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.
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