After Obamacare Enrollment, Three Critical Steps

Massachussetts Considers Mandatory Health InsuranceThis article by LeeAnn Hall, first appeared in

More than 7.1 million people have obtained health coverage under the Affordable Care Act, despite the early confusion and glitches with the computer system. In addition, 6.3 million are approved for Medicaid and the Children’s Health Insurance Program, and an estimated 3 million more young people gained health insurance by staying on their parent’s plans.

We have a once-in-a-generation opportunity to eliminate health disparities so people of color are no longer living sicker and dying younger. If we do our job, no mother will ever have to choose between paying the rent or taking her sick child to the doctor.

To meet this goal three critical steps need to be taken: first, Medicaid expansion needs to occur in all states; second, people with coverage now must actually receive care; and finally, we need appropriate data tracking and reporting to evaluate progress.

Medicaid Expansion

In the Supreme Court’s decision upholding the Affordable Care Act, the court determined that the federal government could not require states to accept the Medicaid expansion; each state would choose independently to accept federal funding to expand—or not. Many of those who would benefit most from Medicaid expansion are people of color, with Latinos and African-Americans each representing nearly 20 percent of those eligible, according to the Urban Institute and Robert Wood Johnson Foundation. Women also stand to gain: The uninsured rate for women between the ages of 19 to 64 could be cut by more than half—from 20 percent to 8 percent.

Many community organizing groups and health advocates stood strong for health reform because of Medicaid expansion’s potential to close the racial and gender gap and make our health care system more equitable.
This expansion of health coverage to the uninsured now faces serious threats. Nineteen states have refused to expand Medicaid and five others are still debating the matter. Many of those are states where people of color would gain the most. In Mississippi, 50 percent of the newly eligible would be black people; in Louisiana, it’s 47 percent; in South Carolina, it’s 43 percent. Texas and Florida, with two of the largest Latino populations, also rejected the expansion.

So first on our agenda is doubling down on the fight for Medicaid expansion—to fill in the gaping hole created by the Supreme Court’s decision. I say hell no to the creation of another racialized structural barrier that denies coverage to communities needing health care most.

Access to Care

The second challenge is to ensure that the newly covered actually get quality care. Existing health care networks do not have enough providers to absorb the new influx of patients, potentially resulting in long lines and wait times.

In addition, many health plans sold in the exchanges have thin provider networks. This means that consumers need to be extra vigilant to make sure each provider they are seeing is covered by their exchange plan. These thin provider networks may eliminate major care facilities in a community. For example, where I live in Seattle, four major insurers do not cover the University of Washington Medical Center or Harborview Medical Center, the university’s top rated trauma center.

Such barriers are unacceptable. If families have insurance, but can’t get care, health disparities among people of color—higher rates of diabetes, prostate cancer, and death from cervical cancer— will remain unchanged.

Care also means investing in doctors and health professionals who come from, and understand, the communities that they serve. We need to actively back President Obama’s budget, calling on Congress to appropriate $14.6 billion to invest in our health care infrastructure by training the medical professionals needed in underserved communities.

At end of the day, to evaluate our success we need to know who is being served – specifically we need to have a breakdown by income, race, ethnicity and geography. The Affordable Care Act has great potential to shrink the racial gap in coverage. But we can’t tell how it’s doing without data on race and ethnicity. The U.S. Department of Health and Human Services (HHS) says they’re collecting only some data and don’t know when, or even if, it will be released.


For the law to work, we need to be able to track its results. The failure to collect full federal data suggests that HHS doesn’t see closing the coverage gap as a high priority. We must demand the data for evaluation to improve our new health care system.
The health care train is rolling down the track, after years of years of political obstruction millions people have insurance.

But now it’s time to get back to work. To fulfill the vision of affordable care for all, we need to meet the next set of challenges: expanding Medicaid, guaranteeing that coverage also means care, and building a system available to everyone.

This article first appeared in

LeeAnn Hall is the executive director of the Alliance for a Just Society, a national research, organizing and policy network focused on health, economic and racial equity.