Black Folks Are Key to Obamacare’s Success

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Over the holidays, first lady Michelle Obama took to the airways to promote the Affordable Care Act, aka Obamacare, on the Rev. Al Sharpton’s radio show, Joe Madison’s radio broadcast and in other outlets with a large black audience, as well as with a group of mothers who were invited to the White House.


Before that, she had mostly steered clear of policy issues related to the ACA, so why is the first lady now going on the offensive over her husband’s controversial health care plan? Well, not only does the public think highly of her—she routinely polls as one of the most popular figures in the country—but African Americans are a key constituency for the Obama administration, whose signature health care legislation has gained ground in recent weeks but still lags in its numerical targets.

Simply put, if Obamacare is going to work, black folks need to be on board. Here’s why:

We’re Disproportionately Sick

There’s no easy way to say this, but from asthma to diabetes to HIV, African Americans are more likely than the population at large to have a major illness. That makes Obamacare particularly important for us. We can no longer be rejected for having a pre-existing medical condition. We’ll also benefit from the preventive care, vaccines, disease screenings, examinations, women’s health coverage and other essential benefits that Obamacare requires health insurers to offer—benefits that can help us ward off disease, manage existing illnesses, care for children and keep ourselves out of the emergency room.

We’re Disproportionately Un- or Underinsured

One in 4 black Americans under age 65 lacks health insurance, compared with 15 percent of whites and 33 percent of Latinos, who are least likely to have insurance. Of course, being uninsured can contribute to poor health outcomes; it also causes many of us to run up medical debt. A 2008 survey of low- and middle-income Americans found that 55 percent of African Americans were carrying medical debt—an average of $1,900—to cover out-of-pocket expenses they couldn’t afford.

Adding insult to injury, to try to control medical costs, more than one-third of the black folks surveyed didn’t go to the doctor when they had a health problem, and 30 percent skipped a medical test, treatment or follow-up session—illustrating the vicious circle between being uninsured and being in poor health.

We’re More Likely to Be Among the Working Poor

The term “working poor” (pdf) refers to Americans who grind for more than 27 weeks a year and yet make less than the federal poverty guidelines. And more than a fair share of us can be found among the working adults who aren’t officially considered poor, yet don’t earn enough to make ends meet: roughly $16,000 a year for a single person or $32,500 for a family of four, a group that typically goes uninsured.


The Obama administration hopes to extend health care coverage to the working poor by expanding Medicaid. The catch? Last summer the Supreme Court gave each state the right to decide whether or not it would extend Medicaid. Although states can still change their minds, most Southern states and a number in the Midwest and West (read: many of those headed by Republican governors) have decided not to increase Medicaid coverage.

Whether intended or not, their position significantly harms black Americans, who are more likely than other groups to live in the South. In fact, 40 percent of black folks who would have qualified for coverage live in states where Medicaid is not being expanded—almost half of this group in Florida, Georgia or (surprise!) solidly red Texas.


The bottom line is that African Americans are a key component of President Obama’s base. And black women in particular are also the health care decision-makers for their households.

Sending Michelle Obama out to rally support for Obamacare was a smart move.

Hilary Beard is co-author of Health First! The Black Woman’s Wellness Guide, which won a 2013 NAACP Image Award, and has led the Black AIDS Institute’s volunteer journalists to the International AIDS Conference in Washington, D.C., and Vienna. Follow her on Twitter and Facebook.


Philadelphia-based writer Hilary Beard is co-author of Promises Kept: Raising Black Boys to Succeed in School and in Life and Health First! The Black Woman’s Wellness Guide, both of which have won an NAACP Image Award. Follow her on Twitter and Facebook