There are clear, race-based inequalities in health insurance and health outcomes

Patient Sharon Dawson Coates (L) has her knee examined by Dr. Nikhil Narang at University of Chicago Medicine Urgent Care Clinic in Chicago June 28, 2012.  REUTERS/Jim Young (UNITED STATES - Tags: EDUCATION HEALTH)
Editor's note:

This is part of a video series in which Brookings experts highlight race-based disparities or discrimination in public policy. Visit Race in American Public Policy for more videos in this series and related research from Brookings experts.

In the United States, there are significant racial disparities in access to health coverage and in health outcomes. People of color are far more likely to be uninsured in America, due in part to several states’ refusal to expand Medicaid. The infant and maternal mortality rates for Black babies and mothers are also far higher than those of white babies and mothers – and nobody really knows why.

Policymakers, scientists, and physicians should all be paying more attention to these issues, and together we should ask ourselves what more we can do to address them.

Try to imagine what would happen if white mothers and white babies were dying at the rate of Black mothers and Black babies.


  • Prior to implementation of the Affordable Care Act (ACA), nearly one in three Hispanic Americans and one in five Black Americans were uninsured, compared to about one in eight white Americans.
  • Since the ACA’s core coverage provision came into effect in 2014, uninsured rates fell across all racial and ethnic groups, with the biggest gains among Black and Hispanic people.
  • Still, 30 million people remain uninsured. About half of those 30 million are people of color.
  • Fourteen states have refused to expand Medicaid under the ACA, which is one of the reasons why people of color are disproportionately likely to be uninsured today. This includes some of the states with the largest populations of Black Americans.
  • More than 90 percent of the people who don’t have insurance because their state did not expand Medicaid live in the South.
  • Expanding Medicaid in these states and taking other steps to move toward universal coverage will reduce racial disparities in access to health insurance.
  • In the U.S., based on data from 2016, white babies die before their first birthday at a rate of 4.9 per 1,000, and white women die from pregnancy and childbirth-related causes at a rate of 13 per 100,000. While those numbers are far higher than other wealthy countries, the picture is far worse for Black babies and mothers.
  • Black babies die before their first birthday at a rate of 11.4 per 1,000, and Black moms die from childbirth-related causes at a rate at a rate of 42.8 per 100,000 – more than double and triple the rates of white babies and moms, respectively.


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