The Unfulfilled Promise: Black Women Still Need Better Healthcare Options

by Jamille Fields


April is National Minority Health month, and it is far past time for our elected officials to implement policies to improve Black women’s health. As a Black woman, I want to see something done to eliminate the health inequities that plague us, our families, and our community. As a public health professional, I recognize that expanded health care access can go a long way toward improving individuals’ health. As a lawyer, I know that politicians, currently, have in their hand an opportunity to make such a change. On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law as an attempt to expand healthcare access to the nearly 50 million Americans who were uninsured at the time. Five years later, some states are still playing political football with implementing the law.

Specifically, the ACA includes tax credits to help the middle class pay for insurance and expands Medicaid to provide insurance coverage for more low-income adults. The Supreme Court, however, in 2012 essentially gave states the option to decide whether or not to expand Medicaid. In February and March, Tennessee’s state legislature rejected the governor’s plan to expand. Alabama’s governor has discussed expansion in the state, but it has not happened. Georgia’s governor has flatly rejected Medicaid expansion, even though the state will lose $33 billion as a result. Twenty-one states have currently not expanded Medicaid. The result? Many Black women are caught in a coverage gap with no access to the care they need.

The only reason these lagging states delay is politics. In January, a host of new members of Congress, new governors, and new state legislatures took office. It is high time these newly elected leaders (and far past time for the old leaders) who receive a taxpayer-funded salary, adopt policies that better African-American’s health. Expanding Medicaid should be the first step.

It all comes down to money. African-Americans still have the lowest average incomes across the country, even though the recession is over, and the U.S. economy has largely recovered. African-Americans are also more likely than whites to be uninsured. So, it makes sense that lower-income, uninsured people are less likely to see a doctor because they cannot afford it. When it comes to Medicaid coverage, eligibility for the program has historically been set by each state. This creates gaps in eligibility depending on where you live. For example, a parent in a family of three making over $318 or $385 per month in Texas or Missouri does not qualify for coverage. Other low-income individuals may not be eligible at all because they do not fit into certain categories, such as caretaker for a dependent child or disabled person. The ACA expanded Medicaid coverage to most adults making less than $15,521 a year and to families of four making less than $31,720 a year (not wealthy by any stretch of imagination).



It is this population that is left out when a state decides not to expand its Medicaid program. A quarter of people within the gap are Black. African-American communities are paying a high toll for politics, as they miss the chance of having quality health insurance and the peace of mind that comes with it.

Below are some of the benefits Medicaid expansion can bring to your state—and you.

Contraception

The average American woman spends nearly three decades of her life trying to avoid pregnancy, and 99 percent of women who are sexually active use some form of birth control in their life. Still, half of all pregnancies in the country are unintended. Unintended pregnancies are associated with delayed prenatal care, premature birth, and other harmful health effects on mother and child. Medicaid covers birth control without any out-of-pocket cost.

HIV/AIDS Treatment

Nearly a quarter of those living with HIV are women. Black women are also 15 times more likely to die from the disease compared to white women with the disease. For these women, insurance coverage is often the difference in whether or not they receive life-saving medications. Unfortunately, Medicaid has not, traditionally, covered all low-income women living with HIV. The Medicaid expansion allows more women living with HIV to be eligible for coverage when treatment is most effective – before their disease progresses to AIDS.

Mental Health Services

We all know that a lack of finances, unemployment, and shifting housing can be stressful. Economic instability often results in mental health concerns. Black women are often the primary breadwinners for their families and are more than twice as likely as white women to be impoverished. They are also 20 percent more likely to experience psychological distress. Medicaid covers mental health and substance use disorder services and would allow women who need care to receive it, without worrying about their pocketbooks.

Breast Cancer Screenings and Treatment

While Black women and white women have similar breast cancer rates, Black women are more likely to die from breast cancer. This in part results from women lacking access to screenings and inability to pay for the treatment. If every state expanded Medicaid, black women would have far better access to free mammograms. Medicaid covers mammograms for women over 40, completely free. And, Medicaid would cover treatment if a woman was diagnosed.

The Medicaid expansion has potential to improve Black women’s health. States where African-American women are struggling the most and have the worst health nationwide are the same ones digging in their feet and refusing to expand Medicaid for their residents. Think Mississippi, Louisiana, and Oklahoma. Many of these same states have conservative governors and/or state legislatures. Think Mississippi, Louisiana, and Oklahoma. See a pattern? The time for this political fronting is over.

It's time that Black women demand the quality healthcare we deserve.


Jamille Fields, J.D., M.P.H. is an attorney and Law Students for Reproductive Justice Fellow at the National Health Law Program (NHeLP). NHeLP is a public interest law firm committed to advancing health care access for the most vulnerable. Jamille is a resident blogger for Repossess Reproductive Justice and you can follow her on Twitter @ms_jamille.