Tuesday, July 25, 2017
When the constitutionality of the Affordable Care Act's Medicaid Expansion was on the line in the U.S. Supreme Court, the Leadership Conference on Civil and Human Rights filed an amicus brief that connected the dots between health care expansion, race, and the human rights norms of the UN Race Convention, to which the US is a party. As that brief pointed out, the ACA would have a particularly important and positive impact on the health of black families and individuals with incomes just above the poverty line. By the time the case arrived at the Court, the US government had already touted the ACA in international fora as an indication of US commitment to narrowing the race gap in health care; the international community had applauded the new law as evidence of progress. In the end, that progress continued. Supreme Court upheld critical aspects of the Medicaid Expansion and 32 states have adopted expanded Medicaid. The race gap in health care narrowed through 2014, and continued to narrow according to the latest data, though less than had been hoped because many of the 18 states that have not expanded Medicaid have relatively large black populations.
As the Senate turns to debating repeal of the ACA, little media has focused on the racial impacts of the proposed rollback of Medicaid expansion, particularly in local media markets. For example, one study found that Wisconsin newspapers had provide "little or no" information regarding racial impacts of ACA repeal.
It's not for want of evidence. In March 2017, at an early stage of the debate, the Center for the Study of Social Policy released a report examining the likely racial impact of cuts to Medicaid. According to the report, " [t[he progress made to date in drastically reducing the uninsured rate in through expanding Medicaid in States (“expansion states”) is now at stake." Many blogs have taken note of this troubling aspect of the repeal effort and urged greater attention to it. A report from the National Women's Law Center predicted that women of color would bear the brunt of an ACA repeal. Of the 8 million women likely to lose coverage upon repeal, the report concluded, two-thirds are women of color.
The Medicaid Expansion of the ACA has been helping the US move toward achieving its human rights commitments. In light of the human impact of repeal, it's cold comfort that, if the Republican party is successful in clawing back the Expansion, the administration will have to answer to the international community committee during the next review of US compliance with the Race Convention.