The U.S. Department of Health and Human Services (HHS) recently released a new report that shows historic gains in health care coverage access and affordability among Black Americans. The report, which was produced by researchers in HHS's Office of the Assistant Secretary for Planning and Evaluation, shows that since the implementation of the Affordable Care Act (ACA) beginning in 2010, the uninsured rate among Black Americans under age 65 decreased from 20% in 2011 (approximately 7.1 million people) to 12% in 2019 (approximately 4.4 million people), a decline of 40%.

“Since the passage of the Affordable Care Act nearly 12 years ago, the law has significantly expanded access to life-saving health coverage, including for Black communities across the country,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “Advancing health equity is one of my top priorities, and, in pursuit of this goal, CMS invested in significant outreach to the Black community during this recent Open Enrollment period. The coverage gains achieved during Open Enrollment are just a first step – CMS will continue to advance health equity by expanding coverage access through Medicaid and the Children’s Health Insurance Program, Medicare and the ACA Marketplaces.”

The ACA has provided subsidized health care coverage to nearly 9 million people who purchased coverage with federal premium help. However, millions more remain uninsured despite being eligible.

The report shows that states that have not expanded Medicaid have the highest percentage of uninsured adults and children who are Black. If the remaining 12 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming) were to expand Medicaid, an estimated 957,000 Black Americans without insurance coverage would become eligible for Medicaid coverage.

The 2021 American Rescue Plan (ARP) extended eligibility for ACA health insurance tax credits and assistance to those who have incomes over 400% of the federal poverty level. This means most of the uninsured are now eligible for financial assistance.

Many of the 30 million uninsured Americans are members of communities of color, and health coverage has been perceived as out of reach because of cost. With increased subsidies from the American Rescue Plan, 76% of uninsured Black Americans could find a plan on Healthcare.gov for less than $50 a month, and 66% could find a plan for $0 a month in 2021.

Unfortunately, however, these provisions were only authorized for two years. The California Medical Association (CMA) is urging Congress to ensure the long-term stability, affordability and effectiveness of the ACA by making the provisions of the ARPA permanent.