Persistent racial bias could fuel an active repeal of the Affordable Care Act (ACA), implemented under former US President Barack Obama, a new study suggests.
Researchers from Brunel University London and Ohio University teamed up to investigate the relationship between anti-black attitudes and support for the ACA, often referred to as ‘Obamacare’. They found that those who buy into negative racial stereotypes are more likely to disapprove of public health policy that is perceived to combat ethnic inequalities.
The new study – published today in the Journal of Racial and Ethnic Health Disparities – used data from the American National Election Studies, which surveyed adult US citizens, both before and after the 2016 presidential election. The researchers identified racial bias as a barrier to enacting health policies and speculate that laws like the ACA could be at risk in the future.
“The anti-black attitudes that affect support for public policy are not always obvious,” said Dr Adrienne Milner, a researcher at Brunel who led the study.
Dr Berkeley Franz of Ohio University adds, “white Americans who hold explicit pro-black attitudes, but who subconsciously believe in negative stereotypes about the black community, are most critical of the ACA – even if they express preferences for greater racial equality.
“Demographics were also contributing factors, with older people, men and more educated individuals slightly less likely to state that the ACA worsened health care.”
Throughout the Trump administration, there has been wide-scale discussion about the perceived shortcomings of the ACA. Despite the act having provisions to help a large segment of society, white and black alike, many white Americans see the act as unfairly and unnecessarily benefiting black communities.
This perception is amplified by the strong association the ACA has with the first black US president, under the title ‘Obamacare’, and the strict party-line vote that saw the policy approved. More recent attempts to repeal the health care law have been a key policy platform of Republican candidates, and the re-election of President Trump in 2020 could spell trouble for the ACA.
“Republicans continue to state that repealing the ACA is a priority, despite the success of the legislation in terms of improving access to health care, and the fact that the average premium is expected to drop next year,” said Dr Milner.
Dr Franz said, “our results suggest that politicians often communicate implicit messages about race, even when they claim to promote policies that are racially neutral.
“The ACA was not explicitly described as a policy to help non-white Americans, but given the history of policy-making in the United States, policies that stand to help improve social welfare are often interpreted as being a handout to poor and non-white Americans.”
Dr Milner adds, “in fact, if the law were repealed, it would negatively affect white Americans, who benefited more from the law in terms of absolute numbers. As such, we see this as a public health concern, where racist attitudes serve as a barrier to improving overall health in the United States.”
The study encourages public health practitioners and policymakers to consider racism as a problem that is crucially important to overcome in the push for greater health equity.
“Public health and policy-makers must talk more openly about how seemingly race-neutral policies are racialised in partisan policy debates. More evidence on who policies benefit, and how, may facilitate opportunities for bipartisan dialogue and collaborative strategies to promote health equity in the United States,” said Dr Milner.
The full study can be found in the Journal of Racial and Ethnic Health Disparities.
Simone McNichols-Thomas, Media Relations
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