Why Obamacare Is Good for White People

With some pundits predicting that President Obama’s re-election could be sabotaged by a slim level of white voter support, I decided to dig through the small print on Obamacare to see how this right-wing lightning rod actually affects my fellow Caucasians.

It turns out that the high-profile legislative highlight of Obama’s first term is very good for white people. When the Affordable Care Act is fully implemented, 12.3 million more white people will have health insurance than have it today, according to an analysis in Health Affairs.

Obamacare looks even more positive for the pale skinned when put next to the Romney-Ryancare alternative. If Obamacare is repealed and replaced by the health reform plan Presidential-candidate Romney now proposes – not to be confused with the plan Massachusetts then-Gov. Romney enacted into law — an extra 24.8 million white people will not have health insurance. (That’s if you apply current demographics to a recent Commonwealth Fund analysis.)

By way of perspective, that’s nearly equivalent to the entire population of Texas (but all white people) having to cope with serious problems accessing medical care and paying for it. Or to use a more politically compelling comparison, 24.8 million white people would be more than twice the size of the whole population of Ohio.

Oh, yes: Ohio. In Ohio, three-quarters of the uninsured adults who would benefit from the Medicaid expansion that was mandated by Obamacare but made optional by the Supreme Court are whites, an Urban Institute analysis shows. If Romney-Ryancare replaced Obamacare, however, Ohio would have to cope with 1.7 million residents without health insurance (the Commonwealth numbers again), mostly white people.

Whites are also the big gainers from Obamacare’s Medicaid expansion in the battleground states of Colorado, Iowa, North Carolina, Virginia and Wisconsin. In Florida, just under half (48 percent) of adults who’d benefit from the Obamacare Medicaid expansion are white. By way of comparison, Romney-Ryancare would result in an eye-popping 3.1 million more Floridians having no health insurance versus Obamacare. Close to 1.5 million of those Floridians would be non-Hispanic whites, or roughly equivalent to a bit more than the entire Jacksonville metro area. If all the people living there were non-Hispanic whites, of course.

Based on the income levels involved, these newly insured will be working-class Americans more familiar with NASCAR than NPR, and, in rural areas, with grain elevators more than car elevators. Fifty-three percent will be male, according to the Urban Institute figures, which should make Obama the “man” for the macho guy who doesn’t want to be forced to depend on friends and families to pay his medical bills if his pickup smashes up with him in it. More broadly, the Obamacare expansion of health insurance coverage that includes an individual mandate makes the biggest difference versus Romney-Ryancare for those with incomes of $44,680 per year or less, notes Commonwealth.

So why isn’t the Obama campaign touting its winning formula for whites? Perhaps they worry that a significant part of the working-class whites they are courting are more likely to be turned off by the disproportionate rate at which the Affordable Care Act helps blacks than energized by the way it helps whites. For instance, a new survey by the Public Religion Research Institute found that 60 percent of non-college educated whites believe that blacks and other minorities get too good a deal from the government.

A recent Associated Press poll found that racial prejudice among whites has increased during President Obama’s term in office. A disturbing 51 percent of Americans now express explicit anti-black attitudes, and when an implicit test is used, anti-black sentiment jumps to 56 percent. Meanwhile, Romney supporters dabble in outright racial attacks, be it Sarah Palin accusing Obama of “shuck and jive” or John Sununu sneering that Colin Powell is supporting Obama for racial solidarity reasons.

Although there are many more uninsured whites than blacks, blacks are eight percent more likely than whites to be uninsured. With the Affordable Care Act, the uninsurance rate of whites will plunge 53 percent, according to the Health Affairs analysis, but uninsurance rate for blacks will drop 55 percent. Overall, the difference between black and white uninsurance rates would shrink to 3.3 percentage points.

Meanwhile, even though Obamacare’s coverage expansion explicitly excludes undocumented immigrants, the rate of uninsurance of Hispanics drops 37 percent while “Asian and other” (including Pacific Islanders, American Indians and Eskimos) drops 44 percent, though big differences persist between them and whites.

The numbers show that the Affordable Care Act is a good deal for white folks, particularly those who are working class. But it’s also very good for many other Americans that too many of their fellow countrymen still view largely as “other” and less as “American.” The larger question is whether coloring in the facts about Obamacare will do anything to override white voter questions about the color of the man who made it possible.

Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, IL; the Mervin Shalowitz, MD Visiting Scholar at the Kellogg School of Management; and a board member of the Society for Participatory Medicine.

27 replies »

  1. I have no problem with the VA system, 16 patients per day max, competitive salary. So lets add 30 million patients to the system and have the current docs cut back from 25 patients per day to 16 patients and see how that works out. Single payor systems work well for a season, then apathy sets in and the system tanks. That is why overseas there are always two systems.(see previous post on the hospital in India). You did not receive socialized medicine at the VA! You received medical care by a physician that was not forced to see 30 patients a day to just make ends meet do to the overwhelming burden of this health care system. Primary care is a social discipline and as long as a dermatologist gets $200 for shaving off a wart and I get $100 dollars for dealing with a chf, diabetic with renal dysfunction nothing will change and contrary to what people think neither obama or romney are going to touch that.

  2. Hey may not change hearts and minds, but he gave me a good laugh. Sometimes providing comfort to those who already agree with you is good enough.

  3. Never read ?, well I have read what is available to download. I know what has already come to fruition, like adult children to the age of 26 who can now stay on their parent’s policies. Mandating that insurance companies must spend at least 85% of each health care dollar on actual health care or refund policy holders. It also addresses the current preexisting conditions against children. So what do you advise to deal with the healthcare crisis? I am a single payer advocate, but I don’t think that will ever happen, so what is the alternative, what would your plan be? As a wife of a 100 percent disabled Veteran, I was eligible to seek my health care needs in women’s health at the VA. BEST MEDICAL CARE I ever had. I continued to carry my heath care insurance through my employer, and paid my portion, but NEVER used it, because I preferred the much better care I got at the VA. So my view on government is not as jaded as yours. Of course Obama’s PPACA is not government takeover of healthcare, and not as good as the “socialized medicine” I was fortunate to receive. There is no perfect answer, but to do nothing is obscene.

  4. Hey, check out the new MoveOn.org ad for Obama that had elderly women swearing and threatening violence against republicans, one of them directly against Romney.

    Wow, they really have taken the Republican thuggery and dropped it several notches. Anyone who thinks the ad just funny and satire, well, you deserve the company you keep.

    God forbid there are race riots, good luck finding independent votes for the next generation. Is this the race issue you thought up with this post, Mr MM?

  5. Michael, apparently you missed DeterminedMD’s above reference to the MMA: “Just like the equally dishonest and disingenuous dialogue by Bush et al 10 years ago.”.

  6. Well, I gravitate to more a Libertarian type of political philosophy, so I do not embrace Democrat chicanery of late, and continue to despise Republican commentary from past through future times.

    There is a better bill to assist health care problems, it just won’t come from EITHER party, and certainly not from existing, entrenched incumbents who will keep their status come Nov 7.

    Ignoring true mainstream physician input is a mistake that will cost all races, and I would clarify it with all Americans, but another over tolerance attitude by Democrats is let any and all with 2 feet to come here welcomed or not and access our FINITE resources, but, to all Democrat hacks, that is equally superfluous to the argument as well.

    If my above comment was taken as insulting, then I apologize, but PPACA as it stands is at least insulting, moreso intrusive, and will be devastating to many people’s health, while the cronies and partisan champions are not affected.

    Here is a tip to people: don’t support laws if the writers except themselves from the impacts. But, if the majority of Americans knew this, we wouldn’t have incumbents in place for decadeS as is now!

  7. Appreciate your respectful reply, freedom is about choice, last I checked, and the Democrats and PPACA supporters seemed to have conveniently discarded that concept in the garbage can put on the street before walking into Congress.

    I offer this separate comment to other readers who seem to continue to take issue with my spirited rejection of this legislation: I would not be such an alleged jerk in my writings if the proponents of the legislation made sincere efforts to engage dialogue and responsible debate in crafting it. But no, they took the pages from Republican hackery and just wrote and passed a bill and expected us to wait unt 2014 to find out what problems it has, and yes, Pelosi did say that nearly word for word.

    You all think you are going to get representation renewed after next week, if able to vote in the upper quarter of the US, and yet, per Pete Townsend wrote so so eloquently in “Won’t get fooled Again”, here comes the new boss, same as the old boss. Not written as endearing.

    More independent people than not I have spoken with don’t like PPACA, so forget the partisan spin, PLEASE!!!

