The Affordable Care Act accomplished one major thing: It increased health coverage for Black Americans, according to a study just released by the Commonwealth Fund. In fact, the insurance rate among Black Americans in states that expanded Medicaid is higher than the insured rate for white Americans in non-expansion states. That flipped a constant factor in American demographics.
But, again, it all hinges on Medicaid expansion and whether the states took it. The provision of the law extending Medicaid in all of the states to people earning up to 133% of the poverty level was struck by the Supreme Court in 2012, when Chief Justice John Roberts decided to split the baby by upholding the law but giving conservatives a win by making the provision optional for states. Most Republican states, of course, jumped at the chance to stick it to President Obama and keep their low-income constituents' lives miserable.
In the seven years since, study after study has shown that there are more improvements in health and in decreasing the racial disparity in coverage in the states that expanded Medicaid versus the non-expansion states. In the 31 states that had expanded by 2018, the uninsured rate of Black residents was 10.1%. The uninsured rate of white residents in the non-expansion states was 12.3. Latino Americans also achieved significant gains in coverage, with the gap between uninsured Hispanics and whites declining from 25.7 points to 16.3 points. And, outside of non-expansion states, white adults have also made historic coverage gains.
The bad news is that the gains made in coverage for people of color "have stalled, and even eroded, since 2016," Commonwealth found. "Black adults have seen their uninsured rate tick up by 0.7 percentage points since 2016, while white adults have seen a half-percentage-point increase. This has largely halted the improvement in coverage disparities. Hispanic adults continue to report significantly higher uninsured rates than either white or black adults."
Elections have consequences, and Trump sure has proven that since he took over the White House. His policies, based simply on maximizing cruelty toward people of color (with whatever fall-out happening to poor whites as collateral damage), are being reflected in the decline in coverage in the past three years. Work requirements and creating fear in Latino populations, preventing them from coming forward to claim benefits, means Trump and his cronies have accomplished just what they intended.