Repealing the Health Care Law Could Impact Women of Color Hardest

Photo: (CC) Jim Sheaffer
By Amie Newman |

Women of color have the most favorable opinion of the Affordable Care Act (ACA) of all Americans, according to a recent Kaiser Health poll, and would be the most impacted if it were repealed, or if key provisions were stripped from the law. Black and Latinx women in the U.S. are more likely to be poor and uninsured and have less access to health care. The ACA has helped counter these conditions.

The ACA has provided close to 20 million people with health care coverage since it was implemented in 2013. Some of the most contentious parts of the health care law have to do with coverage of critical reproductive health care services: pregnancy, childbirth, contraception, and other preventative women’s health services — including mammograms, screenings for sexually transmitted infections, and HPV vaccinations.

This is health care that all women need to lead healthy lives — but ensuring access is especially critical for women of color, low-income women, and immigrant women, who face deep health inequities.

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Black and Latinx women have higher rates of cervical cancer compared to white women (over 25 percent and 50 percent, respectively) and Black women are 40 percent more likely to die of breast cancer than white women. Black women in the U.S. are also nearly four times more likely to die from complications related to pregnancy or childbirth than white women.

At the end of 2013, according to Kaiser Health News, a disproportionately high number of women of color and low-income women were uninsured. The ACA helped to close this gap by expanding Medicaid and providing tax credits to purchase health insurance through state exchanges.

Although women who live in states that have failed to expand Medicaid under the ACA remain at risk of being uninsured, the health and lives of millions of women and, specifically, millions of women of color, have been improved by the health care law. According to the Center for American Progress:

There has been an increase in the share of black women with a “usual source of care”—meaning a particular doctor’s office, clinic, or health center. In 2010, 83 percent of black women had a usual source of care. By 2014, the share had risen to 88.1 percent. Furthermore, black women have experienced a reduction among those who delayed or went without care due to cost. In 2010, 18.6 percent of black women “who had to delay or forgo care because of cost”; by 2014, only 15.1 percent of black women did so. Lastly, 55.6 million women who are enrolled in private insurance are able to get preventive care without paying out-of-pocket costs.

The contraception mandate that requires insurance companies to cover birth control has been a success. For women of color, who often have less control over their reproductive health, affordable and accessible contraception has been especially helpful. Access to affordable birth control has meant fewer unintended pregnancies.

But that’s not the only reason expanded access helps women of color. According to the Black Women’s Health Imperative:

Black women are at greater risk for other health issues for which doctors recommend contraceptive use including: diabetes, heart disease, lupus and HIV/AIDS. Blocking their access to contraceptive care puts them at increased risk for other diseases and life-threatening conditions.

If birth control has been historically controversial, giving birth has not. Right? Given the tenor of misogyny and anti-women’s health policies already implemented by the new administration, it’s perhaps unsurprising that Trump’s pick to head Medicaid and Medicare does not think that health insurance companies should have to continue to provide maternity care coverage to women. Right now, the ACA mandates maternity care coverage for all individual health insurance plans. At her hearing last week, nominee Seema Verma told senator Debbie Stabenow (D-Michigan):

Some women might want maternity coverage and some women might not want it, might not choose it, might not feel like they need that. So I think it’s up to women to make the decision that works best for them and their families.

One of the problems with framing it as some kind of cornerstone of individual choice is that prior to the Affordable Care Act, pregnancy was seen as a “pre-existing condition” — which meant insurance companies could refrain from covering women who were already pregnant and seeking coverage. There wasn’t much of a “choice” for women. If a woman didn’t have insurance coverage and became pregnant — whether by choice or not  — and sought out health coverage, insurance companies could (and did) routinely deny coverage.

In fact, up to 70% of insurance companies didn’t cover maternity care. Without access to maternity care coverage, women and families are forced to pay out of pocket for health care or to forego health care completely, placing their health (and the health of their baby) at risk. This is especially risky for women of color in the U.S. who are more likely to have chronic health conditions like diabetes or high blood pressure that can cause pregnancy complications.

It’s hard to fathom that health insurance coverage for pregnant women could be seen as controversial. But, notes a 2013 article in The Atlantic, it’s the specific demographic of women who raise the ire of conservative lawmakers opposed to mandatory coverage: single women, and most often single women of color: “Conservatives have always been ambivalent about motherhood—when it takes place outside of traditional social arrangements.”

It’s worth noting that the U.S. is one of the only developed countries in the world where maternal health care is not guaranteed.

If the ACA is repealed without a comparable replacement, the reproductive health safety net for women of color will be shredded. In recent days, the administration has backed off of a full repeal of the ACA acknowledging that health care can be “complicated.” Despite over 60 attempts at repealing the law, Republicans in Congress have never agreed upon a plan to replace it. Add to that a growing grassroots movement of support for the law, and the focus has been on repealing key provisions rather than a complete overhaul. Over the last several years, the health care law has allowed millions of women of color to access necessary reproductive and sexual health care that has helped to address some of this country’s worst health disparities. And the law is more popular than ever before. It’s not going away without a strong fight.

You can take action in a variety of ways in support of keeping the ACA and health care coverage in place. Share your story about why access to reproductive health care matters to you, use social media to protect the ACA, or learn more about how the health care law has helped millions of women access they care they need.

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