcare like to pretend that their motives are pure of racial intent. But the reality is that a huge percentage of those who will lose healthcare coverage under Trumpcare are Black. These misguided efforts will be racist in their consequences.
The Republican plan includes an option for states to let insurance companies deny people coverage based on pre-existing conditions ― something prohibited under Obamacare.
Our government has never worked for communities of color. From slavery, to Jim Crow, to the war on drugs and mass incarceration, our people continue to bear the brunt of policy decisions that were designed to target us. This long history and current reality of institutional and structural racism has resulted in a playing field that is vastly unequal. That’s why across every indicator of success ― education, health, employment, housing, and more ― people of color fare worse than their white counterparts. We can’t ignore this fact when making policy decisions; if we do, racial disparities will only increase.
“About 15 million of the nearly 40 million African Americans in the country get coverage through Medicaid..."”
Study after study link poor health in Black communities to histories of segregation, substandard housing, food deserts, poverty, and threats from pollution. This did not happen randomly, or overnight; it’s the result of a series of decisions that have intentionally pushed people of color to the margins in our society. The chance that Blacks are going to have prior health conditions resulting from these social and economic problems is undebatable. Blacks and people of color will get hit the hardest if we let insurance companies deny health coverage to those in need.
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 in the country 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.
One of the themes that runs through the Affordable Care Act is that there are tools that can be used to attack health disparities based on race. Peppered throughout the ACA are provisions for language access, incentives for insurers to help overcome disparities, workforce training programs, and an emphasis on primary care and prevention. These are in addition to and accompany the expansion of insurance coverage through tax credit subsidies and broader Medicaid eligibility.
While some of these provisions of Obamacare are not repealed by the Trump plan, they will be rendered pointless. The key to getting access to health services of any kind right now is having insurance coverage. Letting pre-existing conditions back into the system and cutting millions off of healthcare will doom even the limited efforts to attack the scourge of health outcomes based on race.
Being Black is a pre-existing condition in America, and we can assure you that Trumpcare is not the antidote.
Gerald Hankerson is the Policy Director for Washington Community Action Network, as well as President of NAACP Seattle/King County.
