Health
Blacks Gain Most from Obamacare When Medicaid Expanded
This Nov. 29, 2013, file photo shows a part of the HealthCare.gov website, photographed in Washington. (AP Photo/Jon Elswick, File)
By Freddie Allen
NNPA Senior Washington Correspondent
WASHINGTON (NNPA) – As families prepare to choose health insurance coverage during the open enrollment period, a recent report by the Urban Institute shows that Blacks have the most to gain from the Patient Protection and Affordable Care Act (ACA) if the states they live in expand Medicaid under the law.
The Urban Institute, a nonprofit research group focused on social and economic policy, estimated that Blacks will experience, “the largest decreases in uninsurance rates under full Medicaid expansion: a drop from 11.3 percent (projected with current expansion decisions) to 7.2 percent” and the uninsurance rate gap between Blacks and Whites will fall from 6.5 percent under current Medicaid expansion to 2.6 percent with full expansion.
However, the gap between Black and White uninsurance rates will remain closer to 7 percent, at least for the near future, because most Blacks live in states that have refused to expand Medicaid under the ACA.
The original law, passed in 2010, mandated Medicaid expansion nationwide, but the United States Supreme Court 2012 decision in the National Federation of Independent Business v. Sebelius case reversed that provision, leaving it to the states to decide whether they want to take additional Medicaid funding under the ACA.
According to the Urban Institute, “As of December 2014, 27 states and the District of Columbia had expanded Medicaid or planned to expand by January 2015.”
The Urban Institute projected that Blacks would comprise 12.8 percent of all coverage gains under current Medicaid expansion policies and 2.9 million Blacks would get health insurance. The uninsurance rate for Blacks would fall from 19.6 percent to 11.3 percent.
More than half of all Blacks live in states, primarily in the South and led by Republican governors, that didn’t expand Medicaid after the ACA was passed in 2010.
When states refused to expand Medicaid, the move trapped Blacks in a “coverage gap,” because many of them don’t meet the income-based requirements to qualify for Medicaid under their own state rules or to receive subsidies through the ACA marketplace.
About 1.4 million Blacks fall into this category, accounting for more than 23 percent of the uninsured non-elderly adult Blacks. For example, in Florida, Georgia, Texas and North Carolina, the uninsured rates for Blacks would plummet roughly 30 percent compared to current rates, if those states expanded Medicaid coverage under the ACA.
“For blacks, however, the difference between their uninsurance rates and whites’ rates is projected to narrow under the ACA with current Medicaid expansion decisions only in Medicaid expansion states,” the report said. “Across all states, the difference in uninsurance rates between blacks and whites is projected to stay approximately the same both under the ACA with current Medicaid expansion decisions and without the ACA.”
In August 2014, researchers with the Urban Institute said that 6.7 million residents would still remain uninsured in 2016 in the states that continued to block Medicaid expansion through the ACA.
“These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, which will lessen economic activity and job growth,” the August 2014 report said. “Hospitals in these 24 states are also slated to lose a $167.8 billion (31 percent) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.”
The report continued: “For every $1 a state invests in Medicaid expansion, $13.41 in federal funds will flow into the state.”
The Council of Economic Advisers (CEA), a small group that offers the president domestic and foreign economic advice, predicted that, Medicaid expansion would have added, in nonexpanding states, nearly 79,000 jobs in 2014, “172,400 jobs in 2015, and 98,200 jobs in 2016.”
The August 2014 report also noted that that the rate of uninsured in the states that expanded Medicaid fell by nearly 40 percent, since September 2013, the number of uninsured in the non-expansion states fell by less than 10 percent.
The technical difficulties that plagued the rollout of HealthCare.gov last year have faded from headlines, and the benefits of Medicaid expansion under the Affordable Care Act become harder for governors and state legislators to dismiss.
In December, Republican Tennessee Gov. Bill Haslam moved to expand Medicaid under the ACA, leaving less than two dozen states to weigh providing health care for their poorest residents against future costs associated with Medicaid.
The Urban Institute report on uninsurance rates under the ACA said that improving health literacy, translation services, outreach through ethnic media and working with trusted members of the community can also aid in driving down the levels of uninsured.
