As we wait for the Supreme Court to announce the fate of the Affordable Care Act, researchers at the Urban Institute's Health Policy Center have released a study that indicates that the Affordable Care Act will dramatically shrink racial and ethnic differences in health care coverage. Currently 21.6 percent of blacks and over 33.3 percent of Hispanics are uninsured, compared to just 13.9 percent of whites. According to researchers, Lisa Clemens-Cope, et al., if the Supreme Court upholds the Affordable Care Act, it could potentially cut the black-white differential in half, and the Hispanic-white differential by a quarter.
The fight for affordable health care is a fight for racial equality. Though many who have actively opposed the Affordable Care Act, would dismiss this assertion, the bottom line is that if the Supreme Court upholds the law, it will be a huge step toward dissolving fundamental racial inequities in health care. Historically access to health care has been so deeply shaped by institutionalized and practiced racism that federal health care law is the only means of systematically rectifying disparities. While there is no way of knowing what the court will do, it is important to acknowledge this connection between race and health care to fully understand the impact of the court's decision. If the justices uphold the law, it will advance the dream of equality. If they overturn the law, or effectively do so by striking down the government's right to impose an individual mandate, it will be a terrible blow to that dream.
American history is littered with instances in which blacks received poor care or no care at all, most famously the Tuskegee experiments in which the U.S. Public Health service secretly withheld treatment for syphilis from black men over a 40-year period. Though instances like this one demonstrate how the devaluing of black lives resulted in specific abuses, we should also remember that health care in this country was a critical part of institutionalized racism.
In 1960, a terrible car accident involving seven of my family members brought the relationship between racism and health care into stark relief. They were taken to a hospital, not because it was the nearest, but because it had a Colored ward. Two would be pronounced dead on arrival. A nurse then checked to see how many beds marked Negro would be available for the other five. They were treated with equipment meticulously marked Negro, while my father waited in an area underneath a sign that read Colored Only. In the end, just two would survive. My father lost his wife, mother, sister, brother-in-law, and 4 year-old nieces. As if this grief was not enough, he would spend the rest of his life knowing that maintaining white supremacy had taken precedence over saving their lives.
Though this took place over 50 years ago, the story of how segregation in hospitals was brought to an end, stresses the potential for the Affordable Care Act to address racial disparities today. It was not the Civil Rights Act of 1964 that ended racial segregation in American hospitals. It was Medicare. As sociologist, Jill Quadagno, points out in One Nation, Uninsured: Why The U.S. Has No National Health Insurance, the passage of Medicare in 1965 gave the federal government the power to demand desegregation by threatening to deny Medicare funds to hospitals that did not comply. Medicare went into effect on July 1, 1966, and according to Quadagno in just three weeks, all but .5 percent of hospitals were certified as integrated. In a matter of weeks, Medicare had ended what had previously appeared to be an intractable system of racial segregation.
Unfortunately, Medicare did not end all racial discrimination in health care. The fact that blacks and Latinos today are disproportionately among the uninsured is the de facto extension of this long history. Medicare did, however, establish fair access to health care as an important goal. The Affordable Care Act is a vital step in making that objective a reality.
If this connection between the past and the present seems farfetched, one need only consider today's health care debate to realize that race still impacts attitudes about who merits health care. According to a Greenlining Institute study, opposition to national health care policy can be traced to "racial resentment," or the belief by whites that blacks simply are not working hard enough and therefore do not deserve health care. This idea has been subtly interjected into anti-Affordable Care Act rhetoric. Remember claims that President Obama wanted to "pull the plug" on grandma so that hordes of uninsured people could step over her body to receive free health care? Who did you picture as the beloved grandma on life support when you heard this claim? It probably was not an old black lady.
Now after all this fear mongering, it seems that the Supreme Court holds the real power to pull the plug on the uninsured. If they strike down the law, it will impede the cause of racial equality. If they uphold the law, it could set us on a path toward health care as a fundamental human right. The law's implementation would be expected to be complete in 2014, the 60th anniversary of Brown v. Board of Education, which ruled that segregation in schools was unconstitutional. I can only hope that once again, the court will stand on the right side of history.
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