  8. FU2, why I get told by blog management to watch my comments and you seem to get a free pass, well, takes one to know an alleged one.

    I ignore you of late, care to grow up and reciprocate? Look up the word if confused!

  9. My refusal to toe any party line and my unpleasant habit of looking hard at PPACA – both in historic context and how it actually implements in the real world – is probably good for AEI’s SEO. As is the independence of many of my colleagues here, as per Ed Gillespie telling Chris Wallace: “I can tell you, there are many instances where there have been things AEI came out with and said, I didn’t find it to be necessarily to be helpful to the Republican Party.” http://www.huffingtonpost.com/2012/10/14/romney-tax-plan-ed-gillespie_n_1964934.html

  10. BTW the “not American thing” is totally real. I made a crack about no respect for athesists in the debate (after a Biden comment lauding every religious group on earth except Mormons) even though we’re 15% of the popoulation, and the comments from a Republican “friend” quickly got into the “you’re not a real American” even though I’ve been here 22 years and been a citizen for 11.

    My response was a) I’m the real American as I chose to be one and the bozo criticizing me was born here randomly and b) I passed a test he probably would have faiied!

  11. And how does this comment help AEI’s SEO? Or do you genuinely mean it and are no longer simply just trolling for page views?

    (Sorry JD–you’re just too easy a target!)

  12. Oh, Michael – how could you???

    Reading the actual law and analyzing it to the context of actual demographic data? Tsk-tsk. Next thing you know, you’ll be trying to tell us that PPACA is actually only 955 pages and not the 2400 or 2700 of popular legend. You have hit more than the usual tripwires with this one – and not just because we’re not allowed to talk about race, except by talking about how we’re not talking about it. Don’t you know the “debate” about Obamacare has nothing to do with health care and everything to do with the ideological civil war tearing the country apart?

    The operating realities of Obamacare beneath the mile-thick river of ideological spew against it are all sheer paradox: Obamacare, precisely like Romneycare, is based on previously conservative, market-based ideas about people taking responsibility for carrying private insurance – belatedly standardized to bring transparency and price competition to bear on the process – and about people getting access to it through markets corrected for distortions like medical discrimination and unaffordability by the working poor. I write about this at http://www.nytimes.com/2012/09/30/opinion/sunday/why-obamacare-is-a-conservatives-dream.html?_r=0 Even the huge expansion of Medicaid under Obamacare – a system used predominantly by rural whites in this country, contrary to other folklore – is and will be increasingly managed by commercial insurers, e.g., Amerigroup, Centene, Molinas. I write about that at http://www.forbes.com/sites/realspin/2012/08/23/fools-gold-rush-obamacare-and-the-medicaid-opportunity/

    If people would stop hyperventilating for a moment, they’d realize that Obamacare is nothing more or less than a violent endorsement and expansion than the status quo. How else to explain the deafening quiet from the insurers, drug companies, AMA, AHA? The only reason the Rs hate it is because it contains, thanks to their two-year sneer campaign since its passage, “Obama” in the name. The law could contain free care for all (which it certainly does not) and a cure for all cancers (nor the mandate that IPAB work to preclude finding one) and none of that would matter. The law has been turned into a political football for two sides of the American polity that seem to want to agree and cooperate on exactly nothing these days. Here in DC, scoring points rather than solving problems is the ONLY goal – and for that, we ALL suffer.

    This is a great analysis, but you have clearly hit far too many raw nerves.

  13. I love it when people who have never read obamacare bust on people for not having read obamacare. The problem with obamacare is that over 50% of it is actually not written so nobody knows what it says. It is a blank check that gov’t can use to whatever means they want. As for me I dont have alot of faith in this administration to do what is good for patients. The old phrase “things could not be worse” have proven to be load of crap as we are currently seeing.

  14. Mike:

    It’s better to have a colonoscopy than an enema when one is really needed. These are FACTS, not racism. WE ALL BENEFIT FROM OBAMACARE, even those who “don’t want to hear it.

    Those clinics in the small town, rural areas that Michael speaks of are gov’t subsidized and possibly federally-qualified, delivery high-quality primary & specialty care, regardless of income, race, etc.

    BTW, I’m stranded in DC with several folks, including a white pastor from rural north east Iowa, who has been taking care of his wife for the past six years. He’s become an expert coordinating her care and identifying programs that she’s eligible for. She was recently cut-off from Iowa Medicaid because she’s not eligible for Medicare disability (go figure) and he’s mad as hell.

