This Black History Month, Many Black Americans Are Still Struggling to Access the Health Care They Need

Feb 15, 2024

It seems inadequate to designate just one month a year Black History Month given how central Black people have been to every epoch of our nation’s development dating back to the earliest days of the Republic. Nonetheless, Black History is a good opportunity to take stock of how far we’ve come on ‘life, liberty and the pursuit of happiness,” for everyone and how equitable these outcomes are across race and place.

There’s been substantive progress on increased access to health care, improvements in Black representation in leadership and government and wage gains over the last few years without a doubt. The Biden Administration is the most diverse in the history of America, with Black and Brown leadership that stretches from agency to agency all the way up to our Vice-President, who claims both Black and Asian ethnicities. The Centers for Medicare and Medicaid Services, one of the largest agencies in government with services reaching two thirds of all Americans, is led by a Black woman, Chiquita Brooks-LaSure.

Not only are agencies demonstrating more diverse leadership, they are implementing administrative and legislative policies that increase opportunity and equity for ethnic groups that face a legacy of discrimination when it comes to opportunity and resources. As of this writing, the Biden Administration is taking historic action to implement the Inflation Reduction Act, which makes huge improvements to lower drug prices in Medicare. Just like in every other health program, Black Americans have the least access and greatest challenges in accessing care through Medicare largely because of affordability. And, for a variety of reasons, Black Medicare enrollees have disproportionately higher rates of certain health conditions relative to their non-Black counterparts, including higher rates of hypertension, diabetes, stroke, some types of cancer, and heart failure. Thanks to the IRA, 5.8 million Medicare Part D enrollees who are Black and will benefit from prescription drug price reforms that will make their insulin, heart medicines and vaccines cheaper. 

The IRA also made healthcare more affordable for people too young for Medicare by making coverage on the ACA (Affordable Care Act) exchanges much more affordable than in past years. Between 2020 and 2022, when the new affordability provisions were implemented, Black enrollees increased their participation in coverage by 49%. The extended Special Enrollment Period (SEP), the expansion of marketplace outreach and Navigator funding also helped. 

In 2024, enrollees in the ACA coverage saved an average of $800 a year thanks to increased premium assistance under the new IRA. As a result, we’ve seen record enrollment in the ACA, a 30% increase over last year, particularly in southern states where Black people are most likely to be without coverage. In fact, Mississippi, Arkansas, Alabama, South Carolina, Georgia, Arizona and Texas all saw increased enrollment by 45% or more. Florida enrollment increased by nearly a million more–the most of any state. 

That’s not all. Thanks to Medicaid improvements made under the pandemic era American Rescue Plan and then made permanent in 2022, we’ve also seen more money directed toward addressing Black maternal and infant mortality. Black women, in particular, face greater barriers to accessing health care than their White counterparts, a major contributing factor to the disproportionately high maternal mortality rates faced by Black women. The now permanent law enables states to provide up to one year of postpartum coverage for new mothers that will hopefully address the maternal disparities and result in better outcomes for Black mothers and infants. 

Improved and more accessible coverage for Black American helps chip away at long standing inequities but it takes more than that to equalize the opportunity for good health outcomes, since health outcomes are influenced as much by other factors–like job, environment, safety, etc.–as they are by health coverage. And, unfortunately, in some areas we are moving backwards as a nation in ways that will disproportionately impact Black people. 

For instance, since the Supreme Court’s Dobbs decision, dozens of states have jumped at the chance to implement abortion bans that strip access from patients and put providers at risk of jail time. Several of these states – notably Louisiana, Mississippi, and Alabama – already have the highest maternal mortality rates in the country, particularly for Black residents. Even more chilling, research suggests that under “a nationwide total abortion ban, there could be a 24 percent increase in expected maternal deaths nationwide, with Black women projected to see a 39 percent increase.”

And, of course, politics continues to be an impediment in 10 states that have refused to expand Medicaid, leaving millions of patients locked out of a program that provides quality, affordable health coverage. In these states, “uninsured Black adults are more likely than their White counterparts to fall into the gap, with a 15.0% uninsured rate in states that haven’t expanded Medicaid and an 8.0% uninsured rate for states that have expanded Medicaid.” 

This year, let’s celebrate all the progress that has been made especially in the last few years for Black health in America while we simultaneously double down on the “to-do” list that requires us to keep working hard not.  Black Americans have greater representation, access and affordability in health outcomes–but until their health outcomes are also equal–we have more work to do.