Compared with other Americans, African Americans are less likely to receive preventive care and more likely to have chronic diseases such as diabetes and certain cancers.12,13 Heart disease and stroke account for the largest proportion of disparities in life expectancy between African Americans and non-Latino Whites, despite the existence of proven prevention strategies.14 African American women are less likely to be diagnosed with breast cancer but are more likely to die from it. Researchers suggest this is due to higher rates of uninsurance, unequal access to improvements in cancer treatments, and barriers to early detection and screening among African American women.15
The Affordable Care Act helps to address these disparities by making prevention more affordable and accessible, requiring many health insurance plans to cover prevention and wellness benefits with no cost-sharing (such as a co-payment or deductible).16 The services that many insurers are now required to cover with no cost-sharing include well-child visits, blood pressure and cholesterol screenings, diabetes screening, Pap smears and mammograms for women, and flu shots for both children and adults. Another covered benefit, colonoscopy screening, is particularly important for African Americans, who are more likely to suffer from and die from colorectal cancer than other Americans.17 The law also requires coverage of HIV screening without cost-sharing for individuals at high risk of infection. This is also important for African Americans, as they experience HIV infections at more than seven times the rate of Whites and nearly half of new HIV infections are among African Americans.18 An estimated 5.5 million African Americans with private insurance currently have access to expanded preventive services with no cost-sharing because of the Affordable Care Act.19
The 4.5 million elderly and disabled African Americans who receive health coverage from Medicare also have access to an expanded list of preventive services with no cost-sharing under the Affordable Care Act. These benefits include an annual wellness visit with a personalized prevention plan, and access to such important screenings as diabetes and colorectal cancer screenings, bone mass measurement, and mammograms.20
The Affordable Care Act benefits African Americans in many other ways, including:
- Improving Chronic Disease Management. Racial and ethnic minorities often receive poorer quality care and face more barriers in seeking care and chronic disease management than non-Latino White patients. African Americans have higher hospitalization rates from influenza than other populations. African American children are twice as likely to be hospitalized and more than four times as likely to die from asthma as non-Latino White children.21 The Affordable Care Act’s Innovation Center explores opportunities to invest in care innovations such as community health teams to improve the management of chronic disease.22 This will help African Americans as 48 percent of African American adults suffer from chronic disease compared to 39 percent of the general population.23
- Increasing Access to Community Health Centers. Nearly 26 percent of patients served by community health centers in 2010 were African American, and the Affordable Care Act increases the funding available to the more than 1,100 community health centers — located in all fifty states, the District of Columbia, and Puerto Rico — to enable them to increase the number of patients they serve.24 Health centers have received funding to create new health center sites in medically underserved areas, to expand preventive and primary health care services, and to support major construction and renovation projects.25
- Diversifying the Health Care Workforce and Strengthening its Cultural Competency. The Affordable Care Act increases the racial and ethnic diversity of doctors, nurses, and other health care professionals. For example, the law has helped to nearly triple the number of clinicians in the National Health Service Corps, a network of primary care providers serving communities with significant medical, dental, or mental/behavioral health needs.26 The Corps provides scholarships and loan repayment to medical students and primary care physicians, as well as other health professionals, in exchange for a commitment to serve in an underserved area. African American physicians make up about 17.8 percent of Corps physicians, a percentage that greatly exceeds their 6.3 percent share of the national physician workforce.27
Other initiatives in the Affordable Care Act make it easier for people with disadvantaged backgrounds to become health care professionals and strengthen cultural competency training among health care providers.28 These initiatives will help providers better understand and respond to the particular experiences and needs of African Americans and other minorities and communicate more effectively with their patients.
- Addressing Health Disparities. The Affordable Care Act invests in data collection and research focused on disparities in health and health care to help us better understand the causes of disparities and effective programs to eliminate them.29 The law also invests in the Community Transformation Grant program to support States and communities by promoting healthy lifestyles (for example, tobacco-free living), especially among groups experiencing higher rates of chronic disease such as African Americans. The program aims to improve health, reduce health disparities, and lower health care costs.30
Leveraging the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) has developed and is implementing the HHS Disparities Action Plan, the Department’s largest commitment to the elimination of health disparities.31 HHS is also in the process of upgrading data collection standards to better understand the causes of health disparities and evaluate progress toward eliminating them.32 The law promotes the National Center on Minority Health and Health Disparities at the National Institutes of Health (NIH) to Institute status, enabling it to access increased funding and to plan, coordinate, and evaluate disparity-related research within NIH.33 The Affordable Care Act also creates a Patient-Centered Outcomes Research Institute which will fund research that helps patients and their care providers make more informed treatment decisions, including the study of differences in healthcare outcomes among racial and ethnic minorities.34
Because of the Affordable Care Act, all Americans will have access to affordable health care coverage. For African Americans, the benefits are especially important. The law’s benefits will help reduce disparities in both health care and health outcomes through expanded insurance coverage and better access to high-quality health care services.
Table 1. Key Benefits of the Affordable Care Act for African Americans
Key Benefits of the Affordable Care Act for African Americans
|Benefit||Expanded Insurance Coverage (ages 19-25)||Preventive Health Services (Private Insurance)|
|Expanded Insurance Coverage (ages 19-25)||410000||Plan years beginning on or after September 23, 2010|
|Preventive Health Services (Private Insurance)||5500000||Plan years beginning on or after September 23, 2010|
|Preventive Health Services (Medicare)||4500000||January 1, 2011|
|Expanded Insurance Coverage (ages 0-64)||3800000||January 1, 2014|
Nearly Four Million African Americans Will Gain Coverage Under the Affordable Care Act
Source: RAND COMPARE microsimulation model.
Note: Estimates shown are for 2016 coverage of individuals ages 0-64 reporting themselves as Black or African American.
Estimates do not include individuals reporting themselves as Spanish, Hispanic, or Latino, or reporting more than one race.