Six years ago, President Barack Obama achieved one of the greatest feats in political history with the passing of the Affordable Care Act (ACA). And, despite critics’ attempts to paint it negatively with the moniker “Obamacare,” the name and the accompanying benefits of the law have caught on.
As this year’s historically unpredictable and darkly comedic primary season drags on, “Obamacare” has been painted in a variety of different lights. It’s been hailed by some as a good program that needs tweaks to become great. It has been characterized as a stepping stone to socialized medicine. But the voice and sentiment that’s been the loudest is that of presumptive Republican presidential nominee Donald Trump, who has vowed to “repeal Obamacare.” I understand how one could disregard the notion amidst the neverending side shows about hand size, emails, socialism, superdelegates, contested conventions, race baiting, rally violence and who is or is not “acting presidential.”
I urge you not to be sidetracked by the chatter. Those distractions have covered up a few very real issues that this election will decide. One of the biggest is the future of Obamacare. If Trump is elected and is able to repeal the law, 20 million newly insured Americans (including three million African Americans) could potentially lose access to healthcare. This election presents both opportunities and challenges for health reform. It will determine whether we move toward a more equitable, accessible, patient-centered health system or whether we reverse course back to a system of increasing health disparities.
So, what does life without Obamacare really look like? First, we have to start with getting a really good understanding of how we got here and what exactly has transpired since the law’s passing.
History tells us that a rollback for minority health is not only possible, but has happened before. My book, “150 Years of Obamacare,” gives an accounting of what transpired more than 150 years ago. Shortly after the Civil War, Congress narrowly passed legislation to create the Freedman’s Bureau. It was a federal agency tasked with providing food and medical care to freed slaves and poor Whites in war-torn areas of the country. The Bureau established hospitals throughout the South, and provided care to more than half a million patients. But just seven short years after its creation, Congress voted to shut down the Freedman’s Bureau and dismantle a successful health reform program–a decision that would impact generations of African American families over the next century.
Six years since its enactment, Obamacare has survived two Supreme Court challenges and more than 60 repeal votes. And just a few months ago, it was nearly dismantled when congressional Republicans used a fast-track legislative tool known as reconciliation to send a bill to Obama’s desk with only a simple majority in the Senate (the president, of course, vetoed the bill).
After surviving all of these challenges, the law is understandably seen as invincible by many supporters. And they’ve become complacent and secure in the belief that Obamacare is here to stay. But that complacency is misguided, dangerous for vulnerable populations, and could ultimately halt all of our hard-fought gains for health equity. This law is a year younger than the Freedman’s Bureau was when it was overturned and this newest law is still not out of the woods. Unless ACA obstructionists can propose a health reform policy that will provide comparable or greater protections for the most vulnerable among us, we could be on the fast track to poor health and mortality.
Now that you understand where we’ve been, let’s look at where we are and why repealing the law is not a good option. The law, in its final state, includes 62 provisions specifically designed to reduce and eliminate health disparities among vulnerable populations, making it the most comprehensive healthcare law prioritizing health for people of color. Some of these provisions required insurers participating in the federal exchanges to reward healthcare providers for programs that reduce health disparities and established six new offices of minority health at federal agencies tasked with ensuring that new federal regulations incorporate health equity measures. Other provisions extended and expanded non-discrimination protections to communities that have long experienced discrimination in health care, including women, racial and ethnic minorities, people with disabilities and the LGBT community.
Overall, this historic law has resulted in the lowest uninsured rate ever recorded in our nation’s history–9.1 percent down from 16 percent. Since 2013 when the bulk of the law took effect, the ACA has resulted in three million African American adults and more than 500,000 young adults gaining health insurance. And the nearly 8 million African Americans with private insurance now have access to preventive services like mammograms, diabetes screening, depression screening or flu shots with no co-pay or deductible. I’ve even had people tell me stories of “discovering” benefits with their health insurance that they didn’t have before like insurer-provided breast pumps and various types of nutrition counseling. And a few of my own family members, who are entrepreneurs and were previously unable to get insurance because of pre-existing conditions, will never be denied life-saving care again as long as Obamacare stays intact.
Whether or not you believe in (or are just plain exhausted with) the political process or agree with the proposals of each party’s nominee, staying at home instead of going to vote in November could literally be hazardous to your health.
Daniel Dawes is the executive director of health policy and external affairs at the Morehouse School of Medicine. He is also the author of the new book “150 Years of Obamacare,” which was made possible with support from the Aetna Foundation.