The Role Of The Affordable Care Act In Reducing Racial Disparities In Healthcare
Obama’s Affordable Care Act, signed into law in 2010, was a main focus of his election and the biggest shock to healthcare in years. As the foundation of the election for our first African American president, it is no surprise that the ACA had mixed responses from the public. That being said, there is no denying the statistics showing the wildly positive impact on minority groups, millions of whom were without coverage beforehand. Though the ACA has much room to grow and become more polished, it was a brave, history altering policy that has moved the US closer to racial equality in healthcare. It is important to understand that the full impact of the ACA will not be known until many years from now.
There is no way of knowing how it may evolve or disappear, in which case it could still have success in inspiring future policy changes. It is also yet to be known whether universal healthcare is the right direction for the United States. In a diverse country with conflicting ideas and opinions it will always be hard to please everyone. Though we are far from achieving a healthcare policy that benefits all, we should applaud President Obama’s attempt for its successes in helping minorities gain vital health coverage. Its targeted approach to aiding those with historical barriers to coverage is precisely why it was more effective in helping them than previous policy has been.
In this review of literature, I will begin by citing sources detailing the history of healthcare in the United States. These pieces will provide foundational information to help understand and analyze the Affordable Care Act. My next section will cover literature on the Affordable Care Act, its implementation, and its aim to help uninsured minorities. It will have a focus on the direct impacts to communities of color and other marginalized groups. Finally, literature on the present day status of the ACA will help gauge its success in following through on its original goals.
Background
These pieces show a couple of things. First, telling the history of healthcare will allow me to show how racial disparities in healthcare came about in the first place. With this I will be able to show exactly where the ACA changed things and make some sense of it. Second, this will give insight as I try to make suggestions for the future, looking carefully at what was not covered by the ACA. I plan to start at the beginning of healthcare in the US and take a short trip through different periods in time, showing how racial equality has progressed alongside healthcare.
Bhopal provides a detailed history of healthcare and how it has affected different racial groups. Inequalities in healthcare coverage have led to certain groups having significantly lower life expectancy than others especially for Blacks and Hispanics, and also talks about the effect of income in healthcare coverage, again highlighting those minorities without access for financial reasons. Bhopal’s definitions are important to include in this review, as they clarify the language used in other articles. Race is defined as “The group a person belongs to as a result of a mix of physical features, ancestry, and geographical origins, as identified by others or, increasingly, as self-identified. ” Throughout time social factors have muddied the definition of race, making it more important to have a clear definition for the commonly used term. Bhopal defines ethnicity as “The group a person belongs to as a result of a mix of cultural factors, including language, diet, religion, ancestry, and race”. The last critically important definition is that of racism: “A belief that some races are superior to others, used to devise and justify actions that create inequality between racial groups”
The piece by Rucker and Williams talks about the systemic factors that have led to racial disparities in healthcare. It brings in the topic of stereotypes to help further explain how different groups have had serious disadvantages and barriers to coverage. They also identifies some strategies to make healthcare coverage more effective.
There are many more examples of inequality in existing literature. Wenneker and Epstein showed that black patients had lower rates for coronary angiography and coronary artery bypass grafting than white patients after adjustment for confounding factors. Hannan showed that black patients had fewer cardiac procedures than white ones after adjustment for disease severity. Goldberg et al reported that coronary artery bypass rates in black men and women were a quarter and a third respectively of rates in white men and women. Whittle et al showed inequalities between black and white patients in invasive cardiac procedures. Ayanian et al reported that black patients had fewer coronary revascularisation procedures than white patients. Carlisle et al showed that in Los Angeles invasive cardiac procedures were less common in Latin American and black patients than in white patients, but not in Asian patients compared with white patients. Peterson et al showed that black patients had fewer cardiac procedures yet better short term survival and equivalent intermediate survival rates.
Countless examples expose a glaring difference in healthcare coverage of different racial groups throughout history. Identifying the issue is only half the battle though, because past literature does a good job of this yet offers little in the form of solutions. I speculate that the answer is that nobody really knows what will work best. It is hard to compare the US to any other country in this dimension. The sheer size and diversity of the US make policy formation that much harder than it would otherwise be in more homogenous nations. Next, I will review literature analyzing the ongoing successes and failures of the ACA since implementation.
