I was recently on a telephone call with Antron McKay-West, the president and founder of Upgrade Mississippi. He was describing the frustration people in his tiny hometown on the Mississippi Delta experienced trying to sign up for health insurance under the Affordable Care Act.
Most families in the town still don't have Internet in their homes; cellphone reception is unreliable, it comes and goes like the clouds blowing across the sky.
"It is so rural, most people can't imagine life there," said McKay-West. "Most people don't have Internet, if they do, it's very slow. It's not the technology most people in bigger cities are used to these days.
"I know people who were trying to sign up for health care coverage, but they don't have Internet at home, they don't have email addresses. When they tried to sign up by telephone, the assistants on the other end often told them to just go to the library and use the Internet there to sign up and check their email.
"In the neighborhood where I grew up, the library is 15 miles away," said McKay-West.
His story illustrates just one of the many challenges we have in bringing health insurance -- and then quality health care -- to all people and all communities across the country.
As more people gain health insurance, unless we take concerted action to tackle glaring racial disparities in access to health care, those disparities will only be magnified.
In a new report "Breaking Barriers: Improving health insurance enrollment and access to health care," author and researcher Gary Delgado provides plentiful evidence that the doors to quality health care are still closed to many people of color, families in rural communities, the poor, and those with language and cultural barriers.
Delgado, a visiting scholar at the University of California, Berkeley's Institute of Social Change and a longtime civil and human rights leader, led a team that surveyed 1,200 low-income people in 10 states in Spanish, Cantonese and English. The report was released by the Alliance for a Just Society.
"Obamacare didn't cause the widespread racial disparities we found, but neither did it solve them," said Delgado. "We have a lot more work to do."
There is progress. In late April, Montana Gov. Steve Bullock signed legislation accepting federal funding for Medicaid expansion that will extend health insurance coverage to as many as 70,000 more people.
However, there are still 21 other states where legislators continue to turn their backs on people - about 3.8 million people - who fall into the Medicaid coverage gap, denying them access to affordable health insurance. These are people who earn too much to qualify for Medicaid, but not enough to qualify for ACA marketplace subsidies or afford premiums and deductibles on their own.
It's even more insulting when you plot these 21 states on a map. More than half are states in the Deep South, the states of the Old Confederacy, where a disproportionate share of uninsured people are people of color, especially African American and Latino.
There is no other way to describe it than health care racism. Expanding Medicaid is just the first step toward ending it.
The struggle to access quality care continues even after people of color have health insurance, including the high costs of premiums and deductibles. Many people have never had health insurance, or maybe not for years, and have trouble getting clear information about what's included in their coverage, such as preventive care, checkups and routine tests.
Insurance companies must also be held to their obligation for reducing racial health disparities, and increase transparency in their reporting of results.
In some communities, just finding a personal doctor within a reasonable distance of your home is difficult. Going to the doctor should be no more than a 30-minute trip. Even after enrollment, technology continues to be a barrier when insurance companies expect payments online or send important notices by email.
As the "Breaking Barriers" report recommends, innovative options like school-based health care and community clinics and have to be supported and encouraged, particularly in rural areas.
Medical-legal partnerships should be developed to address environmental factors that impact health, especially in low-income communities where issues like mold in housing and industrial toxins create serious health risks.
Delgado describes the Affordable Care Act as a new house built on an old foundation, using the old bricks. He's right, we need a stronger foundation and more bricks. We also need to welcome everyone inside to enjoy the basic human right of quality, affordable health care.
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