In 2010, during a rally in the nation’s capitol to advocate for passage of the Affordable Care Act (ACA), I heard the Rev. Heyward Wiggins, Pastor of Camden Bible Tabernacle Church, share his experience triaging the countless health care needs of his church members. He and other faith leaders throughout the country were preaching that the fight for healthcare reform was not new, but part of a longer historical arc. That arc bends justly from the creation of Medicaid in the 1960’s to the passage of the ACA in 2010—but it is an arc that, under the Trump Administration, is in serious jeopardy of being sharply reversed.

The fight for access to healthcare has always been a civil rights issue

The civil rights movement not only led to monumental legislation like the Civil Rights Act of 1964 and the Voting Rights Act of 1965, but also led programs like Medicaid, which would become one of the most important public benefits programs in history. Medicaid, along with Medicare, almost immediately changed the way health care was administered for black people, virtually dismantling segregation. Because black Americans were becoming legally entitled to healthcare as beneficiaries of programs like Medicaid, hundreds of hospitals and physicians’ offices throughout the South—which had previously been “For Whites Only”—made medical care available to blacks for the first time.

Black communities have long fought to protect Medicaid.

One example among many is in Chicago. Following Governor Richard Ogilvie’s announcement of an imminent and drastic reduction in the Medicaid budget in 1971, the League of Black Women began a coordinated effort to mobilize black communities throughout the city. This fight, and others to preserve and expand Medicaid, would continue for nearly half a century through attempted cutbacks by both conservative and liberal administrations in federal and state governments. By 2009, 27% of black Americans—10 million people, including 6 million children—were covered by Medicaid. Throughout the country, we accounted for one in five Medicaid enrollees.

The ACA has built on this legacy and produced historic progress for black Americans.

Rev. Wiggins was speaking from the heart when he stood on the podium in that chilly weather on Capitol Hill. The stories told that day of the fight for and importance of access to healthcare were filled with numerous efforts in black communities hopeful for passage of the ACA.

Once passed and implemented, the ACA would extend coverage to even more black Americans. Blacks made up nearly 34% of the individuals who were newly eligible for Medicaid in states that decided to expand, and millions more gained subsidized private care through the marketplaces.

But the positive impact of the ACA goes beyond coverage expansion.

The benefits include mandating collection and reporting of data within the healthcare system by race, sampling racial subpopulations in health surveys to enable more comprehensive reporting of data on health disparities, developing cultural competency curricula, supporting the training and development of a diverse healthcare workforce, as well as supporting community health centers and other community-based initiatives.

Although Rev. Wiggins and countless black communities were victorious in helping to expand health care to a record number of African Americans, the battle continues.

Many states have stubbornly refused to expand Medicaid, which has disproportionately locked black Americans out of coverage. The Trump Administration and Congressional Republicans are now seeking a rapid repeal of the ACA, which would roll back Medicaid expansion and change the program into a block grant or ration care through a per capita cap—an attack that would slash the federal contribution by billions and threaten the livelihood of the program. Ultimately, these changes would drastically jeopardize the health coverage of millions of black Americans.

Today, we must renew our moral commitment to protect the healthcare gains of black Americans.

Historic progress might be in peril, but we can control one factor which Rev. Wiggins alluded to nearly seven years ago: our commitment to fighting for health justice in the long haul.

Quinn Rallins

Writing since December 2015 · 1 story contributed