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 If Obamacare is repealed and replaced by the health reform plan Presidential-candidate Romney now proposes – not to be confused with the plan Massachusetts then-Gov.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.