According to a recent report by the Department of Health and Human Services (HHS), 87 percent of the people who selected health insurance plans through HealthCare.gov were eligible for financial assistance, a 7 percent increase over last year’s numbers.
“That includes more than 3.4 million people who selected a plan in the 37 states that are using the HealthCare.gov platform for 2015, and more than 600,000 consumers who selected plans in the 14 states that are operating their own Marketplace platform for 2015,” stated a press release on the report.
A more detailed view of enrollment data collected from November 15 to December 26 showed that roughly 6.5 million people either selected plans or were automatically reenrolled.
HHS Secretary Sylvia Burwell said that the vast majority of people who signed up for health insurance coverage through HealthCare.gov were able to lower their costs using tax credits.
“Interest in the Marketplace has been strong during the first month of open enrollment,” Burwell said in a recent press release about the enrollment report. “We still have a ways to go and a lot of work to do before February 15, but this is an encouraging start.”
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Activism
Up to the Job: How San Francisco’s PRC Is Providing Work Opportunities That Turn Into Lasting Stability
Each year, PRC serves more than 5,000 clients through a wide range of programs. These include housing navigation, legal advocacy to ensure access to health and public benefits, supportive housing, job and life-skills training, and residential treatment programs.
Joe Kocurek | California Black Media
Seville Christian arrived in San Francisco in the 1990s from Kansas City, Mo., a transgender woman coming from a time and place still hostile to who she was.
San Francisco offered a deeper LGBTQ+ history and a more visible community of people like her, but even in a city known for acceptance, building a stable life from scratch was no small task.
After arriving in the city, she turned to Positive Resource Center (PRC) looking for work — and for a foothold — in a new place.
“PRC gave me my first job,” Christian said. “A simple gig — passing out magazines at the San Francisco Pride Parade.”
That first opportunity marked the beginning of a decades-long relationship with PRC, one that has seen Christian grow from client to valued employee, and eventually to policy fellow.
“Today, I’ve been with PRC for 27 years, going on 28,” she said.
Helping people access employment and build sustainable careers has been a cornerstone of PRC’s mission since its inception nearly four decades ago. In its most recent annual impact report, PRC served 443 clients through workforce development services, including career counseling, educational programs, hands-on training, and job search assistance. The average wage earned by PRC clients is $26.48 per hour — approximately 38% above San Francisco’s minimum wage.
To advance this work, organizations like PRC have benefited from funding through California’s Stop the Hate Program, which provides direct support to community-based organizations leading anti-hate initiatives.
Christian’s path was not without challenges. During some rocky years, she experienced periods of housing instability and struggled with addiction. Through PRC, she enrolled in a life-skills program that emphasized using her own lived experience as a means of helping others. The program helped set her on a path toward completing an associate’s degree and ultimately launching a career in case management.
“Today, whether someone is new to the city or has lived here their whole life, I know how to help them navigate to where they need to be,” Christian said.
PRC welcomed guests to their annual Open House in April, an evening dedicated to connection, reflection, and learning more about the programs and people working every day to support San Franciscans experiencing housing instability, unemployment, and behavioral health challenges.
Each year, PRC serves more than 5,000 clients through a wide range of programs. These include housing navigation, legal advocacy to ensure access to health and public benefits, supportive housing, job and life-skills training, and residential treatment programs.
While PRC was founded to serve people living with HIV, its mission has expanded over the decades to meet the needs of people with disabilities, individuals experiencing homelessness, and those facing mental health and substance use challenges.
According to PRC’s Chief of Public Policy and Public Affairs, Tasha Henneman, some of the organization’s earliest programs remain as vital today as they were at the start.
“Our emergency financial assistance program helped more than 1,200 people this year pay rent, cover medical bills, and keep the lights on,” Henneman said. “And over 1,400 people reached out for legal advocacy, resulting in more than $2.5 million in retroactive benefits unlocked.”
Beyond direct services, PRC is deeply committed to community empowerment and policy change. Programs such as the Black Leadership Council support community leaders in advocating for systemic reform, while the Black Trans Initiative focuses on addressing the unique challenges faced by Black transgender individuals.
