Hastings Race and Poverty Law Journal


Rene Bowser


In 2010, the most monumental health care legislation in forty-five years was enacted. The Patient Protection and Affordable Care Act ("ACA") makes changes great and small in virtually every important component of the American health care system. The new law's implications will not be known fully for many years because state governments and federal agencies are in the process of interpreting key provisions, drafting rules and devising general implementation strategies. And, uncertainty exists about the scope of the ACA because of the recent Supreme Court ruling in National Federal of Independent Business v. Sebelius. The court upheld nearly all of the provisions in the ACA, but it ruled that the federal government cannot withhold Medicaid funds from states that refuse to expand their Medicaid programs to cover individuals with incomes of as much as 133 percent of the federal poverty level.

This article seeks to analyze the most significant changes that affect communities of color and to examine the resulting health equity and social justice implications. Part I explains the moral and economic case for eliminating racial and ethnic health care disparities. Part II analyzes provisions in the new law designed to expand access to health insurance. Part III focuses on the special access challenges communities of color face and how the ACA provisions attempt to address these. Part IV examines key ACA provisions that are explicitly intended to reduce health disparities and improve the health of racially and ethnically diverse populations. Part V argues that achieving health equity for racial and ethnic minority groups will require policy strategies focused outside of the health care arena. This article concludes with recommendations on how to leverage federal spending to advance racial and ethnic equality.

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