Affordable Care Act makes advances to cover African-Americans, but gaps exist
While the Affordable Care Act will allow 3.8 million previously uninsured African-Americans to have health insurance by 2016, African-Americans still lack coverage in larger numbers than other racial and ethnic groups.
Despite making up 30 percent of the U.S. population, Maya Rockeymoore, PhD., founder and president of Global Policy Solutions, says, ”[African-Americans] represent more than 50 percent of the year-round uninsured population. [The ACA is so important] because African-Americans have been structurally excluded from access to insurance coverage, and it’s important to give individuals access to health care insurance who don’t have it.”
The ACA plans to establish Affordable Insurance Exchanges, which will allow individuals to purchase healthcare insurance. This provision, coupled with new Medicaid eligibility requirements, will give more African-Americans coverage.
The forthcoming provisions are much needed.
According to the U.S. Census Bureau, an estimated 20.8 percent of American-Americans are uninsured, while only 16.3 of all Americans are uninsured.
The ACA allows adults ages 19 to 26 without employer-provided insurance to remain on their parents’ plan until age 26. Still, despite gains made since October 2010, when the provision took effect, much work remains.
Based on National Health Interview Survey and the Current Population Survey estimates, 1,184,000 White non-Latino youths are now covered under the ACA, compared to 410,000 African-American youths.
Many factors contribute to fewer African-Americans having healthcare insurance.
As Dr. Cedric Dark notes, high unemployment rates among African-Americans is a primary reason. Dark is an emergency medicine physician at St. Agnes Hospital in Baltimore City, Md. He is also the founder and executive editor of Policy Prescriptions, which offers digests of oftentimes difficult-to-decipher health policies.
“A large part of the problem stems most from people being unemployed,” he says. “There tends to be a high rate of unemployment in the African-American communities, and most Americans get their insurance through their employer.”
Dr. Rockeymoore, whose company develops strategic policy approaches to advance social change, agrees that unemployment is a top reason and says that triggers another problem.
“COBRA premiums are expensive and often African-Americans who lose their jobs cannot afford the premiums,” she says.
Another reason for gaps in coverage among African-Africans, Dr. Rockeymoore says, is job type.
“Healthcare insurance is largely tied to the type of job you have. We lose a lot of numbers that way because many people have jobs that do not offer insurance. These are largely service type jobs and part-time jobs,” Rockeymoore explains.
Also, health insurance exchanges are not yet established. Implementation of the exchanges will be significant because these will allow individuals freedom to purchase insurance even when they work for employers who don’t offer insurance.
Starting in 2014, families with incomes at or below 133 percent of federal poverty guidelines will receive Medicaid coverage — for example, a family of four whose income is $30,657 or less.
Also in 2014, individuals with incomes up to 400 percent of the federal poverty guidelines — or less than $92,200 for a family of four — will be eligible to purchase subsidized coverage from the exchanges.
Coverage will be extended to adults without dependent children living at home, a group that is ineligible in many states.
As evidenced in the recent HHS report, changes are underway, even if not until 2016. Other phased-in changes will be implemented as well. Dark is especially hopeful about the efforts to increase diversity of healthcare professionals and culture competence.
“The government already has invested $1 billion in funds for the National Health Service Corps and community health centers,” Dark says.
The National Health Service Corps offers loan repayment and scholarships to primary care providers and students in exchange for practicing in underserved areas in the United States.
According to the HHS, the healthcare workforce will be more diverse as the number of Corps physicians increases. This is because more African-Americans tend to join the Corps. African-American doctors make up an estimated 18 percent of Corps physicians, as compared to six percent of the national physician workforce.
Many documented ACA provisions plan to address disparities in access, prevention and treatment. And by 2016, the current plan is for more African Americans to have access to affordable, quality health care insurance.