Affordable Care Act
This section shows different dimensions of the ACA. First, the details of the ACA and how it was targeted at certain minorities. I will try to explain how this policy has been similar to and different from other healthcare policies in the past. Next, these pieces help show the impact of the ACA in reducing the race gap, providing healthcare for millions of minorities without prior access. I also plan on talking about which groups were negatively affected by the new policies and why they will be the key to the future. Lastly, I will discuss the progress of the ACA against the promises that were made beforehand and the dimensions that must change in the future to make it more successful. The pieces about the success and progress of the ACA will directly supplement my thesis regarding the coverage of minority groups. They provide good statistics as well as opinions regarding the success of the ACA.
The topic of this article by Blumenthal is the progress of healthcare under the affordable care act, especially for racial minorities. They come to find that over 20 million Americans have gained coverage, reducing racial disparities in healthcare that have long existed. It gives good numbers of how many people, and which groups are covered differently than they were prior. It also addresses some of the obstacles and failures of the ACA and looks toward the future.
It is worth noting that Whites and Asians still boast the lowest uninsured rates. It is also important to note that these drops were less than initially promised in the ACA plans.
This piece by Clemens-Cope talks about projections for the ACA, detailing how it can close the racial gap if certain pieces are executed correctly. One of the most important factors is enrollment rates in states that contain large percentages of blacks and Hispanics, which will determine how effective the ACA really is. This piece shows exactly how certain minority groups are projected to respond to the ACA. It takes an optimistic stance, which can be compared to the more modern progress report for accuracy. This piece by Chen begins by detailing how racial inequality in healthcare has been the biggest contributor to racial disparity overall. It goes on to show how many more people have access to healthcare now than prior to the ACA. Lastly, it talks about cross-state inequalities in implementation and how than can affect the future of the ACA.
Cons of ACA
It is equally important to highlight some of the failures of the ACA since its implementation Wilensky lists several key areas in which Obamacare failed to follow through on its initial promises. Original ACA projections predicted the number of uninsured would drop from over 50 million to under 25 million by 2016 and remain steady thereafter. Instead over 31 million, roughly 10% of the American population, remain uninsured. Kamerow claims that there are certainly more effective and less costly methods to achieve the same goal. In order to reduce high premium costs, several doctors have lost their jobs as well. People want to be able to trust their doctors, so the combination of lost doctors and changed coverage has stirred some anger in the process. Obama also promised people that if they liked their current plan they could keep it. This promise fell through once again as many plans did not comply with new ACA regulations. This has resulted in many states losing more than 75% of their insurers, greatly limiting people’s options. Higher premiums have also been a problem for people who were promised lower ones by Obama. The average employer family premium has risen almost $5,000 since 2008. Lastly, perhaps the most dangerous threat to Obamacare has been the high administrative costs that have accompanied its implementation. It is estimated that the additional administrative costs due to Obamacare will total $275 billion from 2014 to 2022.
Conclusion
Though the ACA is still relatively young and much is destined to change in the coming years, it still provides a very valuable case study for both voters and policy makers. People now see what the necessary steps would look like toward universal healthcare, complicated and slow ones to say the least. Much more work is needed to make healthcare policy that pleases everyone. The main difficulty here is catering to minorities without coverage, while also pleasing the people who like their current policies. Current literature is mixed on the ACA, applauding its success in bringing coverage to millions who were previously uninsured, while criticizing its incompletion and limitations. As shown in my literature review, there is strong evidence supporting the ACA’s targeted mission to provide coverage to historically marginalized groups, marking that as a great success despite overall mixed reception. The media continues to play a large role in public sentiment surrounding Obamacare.
The Northeast and Midwest saw the least change, while western and southern states had a large jump in insured numbers, especially in rural areas. It is worth noting that although more Americans are insured, many are unhappy with the new coverage they are receiving. It is also worth noting that most large cities did not see much change in their insured numbers. These cities also control most of news media, which could indicate that they’ve falsely represented the success of the ACA in rural communities. We don’t often hear from the communities that benefitted most from Obamacare, and it is hard to trust any major news outlet nowadays as their narrative reflects the upcoming election. It will be incredibly interesting to see if healthcare is a main topic of discussion in the 2020 election. It is my guess that with everything else going on the candidates will be distracted from the issues surrounding healthcare, and it won’t be till both sides can find some form of cooperation that we will see any sort of progress.
