Overview: MLK’s legacy includes a call for access and equality in the nation’s healthcare system. Decades later, the nation’s first Black President ,Barack Obama, made major strides in access to care for all Americans with the implementation of the Affordable Care Act. The Affordable Care Act has improved access to healthcare for all Americans, but there are many disparities in health outcomes that persist. The expansion of Medicaid under the ACA has reduced mortality in non-elderly adults by nearly four percent, but millions remain uninsured, particularly in Republican-led states with large Black populations.
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“From Slavery through Jim Crow, systemic racism excluded African Americans and other marginalized groups from quality health care,” noted the Assistant Secretary for Planning and Evaluation, Health and Human Services Department, in a June 2024 report. The analysis included a look back at how segregated hospitals, unethical medical practices, and structural barriers such as redlining restricted access to essential care.
Many readers may already be familiar with the quote, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” These words were spoken by Rev. Dr. Martin Luther King, Jr. (MLK) in reference to the nation’s racist history regarding access to healthcare for Blacks.
Data also informs the reality that poverty—undergirded by issues like inadequate housing, food insecurity and exposure to environmental hazards, underemployment, etc., exacerbates health inequities and access to care. Even with the passage of the 1964 Civil Rights Act, these glaring inequities continued.
For more than 100 years the nation toyed with the idea of providing some form of affordable healthcare option. Although some had tried, Barack Obama–the nation’s first Black president–made it the priority of his first term in office. He successfully passed and signed into law the historic Affordable Care Act (ACA) legislation.
In the years since, the ACA has proved the adage that a rising tide lifts all boats as an additional 20 million Americans gained coverage and the nation’s uninsured rate dropped below 10%. Healthcare experts have noted that this, coupled with healthcare innovations, advancements in public health and science related progress, is making this nation healthier.
Obama understood what MLK understood, that “poverty, inadequate healthcare, and systemic inequalities were barriers to individual well-being and national progress”.
One of the ways Obama sought to mitigate this issue via ACA was by providing more access to coverage through Medicaid expansion, MediCal in California. Despite this effort and inclusion in ACA, millions of Americans remain uninsured because most Republican-led states—including those with large Black populations like Tennessee (16% Black) Alabama (25.6% Black), South Carolina (24.8%), Georgia (31.3% Black), Mississippi (36.9% Black) and Texas (37% Black)—refused to participate in the Medicaid expansion. Although Blacks are only about 15% of the nation’s total population, among the ten states still refusing to expand Medicaid under ACA, six of the ten have majority Black populations. Many of those Black populations have poverty rates above 20%. Would it fall into the category of conspiracies were I to identify this as the intentional targeting of Blacks at the expense of their poor white neighbors who also need this coverage? This question, of course, is rhetorical.
“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”
Martin Luther King Jr.
Just as during the life of MLK, poverty continues to be a significant determinant to access to quality healthcare, especially preventative care, which leads to poorer health outcomes and higher health related costs.
We experienced this during the COVID-19 pandemic of 2020-21, when a once-in-a-century health crisis collided head on with structural and institutional racism even with the additional protections of the Affordable Care Act (ACA) in place. During this crisis, we witnessed communities of color, particularly Black communities, initially experience roadblocks to care and access to COVID-19 vaccines.
Yes, we can concede the ACA was not a perfect bill. Those of us who advocated for the single payer option, were disappointed. Certainly, with the nation’s rapidly aging population, to have long-term care stripped from the bill at the last minute was also disappointing as the need for access to long-term care continues to grow exponentially, However, the impact ACA has had on improving the quality of health and thus, the quality of life for Blacks in America, is measurable and quantifiable though disparities persist.
Since passage of ACA, however, Republicans have worked relentlessly to destroy it with a vigor almost greater than their efforts to undo the Civil Rights Act of 1964 and the Voting Rights Act of 1965. One of the ways they sought to do this was by failing to extend the COVID-19 era subsidies that expired December 31, 2025.
On Friday January 9, after signing a discharge petition in December to bring the bill to the floor for a vote by overriding the Republican Speaker of the House, 17 House Republicans joined a majority of Democrats and voted to extend the controversial Affordable Care Act subsidies for three years. Although the vote was crucial, it was also late when you consider the subsidies had already expired.
The question to ask now is, whether or not passage of the subsidies in the House will make a difference? As much as I want to believe it will, the reality is that it probably won’t. There is still no groundswell of support among Republican Senators to vote with Senate Democrats to extend the subsidies. And even if enough Republican senators do coalesce in support of the legislation and vote to pass it, the bill will most certainly be vetoed by Donald Trump.
Despite this probable setback, how would MLK perceive the impacts of ACA? I believe he would celebrate its progress to date, while standing at the forefront of activism for greater change. I see him advocating for continued progress on this issue beginning with extension of COVID-19 era ACA subsidies.
King would be pleased with the additional 3.3 million Black Americans who now have health insurance coverage as well as the 10-percentage point decline in the uninsured rate among Blacks. And, I strongly believe he would continue advocating assertively for increased enrollment among Blacks.
An interesting aside to enrollment is that as we strive to increase the percentage of Blacks with access to care we must keep in mind America’s Black population is expanding. This may largely explain why a racist Trump is blocking immigration from so many Black countries.
In 1870, when America conducted its first post Civil War census, Blacks were about 12.5% of the population. Today, in alignment with the browning of America, some experts project the country’s Black population will increase 13% by 2045. In addition, more than 58% of Blacks in this country are under the age of 40 and tend to be younger than the nation’s population as a whole. The median age for Blacks is 32.5 years compared to a median age of 38.2 for Americans in general. As the nation’s Black population expands and is younger, the need for equitable access to preventive care will also increase.
Few can argue that substantive progress in healthcare coverage and access to care for Blacks has improved. Yet, despite this progress, disparities in health outcomes persist. A large volume of research shows centuries of social, systemic and institutional racism–including implicit and explicit biases, “has had a profound and negative impact on the physical and mental health of Black Americans.”
Today, despite progress, Blacks remain more likely to die prematurely or live with health conditions that are preventable compared to our white counterparts.
In a March 25, 1966 AP interview with MLK at the annual meeting of the Medical Committee for Human Rights, MLK called for direct action to “raise the conscience of the nation” regarding health care. Across decades, nearly 44 years to the day, on March 23, 2010, Obama signed the Affordable Care Act into law.
Since its implementation the uninsured rate has dropped from 17.8% in 2010 to 9.6% in 2022; the uninsured rate for low-income adults dropped from 35 percent in rural areas in states that expanded Medicaid; Medicaid expansion has reduced mortality in non-elderly adults by nearly 4%, and nearly 710K children gained coverage as a result of their parents enrolling in Medicaid between 2013 and 2015, among other gains.
Were MLK alive today I perceive he would encourage us to continue efforts to expand Medicaid or adopt universal health care to ensure that everyone, regardless of income, has access to affordable care. He would push for improvements in impediments to good health including improved housing, education and food security for those in need. Certain to be at the top of his list would be combating implicit bias in the healthcare system and advocating for more Black doctors and nurses.
One of the ways we can honor the legacy of MLK is to stay focused on this issue and continue working for equity in healthcare because for far too many Black people it can mean the difference between life and death.
Of course, this is just my opinion. I’m keeping it real.