Barack Obama and the Racial Politics of the Affordable Care Act

This chapter examines the Obama presidency, the politics of race and health care, and the role that African Americans played in shaping the Affordable Care Act (ACA). We argue that race—and specifically the elimination of racial and health disparities—was very much part of the ACA’s development. From the perspective of Black lawmakers health equity and patient protection advocates, who worked hand-in-glove with the Obama administration, the ACA was not race-neutral or indifferent to Blacks and the working poor. The law had special significance for African Americans despite Obama publicly discussing its impact in deracialized terms. Daniel Dawes, a leading advocate for health equity and author of the groundbreaking book 150 Years of Obamacare, called the ACA the “most comprehensive minority health law” and the “most inclusive [health] law” in the history of the United States. He identified sixty-two provisions that “directly address inequities in health care” that are embedded in the ACA.” This chapter thus argues that Obama’s ACA was substantively accountable to the coalition of Black lawmakers and activists—what we refer to as a policy ecosystem—who were purposeful about incorporating provisions in the bill designed to reduce racial disparities and income-based inequities in health care.