JAMILA MICHENER: In particular, with respect to race and ethnicity, the Affordable Care Act was explicitly designed to address those kinds of disparities, and to make it so that, no matter what your racial or ethnic background was, you could have access to health care, and ultimately, in the long run, have the ability to be healthy, right?
And so that was an exciting goal of the ACA. But you know, the goal of a policy is really different than the politics that unfold. And those politics can sometimes stymie the goals. While the Affordable Care Act, as originally written and intended, was supposed to expand Medicaid in all states, so that any low income person at 138% of the poverty line or below would have access to health insurance and health care through Medicaid.
What happened, as the political process unfolded, is that a variety of states did not like that, and didn't want to do it. They went to the Supreme Court, and the Supreme Court said, you know what? You don't have to expand Medicaid. You can't be coerced into doing this by the federal government.
I'm not saying that all the states that didn't expand Medicaid did so because they were intentionally trying to be racist. But it certainly is true that it's clear to everybody what the racial implications are. It's clear that by not expanding Medicaid, you're making it so that people of color are less likely to have health insurance. And so I think the issue is the larger structure of our politics-- not so much the way that the law was written itself, at least not with respect to the Medicaid expansion.
The ACA was pretty-- it was a lot. It's not like the ACA was just an incremental baby step. It was somewhere between tiny and incremental and total radical transformation. And it was able to positively change many people's lives and give many, many millions more people access to health insurance.
So I just think that something more transformative could matter even more, and could keep even more people alive, and allow people-- because we don't just want survival, we want people to thrive-- allow people to live lives where they're thriving, and where their health isn't a barrier to living well. And all kinds of people-- not just the people who are already thriving and who already have access to resources and advantages, but the people who are fighting for what we think of and what we hope is something like the American dream.
For that to be real-- for many people it's just not real right now. For it to be real, the most basic building block, the most basic resource is health. And so I don't think it's crazy for us to pursue transformative action to provide people with that most basic building block.
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The Affordable Care Act, passed in 2010, was designed to close racial disparities in access to health care. In the first decade of the ACA’s implementation, however, many such provisions are being blocked by racial politics, says Jamila Michener, assistant professor of government at Cornell University.