Black Women’s Access to Health Care Improves, But Faces Big Risks

One Pagers

By Susan Green, IWPR Affiliated Researcher

Congress’s current health care debate reverberates particularly strongly for Black women. That’s because Black women historically have faced disparities in access to health insurance and high-quality care. The Status of Black Women in the United States, which IWPR recently published in collaboration with the National Domestic Workers Alliance, documents the associated health problems: higher rates of heart disease mortality, breast cancer mortality, AIDS, diabetes, and other often-preventable conditions. The Affordable Care Act (ACA) and its Medicaid expansion were designed to narrow these gaps in access. Reversing those policies might well spur a different outcome.

The report documents the status of Black women’s health across many indicators, both nationwide and state by state. At the national level, Black women die of heart disease more than White, Native American, Hispanic, or Asian/Pacific Islander women. More than 177 in 100,000 Black women die of heart disease each year—a rate nearly 25 percent higher than for White women, who have the next highest rate of heart disease mortality. This disparity is due in part to Black women’s higher rates of diabetes, elevated cholesterol, high blood pressure, and obesity. The report also cites research revealing that Black women with heart disease may be less likely than their White counterparts to receive appropriate preventive care. Similarly, women and racial minorities are often underrepresented or entirely excluded from clinical studies of heart disease. These systemic issues may contribute to disparate health outcomes.

According to the report, Black women die of heart disease at widely varying rates depending on their state of residence. Alaska, Minnesota, and Oregon are at the low end:  Black women’s heart disease death rates are 70.3, 99.9, and 105.7 per 100,000, respectively. By contrast, in Michigan, Oklahoma, and Mississippi, Black women die of heart disease at far higher rates: 226, 224.9 and 221.1 per 100,000, respectively. In all but four states, Black women’s heart disease mortality rates exceed those of White women.

Cancer rates also differ among racial and ethnic groups. The report finds that White women have the highest incidence rates of cancer, whereas Black women have the highest death rates from cancer.  This deadly distinction holds true for all cancers combined and for breast cancer, the most common form of cancer for women in the United States. The breast cancer mortality rate is over 40 percent higher among Black women than among their White counterparts, and nearly triple the rate found among Asian/Pacific Islander women. Black women’s breast cancer death rates dropped in most states between 2008 and 2012. At the national level, however, the Black/White mortality gap increased during the same period.

Black women experience especially large disparities in reproductive health outcomes compared with other racial/ethnic groups, as evidenced by high rates of maternal mortality, low-birthweight babies, and infant mortality, among other measures. As the report describes, the Affordable Care Act’s Medicaid expansion increased women’s access to preventive health and family planning services. Eleven states that did not expand Medicaid increased family planning coverage for low-income women under a different provision of the ACA.  Eight other states opted not to expand services under either section of the law. In those states, the rates of infant mortality were at least twice as high among Black women as their White counterparts.

The report details the many reasons that Black women’s health outcomes are especially at risk during the current health care debate. Read the report and accompanying policy recommendations.