This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.

The Better Care Reconciliation Act (BCRA) would result in 22 million people losing their health care coverage over the next decade, cause long-term damage to the Medicaid program and raise health care costs to extremely unaffordable levels for consumers. Millions of low-income people of color, especially those with chronic health conditions, would be among the hardest hit. A recent analysis conducted by the Urban Institute estimates that by 2022 roughly 21 percent of those who would become uninsured because of BCRA are Latinos, and 12 percent are Black. This bill would reverse racial health equity gains made under the Affordable Care Act (ACA) and strike a blow against signature victories for racial equality in America.

Massive cuts in Medicaid would cause millions of people of color to lose coverage

According to the Kaiser Family Foundation, more than one in five adults of color and nearly six in ten children of color are currently enrolled in Medicaid. Medicaid represents an important source of insurance coverage for low-income people of color who are more likely than whites to work in low-wage jobs that provide limited access to employer-sponsored insurance. The program is a vital tool for states to respond to fluctuations in unemployment, public health crises and changes in population growth many of which disproportionately affect people of color. Yet, according to the Congressional Budget Office, the BCRA would cut as much as 26 percent of Medicaid funding ($772 billion) over the next decade, which would hamstring state programs and budgets. Specifically,

  • The BCRA would effectively end Medicaid expansion, putting at least 15 million low-income people at risk of becoming uninsured and losing access to the care they need. For people of color, eliminating Medicaid expansion would leave as many as 1.5 million African Americans and 3.3 million women of color without health insurance or enrolled in extremely expensive private options with deductibles as high as half of their annual income.
  • The BCRA would permanently convert Medicaid to a per capita cap funding system, which would not keep up with the underlying costs of the program. Because of massive losses in Medicaid funding, states would be forced to cuts costs by eliminating essential programs and services people of color are dependent upon. Many rural hospitals would be forced to close down. Particularly in southern states with centuries’ worth of social and structural inequalities, African Americans and Latinos who have already experienced worse health outcomes would have to travel longer distances for essential and preventive care or die from emergency conditions (like accidents or heart attack).

Allowing states to drop the Essential Health Benefits (EHB) for private insurance, leaving millions of people with pre-existing conditions without essential coverage 

On average, people of color experience shorter life spans, higher infant mortality rates and higher prevalence of many chronic conditions compared to whites. This bill would take away access to critical care services (including prenatal and maternity care, chronic disease management and treatment for mental health and substance use disorders) from people of color who face serious physical, mental and behavioral health problems.

Eliminating the Prevention and Public Health Fund would cut supports to low-income and vulnerable communities

The BCRA would end the appropriations for the Prevention and Public Health Fund, which would directly affect everyday Americans and their families living in low-income and underserved communities. Facing massive cuts in Medicaid and prevention funds, states would be unable to prevent the onset or spread of infectious diseases (such as measles, zika and ebola) and redress long-standing inequities in health and safety by investing in communities with greatest needs.

The BCRA is dangerous for millions of low-income and vulnerable Americans. The combined effects of the BCRA have devastating and long-term impacts on the health and economic security of communities of color. We need to keep up our pressure on Republican Senators and plainly call out the damaging impacts this bill would have on their constituents.