A recent study from the Williams Institute highlighted findings that 71% of transgender homicide victims in the U.S. between 2010 and 2021 were Black and that nearly a third of the transgender homicides during that period were confirmed or suspected hate crimes.
PRC’s direct and indirect services can be a lifeline for people experiencing hate and are an example of the resources people can get connected with through the state’s CA vs Hate hotline.
PRC is now also producing a film project that centers the lived experiences of Black trans clients, including individuals like Christian.
“Our film highlights the health journeys and lived experiences of some of PRC’s Black trans clients,” Henneman said. “Our goal is to give voice, visibility, and agency to the participants — and to bring their stories, both harrowing and inspirational, to policymakers and the broader public.”
The film, expected to be released later this year, is directed by Yule Caise, with assistant director Zarina Codes, a Black transgender San Francisco resident.
Today, Christian continues her relationship with PRC as an ambassador, reflecting on a journey that began with a single job opportunity and grew into a lifelong commitment to service.
“Sometimes I’ll be riding the bus or standing in a grocery store, and someone will come up to me from a women’s shelter,” she said. “They’ll say, ‘Oh, Miss Seville, I just want to thank you. You really helped me with what I was dealing with.’”
She paused, smiling.
“And in those moments,” Christian said, “I think to myself, “Well!.”
A single word that sums up pride in a journey to find the best in herself.
Get Support After Hate:
California vs Hate is a non-emergency, multilingual hotline and online portal offering confidential support for hate crimes and incidents. Victims and witnesses can get help anonymously by calling 833-8-NO-HATE (833-866-4283), Monday to Friday, 9 a.m.–6 p.m. PT, or online at any time. Anonymous. Confidential. No Police. No ICE.This story was produced in partnership with CA vs Hate. Join them for the first-ever CA Civil Rights Summit on May 11, 2026. More information at www.cavshate.org/summit.
Alameda County
Stanford Health Care Collaborates with Alameda Health System Affiliate, Expanding Access to Care in East Bay
Introduced at a community event hosted at St. Rose Hospital in Hayward, an AHS affiliate, the partnership will enhance care for nearly 400,000 residents and solidify St. Rose’s position as a cornerstone of health and healing in the East Bay.
By Carla Thomas
On April 9, Alameda Health System (AHS) and Stanford Health Care announced a new collaboration to expand access to specialized medical services across central and southern Alameda County.
Introduced at a community event hosted at St. Rose Hospital in Hayward, an AHS affiliate, the partnership will enhance care for nearly 400,000 residents and solidify St. Rose’s position as a cornerstone of health and healing in the East Bay.
The initiative marks a milestone for the region, uniting two leading institutions in a shared mission to deliver high-quality, patient-centered care closer to home. Through this collaboration, AHS and Stanford Health Care will expand rehabilitative and behavioral health services, increase use of St. Rose’s operating rooms for advanced procedures, and enhance inpatient medical-surgical units managed by Stanford Health Care physicians.
The partnership will also support the AHS/St. Rose Foundation to advance local health programs that directly benefit East Bay residents.
Alameda County Supervisor Elisa Márquez praised the collaboration’s impact on local stability.
“This hospital was on the brink of closing, and saving it became my top priority,” Márquez said. “With continued collaboration, we’ll not only strengthen St. Rose but restore vital services like labor and delivery so babies can be born in Hayward again.
“When Stanford Health Care in Santa Clara stepped up, it was a pivotal moment,” she said. Keeping St. Rose open protects the entire regional health care ecosystem.”
James Jackson, chief executive officer of Alameda Health System, highlighted how the effort builds on recent progress at St. Rose.
“In just two years, AHS has made St. Rose financially stable and thriving,” Jackson said. “We want to make sure patients no longer need to drive miles down the highway to get care.
“Our mission; caring, healing, teaching, and serving all, remains at the heart of this collaboration. While HR1 presents real challenges for health care funding nationwide, it also offers an opportunity to reimagine how we deliver care. I’m confident that, through innovation and partnership, we’ll emerge stronger than before.”
For Rick Shumway, executive vice president and chief operating officer of Stanford Health Care, the alignment between the two organizations is crucial.
