Obamacare and Race

One of the signature issues for both major political parties is health care. Many Republicans want to repeal the Affordable Care Act, also known as Obamacare, that passed in 2010. President-elect Joe Biden, who was Vice President in the administration under which Obamacare was passed, says he wants to expand it. These are two wildly differing views on what to do with our health care system.

However, given the current climate of racial unrest in the United States, as well as the potential repeal of the law being considered by the United States Supreme Court, it seems timely to talk about Obamacare from a racial justice standpoint.

So, where does Obamacare stand from a racial justice standpoint? Well, I have some good news for proponents of Obamacare, and some not-as-good news:

Reductions in uninsured rates were significant among minorities.

Among the highlights of those gains:

  • 21.8% of American Indians and Alaska Natives were uninsured as of 2018, down from 32% in 2010.
  • 19% of Hispanics were uninsured as of 2018, down from 32.6% in 2010.
  • 11.5% of Blacks were uninsured as of 2018, down from 19.9% in 2010.
  • 9.3% of Native Hawaiians or Other Pacific Islanders were uninsured as of 2018, down from 17.9% in 2010.
  • 6.8% of Asians were uninsured as of 2018, down from 16.7% in 2010.[1]

These are undoubtedly significant gains. However…

The aforementioned gains I mentioned have stalled out.

Most of the gains that occurred were between 2014, when important provisions of Obamacare were implemented, and 2016. Those gains have stalled since then, and for Blacks the rate of those uninsured has started to tick up in recent years. The Kaiser Family Foundation, which focuses on health care issues, attributes this to certain policy changes in the Trump Administration “that affected the availability of and enrollment in coverage.”[2] But whatever the reason for this stall, it has happened, and this stalling trend is one that a President Biden will need to address (assuming the Supreme Court doesn’t repeal the law).

However, the gaps in insurance by race are about more than just what’s coming out of Washington, DC. It’s also because of policies at the state level.

Many states with large Black populations have refused to expand Medicaid under Obamacare.

As a result of this, even though there appear to be modest gains in racial disparities among the uninsured overall as a result of Obamacare, the gains are not as big as many might like. Additionally, the result of this is that about half of the remaining uninsured Americans are people of color.[3] This goes to show that elections have consequences—not just federal elections, but state ones too. This is worth keeping in mind for future elections at the state level.

In spite of the issues I’ve mentioned, the racial gap among the uninsured has closed somewhat.

The rate of those without insurance has dropped among whites too, but as there were fewer uninsured whites than uninsured people of any minority group to begin with, the rate among whites of those lacking insurance dropped more slowly than among any other racial group. As such, the racial gap among the uninsured has closed somewhat, even if there are disparities that still exist.[4]

In spite of all this data I’ve shared, there are some unanswered questions.

So far, I have painted a mixed picture of what Obamacare has been like for minority groups, particularly from an insurance coverage standpoint. But there are some unanswered questions about the true impacts of the health care law, too. Here are a few such questions:

  • While the number of uninsured Americans has decreased significantly since Obamacare was passed in 2010, the number of underinsured Americans has also increased.[5] To what extent does this underinsurance issue affect people of color?
  • Is there anything about Obamacare that might, even unintentionally, contribute to the continued (if somewhat decreased) gap in the uninsured between some minorities and whites?
  • There are mixed messages about how Obamacare affected health care costs—out-of-pocket health care spending decreased, while premiums increased.[6] To what extent are people of color getting the benefit of reduced health care spending, or the drain of increased premiums?

The unanswered questions are so numerous that I may need to republish this post at some point, as a version that hopefully answers some of the questions that I’m asking here.


Over the last several hundred words, I have painted a rather mixed message on the question of Obamacare and racial justice. But where does this leave us?

For those in the United States who care about American health care, this raises some questions. For the Republicans, who are proponents of repealing and replacing the law, how does the law get repealed and replaced without erasing all the gains that people of all races, particularly minorities, have seen as a result of Obamacare? For Biden and his supporters, how can we continue making progress in increasing the number of insured Americans, and how might the issues with underinsurance and health care premiums be addressed (assuming, once again, that the Supreme Court doesn’t strike down the whole law)? And for all sides of the debate on this law, how can we ensure that every American is insured?

The last question is maybe the most important one of all, because access to affordable health care should be a human right, not just a privilege to those fortunate enough to access it.



[1] https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

[2] Ibid.

[3] https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2020/02/19/there-are-clear-race-based-inequalities-in-health-insurance-and-health-outcomes/

[4] https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

[5] https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca

[6] https://www.cnbc.com/2018/01/22/out-of-pocket-health-spending-dropped-after-obamacare-rolled-out.html

4 Replies to “Obamacare and Race”

  1. These aren’t unanswered questions. The confounding issues are the continued belief among 20 and 30-year-olds that they can do without health insurance, and how people are accustomed to using healthcare. In affluent households, the notions of carrying health insurance and having a long-term relationship with a doctor are no-brainers. Poorer households aren’t accustomed to that and are accustomed to using clinics and ERs, where they are unlikely to see the same doc on consecutive visits. The ACA was designed to change that behavior, which ultimately would have improved the quality of care and lowered costs. However, the orange idiot undercut it.

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    1. Hmmm. Do you have articles (or other information) that answers some of the stuff that I said was unanswered?

      You might be interested in this article, by the way: https://www.commonwealthfund.org/publications/issue-briefs/2019/aug/who-are-remaining-uninsured-and-why-do-they-lack-coverage. I’m actually left with a different impression, which is that a lot of younger people who don’t have health insurance are going without because they don’t think they can afford it, not because they believe they can do without. One of the unfortunate things about Trump in the White House is that it means we lack that information campaign to inform people that it is quite possible that some of them in fact can afford health insurance.

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  2. The pandemic had the effect of spotlighting the fact that if people lose their job they lose the health insurance, if insurance wasn’t always connected to your job then it might be more viable. Companies could off the option but if an employee didn’t want their offered plan then the deduction from their paychecks would be put back into their take home pay. A lot of people have the option of not taking long term disability insurance from their employer so they do not need to pay for it. These could be options to make it more palatable for people who like their health care options from their employers. Living in Massachusetts we had mandatory health coverage before the ACA so we are a study for the rest of the country.

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    1. You’re absolutely right that the pandemic has put a spotlight on how if people lose their jobs, they lose their insurance. That deserves more attention than it is getting. Which casts into issue the fact that health insurance is tied to one’s employers.

      Ironically, when Obamacare passed it was while we were still trying to recover from a time when many were reeling from lost insurance due to lost work (the Great Recession).

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