Policy Selection and Background, The Affordable Care Act and Racial Health Disparities IntroductionRacial disparities ar

Policy Selection and Background, The Affordable Care Act and Racial Health Disparities

Introduction
Racial disparities are not only one of the most deeply rooted and longstanding problems of social justice in health care in the United States. African Americans are more susceptible to chronic disease, and they are less likely than White populations to receive quality care. These health inequities are in turn caused by systematic racism, socioeconomic marginalization, and bureaucracies that fail to address them. As has been uncovered in the Week 2 assignment. Out of those differences the Affordable Care Act (ACA) was enacted in 2010 and is one example of a federal policy to make accessible quality, low-cost healthcare to all people and most specifically to vulnerable and traditionally marginalized groups. The selected policy that will be analyzed in the paper is the ACA because it helps to reduce racial health disparities affecting the African American population and analyze it in terms of purpose, services offered, its historical underpinnings, and the context of its implementation within social justice and anti-oppressive approaches.

Policy Purpose and Population to be covered

ACA came into law in March, 2010, during the reign of President Barack Obama. It is mainly aimed at widening the availability of inexpensive health care insurance, enhancing care quality, and lowering healthcare expenditures with a view of ending discriminative practices in the realm of health insurance (Sommers, Maylone, Blendon, Orav, & Epstein, 2017). Among other programs, it had a mission of cutting down the number of uninsured Americans, especially the low-income and minority population by making use of the Medicaid expansion and opening health insurance marketplaces.

The population that African Americans could easily constitute to be a primary focus of this legislation is since they were previously disproportionately covered by no health insurance coverage before 2010. As noted by the U.S. Department of Health and Human Services (2022), the prevalence of uninsurance in the group of African Americans exceeded the prevalence of uninsurance among White people by more than 1.5 times. The provisions relating to these disparities are specifically to limit denials due to preexisting conditions, to provide young adults with parental insurance coverage, and to require essential health benefits coverage as outlined in the provisions of the ACA.

Programs and Services Provided Through the ACA
The ACA introduced such programs and services as: increasing access to health; making it more affordable; ensuring equity. To begin with, the law has increased the number of people who qualify to use Medicaid to the amount of people who earn up to 138 percent of the federal poverty level. This growth had a lot of positive impact on African Americans, who make up a big percentage of low income populations in most states. As indicated by Artiga, Orgera, and Damico (2020), the prevalence of uninsured Black adults was reduced by 9.2 percent, which is down to 11.7 percent in 2018 in states that expanded Medicaid.

Secondly, the ACA established the Health Insurance Marketplace that provides subsidized versions of a privately based health insurance plan, the option depends on the levels of income. These policies get African American enrollees higher results as they get premium tax credits and cost-sharing reductions, which may make a plan affordable.

Third, the ACA created the Prevention and Public Health Fund (PPHF) that invests in community-based health projects aimed at dealing with such conditions as obesity, hypertension, and diabetes that African Americans are disproportionately affected by. Additional services are to be made in terms of mental health and substance abuse treatment coverage, maternal and child health programs support, and the Office of Minority Health financial support to track and eliminate the health disparity.

Connection Between the ACA and the Social Justice Problem
The racial health disparities in the context of social justice is a direct response to the Affordable Care Act. African Americans have historically served as a group systematically denied healthcare access by the practices of segregationism in healthcare, discrimination in personal employment, and lack of access to employer-sponsored insurance. The broad based reforms of the ACA aimed to bring down these obstacles by institutionalizing equity-oriented mechanisms in delivery of health insurance.

Racial health disparities are not new but during the era of the ACA they were recontextualized as a public health and civil rights concern requiring the attention and the federal resources. Section 1557 of this law also requires non-discrimination in the healthcare setting and prohibits healthcare providers and insurers accepting federal funds discourteously due to their race, ethnicity, or national origin (Pande et al., 2020).

The structural inequalities, such as access to housing, income, and education, still interfere with the total health equity despite the decreased gaps in coverage and access to preventive care provided by the ACA. However, the policy is a considerable instantiation on an old and unresolved issue that had otherwise remained unaddressed on a federal level.