“This partnership reflects exactly who we are and who we aspire to be,” he said. “Working alongside AHS and St. Rose allows us to better understand community needs and respond meaningfully. Partnerships like this will carry us forward. We’re stronger together.”
AHS Chief Operating Officer Mark Fratzke echoed the same sentiment.
“I’m excited that the communities of Hayward and S. Alameda have access to care like this, he said. “Never underestimate the power of collaborations and partnerships.”
For nearly six decades, St. Rose Hospital has served Alameda County as a community-based safety-net hospital. One of Hayward’s largest employers, it provides more than 800 jobs and 300 skilled physicians and is designated by Alameda County as a ST-Elevation Myocardial Infarction STEMI Receiving Center for heart attack care.
Activism
COMMENTARY: The Biases We Don’t See — Preventing AI-Driven Inequality in Health Care
For decades, medicine promoted false assumptions about Black bodies. Black patients were told they had lower lung capacity, and medical devices adjusted their results accordingly. That practice was not broadly reversed until 2021. Up until 2022, a common medical formula used to measure how well a person’s kidneys were working automatically gave Black patients a higher score simply because they were Black. On paper, this made their kidneys appear healthier than they truly were. As a result, kidney disease was sometimes detected later in Black patients, delaying critical treatment and referrals.
By Sen. Akilah Weber Pierson, M.D., Special to California Black Media Partners
Technology is sold to us as neutral, objective, and free of human flaws. We are told that computers remove emotion, bias, and error from decision-making. But for many Black families, lived experience tells a different story. When technology is trained on biased systems, it reflects those same biases and silently carries them forward.
We have seen this happen across multiple industries. Facial recognition software has misidentified Black faces at far higher rates than White faces, leading to wrongful police encounters and arrests. Automated hiring systems have filtered out applicants with traditionally Black names because past hiring data reflected discriminatory patterns. Financial algorithms have denied loans or offered worse terms to Black borrowers based on zip codes and historical inequities, rather than individual creditworthiness. These systems did not become biased on their own. They were trained on biased data.
Healthcare is not immune.
For decades, medicine promoted false assumptions about Black bodies. Black patients were told they had lower lung capacity, and medical devices adjusted their results accordingly. That practice was not broadly reversed until 2021. Up until 2022, a common medical formula used to measure how well a person’s kidneys were working automatically gave Black patients a higher score simply because they were Black. On paper, this made their kidneys appear healthier than they truly were. As a result, kidney disease was sometimes detected later in Black patients, delaying critical treatment and referrals.
These biases were not limited to software or medical devices. Dangerous myths persisted that Black people feel less pain, contributing to undertreatment and delayed care. These beliefs were embedded in modern training and practice, not distant history. Those assumptions shaped the data that now feeds medical technology. When biased clinical practices form the basis of algorithms, the risk is not hypothetical. The bias can be learned, automated, and scaled.
For us in the Black community, this creates understandable fear and mistrust. Many families already carry generational memories of medical discrimination, from higher maternal mortality to lower life expectancy to being dismissed or unheard in clinical settings. Adding AI biases could make our community even more apprehensive about the healthcare system.
As a physician, I know how much trust patients place in the healthcare system during their most vulnerable moments. As a Black woman, I understand how bias can shape experiences in ways that are often invisible to those who do not live them. As a mother of two Black children, I think constantly about the systems that will shape their health and well-being. As a legislator, I believe it is our responsibility to confront emerging risks before they become widespread harm.
That is why I am the author of Senate Bill (SB) 503. This bill aims to regulate the use of artificial intelligence in healthcare by requiring developers and users of AI systems to identify, mitigate, and monitor biased impacts in their outputs to reduce racial and other disparities in clinical decision-making and patient care.
Currently under consideration in the State Assembly, SB 503 was not written to slow innovation. In fact, I encourage it. But it is our duty must ensure that every tool we in the healthcare field helps patients rather than harms them.
The health of our families depends on it.
About the Author
Sen. Akilah Weber Pierson (D–San Diego) is a physician and public health advocate representing California’s 39th Senate District.
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