    Michael tells truths that nobody wants to hear. Thanks Michael, better primary care than emergency care (and driving 500 miles to the next ER if you can afford the gas)!!

  15. Micheal, thank you for the informative and well-written article. I am amazed by the number of people who make blatant claims about “Obamacare” and never reference the actual law itself. I find most of their claims to be baseless and rooted in emotion and speculation.

  16. Determined MD, Not a big Obama fan, and his the PPACA is not what I wanted it to be. (The Public Option should have been part of the equation) but it is better than the status quo of over 50 million uninsured. Insurance companies have been dictating how doctors practice medicine for years, The decisions of medical coverage are usually made by some pencil pusher with no medical background but people armed with their company bibles on how to pay out the least amount on a claim. I have worked both sides of the coin. As a nurse for over 35 years, and a brief stint in a review department for an insurance company. When I go to the polls it will not be with enthusiasm but with the intent of protecting the small gains our country has made, although not enough for my liking, far better than the alternate choice.

  17. “Politicians and bureaucrats do not and will not set policy based on true health care needs and efficacious interventions.”

    And, of course, only YOU know what they are.

    Tiresome troll.

  18. DeterminedMD, if you don’t like Obamacare taking effect with a delay, how come you’re not absolutely livid about the Ryan reform plan that would take a 10-year roll-in period? Or Ayn Rand is always worth waiting for?

    And, of course, the model for pass-and-delay is the Medicare Modernization Act of President George W. Bush, with its “get the votes of seniors for a Medicare drug benefit but wait to implement.”

    You ARE determined to be consistent, are you not? Or the symptoms of political disease are only among Democrats?

  19. Politicians and bureaucrats do not and will not set policy based on true health care needs and efficacious interventions. It will solely come down to cost. Period. IPAB will be a travesty.

    And, how disingenuous to write a law that does not take effect for 4 years. The sheer hypocrisy of the Democrats who bitched like 8 year olds when Republicans controlled the executive and legislative branches for 6 years is just astounding to witness. Bush screwed our military, and Obama screws the public. Next week is not about the future of America, but which evil America can be screwed by.

    And all races will feel the pain. The cronies and special interests will continue on merrily. Probably you as one of them!

  20. Hi Michael.

    The issue of affordable health insurance is very important to all ethnic groups, all classes, and gender. You certainly show how this Act impacts us all, no matter the genotype or the phenotype. Your simple detailed explanation of the issue is very informative and interesting.
    The improvement in the system will insure that more people will have health coverage to attend to their healthcare needs, not to mention the improved quality of care objectives and other benefits to the patient.
    thank you.

  21. Whatever you intended, the racial overtones in this post are glaring and insulting. Sorry, but I doubt you would change many hearts and minds with this misguided approach…

  22. DeterminedMD: I will agree to presume that you dislike PPACA based on genuine knowledge of its many components (beyond the individual mandate and the headlined stuff) if you’ll agree to presume that I like it, acknowledging various flaws, based on similar genuine knowledge. I also presume that such first-hand study of the law is common among many of this site’s readers of all political persuasions. MM

  23. It will harm all races equally. It never ceases to amaze how disingenuous and dishonest the PPACA proponents continue to promote to try to save this legislative mistake. Just like the equally dishonest and disingenuous dialogue by Bush et al 10 years ago. Unfortunately, with a third of the country now pathologically dependent on government services/entitlements, what can anyone expect as long as enough Democrat demagoguery can endure.

    Not that Romney would do any better.

  24. Dear MD as HELL:

    Naah. You and I may disagree politically, but I am not calling you a racist.

    The point here is that Obamacare is not a government program for the underclass but helps working-class whites and others even more. As addressed in the Associated Press poll, and the religious foundation poll I also cite — not liberal organizations, but non-partisan ones — the white working-class view of Obama and the benefits he has brought them is often obscured by racial overtones.

    Not everyone acts this way and, of course, not all opposition to Obama is racially based. But it happens more than we talk about. And it is abetted by some like Palin, with jive and shuck; like Sununu; and like Gingrich, calling Obama the food stamp president.

    If you’re a conservative and you don’t like Al Sharpton — and, really, who can like Al Sharpton very much? — for his race baiting, you have to dislike conservatives who race bait and acknowledge its reality.