Senate bills' threats to Medicaid would disproportionately impact black women

By Meghan Jusczak, Jane Crow Project Writer
July 25, 2017

Despite last week’s failure, Congressional Republicans’ single-minded quest to repeal the Affordable Care Act continues. With their mantra, “repeal and replace,” the Senate Republicans voted today to open debate on the most recent bill.

The nation faces a long week of debate and voting in the Senate, and potentially the House as well. It’s bound to be complete political theater, with President Trump making inconsistent statements, the senators on the fence deciding their votes and media updates hour-by-hour as the drama unfolds.

The health care of millions of Americans, particularly women, is at stake.

Christy Gamble, the director of health policy and legislative affairs at the Black Women’s Health Imperative, said the bills in question will “decimate Medicaid” by cutting its funding in the billions, a move that disproportionately impacts people of color, specifically black women in the South.

The bills coming out of Congress to repeal the ACA will exacerbate racial health disparities and lead to economic insecurity for black women and their families, Gamble said. Because black women are more likely to be heads of their households or single mothers, their children usually rely on their health care plans.

However, even under the Affordable Care Act, the United States has serious health care access issues that amount to racial “health care apartheid,” said Monifa Bandele, the vice president and chief partnership and diversity officer at

Thirty percent of black women of reproductive age are enrolled in Medicaid, Gamble said, and this does not account for the “significant number” of black women who go uninsured under the Affordable Care Act because they earn too much to qualify under their states’ Medicaid rules and too little for private insurance. (The Kaiser Family Foundation, a health care policy nonprofit, estimates that this gap accounts for 1.1 million uninsured women).

Bandele put it simply: “If you were to cut down Medicaid or gut Medicaid--as is clearly the case with what these bills are ultimately trying to do--you are going to kill black women.”

In Bandele and Gamble’s opinions, Medicaid funding should be expanding further than it did under the ACA--but they say they cannot discount that the ACA brought a 40 percent drop in the number of Americans who were uninsured. This means that tens of thousands of women who did not previously have access to preventative care now do, under the ACA. Gamble named lack of access to preventative care--which includes well visits with doctors, cancer screenings, prenatal care and beyond--as the source of some of the most prominent racial health disparities.

Black women are 41 percent more likely to die of breast cancer than white women, largely because it is often detected much later, Gamble said. African American women are also more vulnerable to triple-negative breast cancer, a form that strikes younger women and is highly aggressive. Maternal mortality is also up to four times as high for black women and maternal morbidity is twice as high in comparison to white women.

In fact, the United States is the only developed nation in the world where maternal mortality is on the rise, Bandele said.

“Maternal deaths--it’s the type of thing that a lot of people think exists only in countries with shortages of water, poverty, too few medical providers,” Bandele said. “But black mothers are facing a crisis here.”

Bandele described the racial disparity in maternal deaths as one with “many, many levers.” One of the most important, though, is access to health care. If mothers receive adequate care during their pregnancies, health care providers can protect against many of the conditions that lead to complications during pregnancy and birth, such as preeclampsia, hypertension and preexisting conditions like heart disease or diabetes. This preventative care can save the lives of both mothers and infants, she said.

“Medicaid covers nearly half of all births in the United States,” Bandele said. “You already have people falling through the cracks, and if you were to remove that, the number of women dying would increase and explode.”

The Senate bills also propose eliminating maternity care as an essential health benefit, meaning plans will be able to choose if they cover it--and this typically means they will not or that level of coverage will be extremely expensive, Gamble said.

According to data from Castlight Health, a health care information company, American women pay, on average, $8,775 for vaginal births and $11,525 for cesarean sections (though in Los Angeles, c-sections can cost more than $40,000). Without maternity care coverage, many women may be forced to choose between their health and economic security.