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Healthcare reform is a major debate in the United States, with the focus centering around healthcare access. The Affordable Care Act (ACA), implemented in 2010 by the Obama Administration, has received praise for its aim to reduce the number of uninsured Americans through an expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income individuals purchase coverage.

The ACA led to major reductions in uninsured individuals in all racial groups. Between 2013 and 2016, the uninsured rate for Hispanic Americans decreased from 26% to 17%. Furthermore, the uninsured rate for Black Americans decreased from 17% to 12% between 2013 and 2016. During this time, the uninsured rate among White and Asian populations both lowered to 8%, with the uninsured rate for the Asian population starting at 15% and the uninsured rate for the White population starting at 12% in 2013.

The ACA led to major reductions in uninsured individuals in all racial groups.

Black Americans are one of the racial groups still disproportionately affected by a lack of access to healthcare even after the implementation of the ACA. According to the Kaiser Family Foundation, Black adults (19 — 64) are nearly two times as likely to be uninsured or receive some sort of public insurance than their White counterparts. Furthermore, less than half of non-elderly Black Americans have private coverage compared to seven in ten non-Hispanic Whites. A historic look at this issue could provide a rationale for the disproportionate debarment from healthcare that Black people experience in America. Jim Crow laws represented a formal, codified system of racial apartheid that dominated the American South for nearly a century beginning in the 1890s. The presence of Jim Crow laws led to segregation and the disenfranchisement of Black Americans. The laws mandated segregation of every aspect of daily life including parks, schools, restrooms, trains, and restaurants. A commonly overlooked effect of Jim Crow is the segregation of hospitals and medical facilities. During the Jim Crow era of segregation, many hospitals, clinics, and doctor’s offices were totally segregated by race. Furthermore, several medical facilities maintained separate wings or medical staff that could never be intermingled under the law.

Another issue present during the Jim Crow era was the shortage of trained Black medical professionals at segregated hospitals, which was influenced largely by education segregation both generally and in the medical context. Many Black students were not prepared for medical training because of the disadvantages they faced in a segregated education system at the primary and secondary levels. The lack of competent Black medical professionals meant that the healthcare that Black people accessed during the Jim Crow era was of a lower quality than their White counterparts. Furthermore, Black patients were commonly denied access to White hospitals during the Jim Crow era when they were seeking emergency care. W.E.B. Du Bois lost his two-year-old son to a treatable infection because “no White physicians [were] willing to treat a Black child.” Hospitals that treated Black people were often located far from the people who needed them most. In Mississippi, for example, there were only six hospitals that would treat Black patients, and none of them were in the Delta. The lack of hospitals treating Black patients in Mississippi led to fewer than 10% of all births of Black children in the state taking place in a hospital compared to nearly 70% of white births.

The effects of segregated healthcare have looming effects for Black Americans and their health outcomes. We see today, for example, that Black doctors account for only 4% of doctors in the United States despite Black people representing 12% of the population in this country. The continued lack of access to doctors who share a common identity leaves many Black Americans without the opportunity to gain culturally competent care from an institution that they do not trust because of the social and structural harms it has caused them.

Effects of segregated healthcare have looming effects for Black Americans and their health outcomes.

Because of historical structural violence, present racist structures, and racial disparities in income, Black Americans are still less likely to have access to high-quality medical care today. Research has shown that Black patients tend to live closer to higher quality hospitals than White patients but are 25% to 58% more likely than White patients to receive surgery at lower quality hospitals.[1] This startling statistic shows that the medical system is still haunted by the Jim Crow era, with Black Americans often having restricted access to higher quality healthcare. Unfortunately, there is a gap in the research literature on segregated hospitals, but we can still conclude that restricted access to quality healthcare may be a contributing factor to many of the racial health disparities that Black Americans face from maternal mortality to life expectancy.


  1. Penson, D. F. (2013). Re: Black Patients More Likely than Whites to Undergo Surgery at Low-Quality Hospitals in Segregated Regions. The Journal of Urology, 190(6), 2211. doi:10.1016/j.juro.2013.07.080