The economic turmoil caused by COVID-19 has swelled the number of uninsured by tens of millions and driven surging enrollment in Affordable Care Act coverage—a lifeline that the Justice Department last week urged the Supreme Court to cut loose.
The department's legal brief in California v. Texas restated the administration's position that the law's coverage provisions cannot stand without the defunct individual mandate. So, it was not surprising the Justice Department made this argument. But it was deeply disappointing the department made it as the nation reels from converging forces that make healthcare coverage more important than ever.
The timing of the department's legal brief is especially unsettling for the nation's safety net and for the essential hospitals at its center. These hospitals regularly and disproportionately care for racial and ethnic minorities, and they have stood on the front lines of COVID-19 as the pandemic falls hardest on those same populations.
The terrible toll of COVID-19 on people of color, the poor, and other disadvantaged groups has been stark and well documented. Just this past week, administration health officials released Medicare data showing that Blacks were hospitalized with the disease at rates nearly four times that of whites. The disparities were similar for Latinos and Asians, with hospitalizations occurring at rates double and 50% more than whites, respectively. COVID-19 death rates have shown similar disturbing disparities, with blacks dying of the disease at rates typically multiples of their share of a given population.
Compounding the poor health outcomes COVID-19 has inflicted on racial and ethnic minorities are historically persistent disparities in healthcare and health insurance coverage among these same groups. People of color are far more likely to be uninsured compared with whites—and the problem was especially bad before the ACA, when nearly 1 in 3 Latinos and 1 in 5 Black Americans lacked insurance compared with about 1 in 8 whites, according to Brookings Institution reports. The ACA improved those numbers dramatically, with Latinos showing the largest percentage point-decrease in their uninsured rate: from 32.6% to 19.1% between 2010 and 2016, Kaiser Family Foundation data shows.
All this makes it particularly confounding that the administration would choose now to attack a law that has helped populations at greatest risk during the pandemic. Further, this latest show of support for dismantling the ACA comes as the administration advances its Medicaid Fiscal Accountability Regulation. This proposed rule would gut programs states use to pay for their share of Medicaid and weaken state budgets already straining under the costs of COVID-19. It also would jeopardize access to Medicaid services, making an even stronger case for preserving the ACA—and the access it provides—rather than tearing it down in court.
The health and welfare of our people must come first, especially individuals of color and others who struggle today to overcome systemic and historical barriers to health and healthcare access. We must always make access to affordable healthcare—such as that provided by Medicaid and the ACA—a priority. The health and economic crises we face now due to COVID-19 add urgency to that goal and demand we set aside differences and focus on solutions that protect our most vulnerable people.