While running for President, Donald Trump asked African Americans, “What do you have to lose by trying something new like Trump?”  As it turns out, one answer is health insurance.

The likelihood of having health coverage shouldn’t vary by a person’s race or ethnicity.  The Affordable Care Act (ACA) helped cut the uninsured rate for nonelderly African Americans by more than one-third between 2013 and 2016, from 18.9 percent to 12.1 percent.   But that’s still well above the 7.5 percent uninsured rate for whites, so we can ill afford to reverse this progress.    

Unfortunately, that’s exactly what President Trump and congressional Republicans may soon do.  The House bill would cause 23 million people to lose health insurance and the Senate bill is projected to cause 22 million people to lose health insurance, and its Medicaid cuts would be even deeper than the House bill’s after the first decade.    

The Republican bills would undo African Americans’ health coverage gains by:

• Repealing the Medicaid expansion and radically changing Medicaid financing.  Both the AHCA and BCRA effectively repeal the Medicaid expansion and impose a per capita cap on Medicaid as a whole.  These changes would cut federal Medicaid funding by $834 billion over ten years under the AHCA and $772 billion under BCRA, forcing states to make up the difference or, more likely, cut eligibility, benefits, and provider payment rates.  Large Medicaid cuts would disproportionately harm African Americans, 15 million of whom are enrolled in the program.  African Americans make up 13.3 percent of the U.S. population but 19 percent of Medicaid enrollees.

• Undermining enrollment in ACA marketplaces.  Over 660,000 African Americans were among the 12 million people who signed up for ACA marketplace health plans during the 2017 open enrollment period in the 39 states that use the Healthcare.gov enrollment platform. The AHCA and BCRA would shrink tax credits and eliminate cost-sharing subsidies, causing steep increases in out-of-pocket costs for people who buy health insurance through the ACA marketplaces, including higher premiums, deductibles, copays, and coinsurance.  The Republican bills also allow states to weaken or eliminate key consumer protections, such as those requiring plans to cover essential health benefits like maternity care and treatment for mental illness and substance use disorders.  

Also, Congress’ continued efforts to repeal the ACA, along with Trump Administration actions to undermine the stability of the marketplaces, are creating uncertainty among insurers about participating in the marketplaces — and confusion among potential enrollees.

Instead of reversing coverage gains and continuing to foster uncertainty, policymakers should build upon the ACA to further close the coverage gap for African Americans and make sure everyone has access to high quality, affordable health care.

To learn more about health coverage gains for African Americans under the ACA and what’s at risk in various ACA repeal proposals, see our report at the Center on Budget and Policy Priorities.