Historical Issues and Policy Development Context
The real problem is that the racial health disparity in the United States has a long history of racial injustices, spanning slavery and Jim Crow to today, where racial segregation in housing and environmental racism find their lodging. Before the enactment of the ACA, policies such as Medicare and Medicaid (1965) offered partial access to care to old people and low income earners yet did not help in eradicating racial differences in insurance coverage and outcomes. The individual market of the private insurance system left individuals who had a chronic condition unable to access it, and the largest form in the U.S., employer-based insurance, mostly excluded people with precarious jobs or low-wage work, and this created an additional burden to the African Americans.

ACA has a highly polarized political initiative behind it. The act passed the Senate in December, 2009, by the power of sixty to thirty-nine and the House by a close margin of two hundred and nineteen to two hundred and twelve in March, 2010 (Congressional Research Service, 2011). The leaders of the key legislation were represented by Nancy Pelosi, who was the Speaker, Senate majority leader Harry Reid, and even President Obama who had healthcare reform as one of his key pillars of his administration.

The policy was vigorously opposed by Republican members of Congress and other lobby organizations that influenced its final terms and its public popularity. The racial and ideological split in the US healthcare policy was already evident, and it is still being witnessed in the post-legislation efforts by political forces to repeal or defund the ACA.

Historical Influences on Policy Implementation
The history of resistance to federal civil rights reforms on the state levels largely contributed to the implementation of the ACA. This is after the 2012 Supreme Court judgement on NFIB v. Sebelius, states were given the freedom to expand Medicaid. As of 2025, some states with high numbers of blacks in the south, like Mississippi and Alabama, have failed to expand Medicaid and therefore lack coverage of millions of low-income adults, which predominantly black citizens (Garfield et al., 2023).

Further, the Trump administration administratively rolled back parts of the ACA, such as ACA advertisement and outreach, that had disproportionate negative effects on enrollment levels in the communities of color, which was predetermined by a lack of awareness of or trust in the system.

Nevertheless, the ACA is the biggest legislative effort to integrate racial equity into the American healthcare system. It has made it more accessible and affordable to millions of people, though, its efficiency is characterized by uneven effects as political, historical, geographic aspects still have a considerable influence on it.

Conclusion

The ACA was a paradigm-shifting policy that sought to decrease both racial and economic inequality when it comes to accessing healthcare. The ACA has solved the most difficult getting-out-of-the-bottle health racial inequality problem by targeting African Americans, and it can be seen through Medicaid expansion, marketplace subsidies, anti-discrimination measures, and strategic investment of underserved populations. Even so, the continued political opposition and unequal application of the policy to bury systemic racism illustrates the difficulty of destroying it with federal policy. Such an analysis becomes the basis of further critical analysis that will be conducted in Weeks 6 and 9 when policy impact and recommendations will be discussed in more detail. Advocacy efforts should be continued to make sure that such policies as ACA achieve their potential to achieve health equity and social justice.

References

Artiga, S., Orgera, K., & Damico, A. (2020). Changes in health coverage by race and ethnicity since implementation of the ACA, 2010–2018. Kaiser Family Foundation. https://www.kff.org

Buchmueller, T., Levinson, Z., Levy, H. G., & Wolfe, B. (2016). Effect of the ACA on racial disparities in health insurance coverage. Health Affairs, 35(8), 1406–1411. https://doi.org/10.1377/hlthaff.2016.0413

Garfield, R., Orgera, K., & Damico, A. (2023). The coverage gap: Uninsured poor adults in states that do not expand Medicaid. Kaiser Family Foundation. https://www.kff.org

Pande, A. H., Ross, D., Zuckerman, R., & Spencer, A. (2020). Non-discrimination in healthcare: The ACA's Section 1557. Journal of Health Politics, Policy and Law, 45(4), 553–566.

Sommers, B. D., Maylone, B., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2017). Three-year impacts of the Affordable Care Act: Improved medical care and health among low-income adults. Health Affairs, 36(6), 1119–1128. https://doi.org/10.1377/hlthaff.2017.0293

U.S. Department of Health and Human Services. (2022). Health coverage under the ACA: Equity gains and gaps. https://aspe.hhs.gov