The U.S. Supreme Court is set to hear arguments in March for and against the Affordable Care Act and whether the mandate requiring individuals to purchase health care coverage is constitutional. How the justices will rule is anyone’s guess, but there is no question, experts and advocates say, about who has the most to gain or lose if the law is repealed: African-Americans and other people of color.
“The implications for African-Americans and other minorities are significant, whether we’re talking about repealing the individual mandate or the law more broadly,” said Brian Smedlely, who heads the Joint Center for Political and Economic Studies’s Health Policy Institute. “The individual mandate is the piece of the law that makes other elements of it work, including reforms that prohibit insurance companies from cherry-picking enrollees or denying claims based on pre-existing conditions.”
Smedley says that in addition to expanding coverage, the law’s preventive care provision is one of its greatest benefits, particularly for African-Americans because it provides access to medical care and services before preventable illnesses and diseases occur. It also provides greater access to care in underserved communities and seeks to align resources with the greatest need. The law would increase the number of community health centers and provide health care providers with incentives to serve in those communities.
A Gallup poll released Nov. 11 found that 44.5 percent of Americans do not have employer-based health insurance coverage and the percentage of people who do has steadily declined since 2008.
“We don’t let people wait until after they’ve been in a car accident to apply for auto insurance and get reimbursed, and we don’t want to do that with health care,” said White House advisor Stephanie Cutter. “People who make a decision to forego health insurance do not opt out of the health care market. Their action is not felt by themselves alone. Instead, when they become ill or injured and cannot pay their bills, their costs are shifted to others.”
Jerrell Green, a 25-year-old law student at the University of the District of Columbia, is one of those who've had to navigate the twists and turns of health insurance today. When she received her undergraduate degree in December 2009, before the law was passed with the provision to cover dependents up to age 26, she was immediately forced off of her parents’ plan.
“I knew my parents would help if I got sick, but anything can happen and I wondered whether a hospital would treat me without insurance,” said Green, who inconveniently had to have some costly dental work done. “It was a nerve-wracking time.”
Green got a job at Bloomingdale’s, which provided benefits, but she had to pay much more for medical and dental services than she would have under her parents’ plan. In addition, she didn’t realize that under the new law she could have gone back on the plan in September 2010 and mistakenly believed the provision was only for full-time students. Now back on her parents’ plan, she’s grateful and hoping to find a job before her law school graduation so she won’t have to worry about health care access again.
“If the Supreme Court overturns the law it will have significant negative ramifications for African-Americans and all Americans because it would undercut efforts to extend health care as a right more than a privilege,” said Wade Henderson, who heads the Leadership Conference on Civil and Human Rights. “The impact [of a repeal] on people of color, particularly in communities without resources, would be devastating.”
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