Hi, I’m Jeremy Quittner, a writer for Fortune.com’s Venture channel. I’ll be filling in for Ellen McGirt until Wednesday while Ellen crunches on some magazine assignments.
The new Republican Congress will soon attempt to repeal the Affordable Care Act.
While their replacement plan is currently unknown—possible ideas include a system of tax credits or refunds and health savings accounts linked to high-deductible health care plans—broadly speaking, rolling back President Obama’s signature law is likely to cause confusion and chaos for the health care market.
Lacking a replacement strategy by Congress, an estimated 18 million people who obtained coverage since 2013 via new state and federally administered exchanges are likely to have their coverage thrown into limbo.
Certainly whites made up the biggest group of newly insured Americans under the ACA, with 9 million new people gaining coverage. But poorer minorities also benefited dramatically from provisions in the ACA, including an expansion of Medicaid that provided health care subsidies for many low-income people.
Three million African Americans and 4 million Hispanics--the minority group most likely to lack health insurance--accessed coverage through the ACA. As a result, these groups saw uninsured rates drop 11.8 percentage points and 11.3 percentage points, respectively. That’s according to a 2016 report from the Assistant Secretary for Planning and Evaluation, the principal advisor to the Department of Health and Human Services (HHS).
Other minorities, such as LGBT people, benefited in different ways. The health care act forbid health care providers who take funding from the HHS from discriminating on the basis of sexual or gender orientation. It allowed same-sex families to apply for joint coverage. It also removed lifetime caps on care for chronic conditions, such as HIV, where the annual cost of treatment can be very high.
These groups will continue to be vulnerable without the ACA or something like it, particularly because of its anti-discrimination provisions.
As it is, there are major disparities in the mortality and morbidity rates of black and white Americans. A report published in October by the centrist Brookings Institution highlights some of the statistics: black infants die at twice the rate of their white counterparts—a gap that increases, rather than decreases, as black families become more affluent and educated; black men have the shortest life expectancy of any group; and college-educated whites outlive both black men and women with a high school education or less by a decade or more.
The reasons are varied, and not all a direct result of explicit discrimination -- broader economic problems, such as housing inequality and access to healthy food, contribute as well. But unconscious bias has been shown to influence the care black patients receive.
“When compared to whites, black patients are referred to see specialists less often, receive less appropriate preventive care such as mammography and flu vaccines, receive fewer kidney and bone marrow transplants, receive fewer anti-retroviral drugs for HIV, receive fewer antidepressants for diagnosed depression, and are admitted less often than whites for similar complaints of chest pain,” the report finds.
A recent Kaiser Permanente report shows that other minorities, including Hispanics and Native Americans, also have disproportionately bigger challenges accessing and using health care than whites.
If the ACA is repealed, it will cost the economy about $350 billion over the next 10 years, according to a recent Committee for a Responsible Federal Budget report, and it would leave no revenue left over for a replacement plan.
While the ACA was not a perfect solution, it laid the groundwork not only for opening up access to health care, but for tackling ways to make health care more equitable for everyone. Without it, and with no revenue for a new plan, the health care environment is likely to revert to the way it was prior to 2010. And in that environment, minorities will continue to suffer most.
Two men dressed as Ku Klux Klan members crash Jeff Sessions' confirmation hearing
Donald Trump's nominee for Attorney General, Alabama Sen. Jeff Sessions, saw his confirmation hearing disrupted this morning by two protesters in KKK costumes. As security removed them, they yelled “you can’t arrest me, I am white!” and “white people own this government!” Since his nomination, Sessions' record of racist remarks and behavior have been front and center. In his opening statements during today's hearing, Sessions said he understands “the history of civil rights and the horrendous impact that relentless and systemic discrimination and the denial of voting rights has had on our African-American brothers and sisters.” The last time Sessions faced a confirmation hearing was in 1986, when President Ronald Reagan nominated him for a federal judgeship. That nomination was refused.
Trump’s pick for Homeland Security says he’s committed to diversity, tolerance
Retired Marine Gen. John Kelly will pledge to “speak truth to power” as secretary of Homeland Security, according to prepared testimony for his Senate confirmation hearing today. Kelly will likely speak about Trump’s controversial campaign promises, which include a halt on Muslim immigration and a wall along the Mexican border.
California bans government travel to states with anti-LGBT laws
The Golden State has banned taxpayer-funded travel to Kansas, Mississippi, North Carolina, Tennessee, and any other state with laws that target the rights of LGBT individuals and families. The ban is the result of Assembly Bill 1887, which was signed into law in September 2016 and went into effect January 1 of this year. "California must take action to avoid supporting or financing discrimination against lesbian, gay, bisexual, and transgender people," according to the state’s legislature.
As the Women’s March comes together, a divide forms
The Women’s March on Washington is expected to be the largest demonstration yet against Donald Trump. But while it’s an event meant to unite, conversations about race are making some women feel unwelcome.
The Woke Leader
Meet the woman who designed the sets for ‘Moonlight’ and Beyoncé’s ‘Lemonade’
Hannah Beachler has helped bring to life some of the most highly acclaimed films and videos of the moment. As Hollywood’s only top-level black female production designer, she’s had a firsthand view of the industry’s diversity gap on and off-screen. "I think it's a combination of films not hiring enough people of color, and people not knowing that this is even an option as a career path,” she says. “I’m hoping that maybe I change some minds on the Hollywood side, and also maybe introduce aspiring professionals to this idea as an option. Like hey, everyone! In case you didn't know, there's a really great craft in production design!"
How this LGBT entrepreneur created a company that bets big on diversity
Robyn Streisand, entrepreneur and second-cousin of legendary singer Barbra Streisand, operates a collective of media, marketing, and communications agencies that can service clients under a single contract. What differentiates her business from others: each member company must be “a certified-diverse business.”