For more anti-racism resources, check out our guide, Racial Justice Is Reproductive Justice.

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report. 

Rebecca Lee Crumpler, the first Black woman to earn a medical degree in the United States, wrote about the burden of diseases on Black people in 1883, “They seem to forget there is a cause for every ailment, and that it may be in their power to remove it.”

The world’s focus right now is on COVID-19, and it’s exposing the many flaws in our health-care system that Black women have known for too long: Our health-care system and health-care reform efforts have always carelessly or purposefully excluded us.

It’s ironic that this outbreak is happening alongside the tenth anniversary of the Affordable Care Act (ACA) today. Since its passing, the ACA has expanded health insurance to nearly 20 million previously uninsured people, eliminated discriminatory insurance practices like gender rating, and made sure insurance plans cover many of women’s major health needs, including maternity care.

Since 2013 when ACA enrollment began, the rate of uninsured Black people has decreased by more than half, which means millions more Black people have gotten coverage for their medical needs, such as chronic disease management, prescription drug coverage, and preventative services.

But the rate of uninsured Black women fell by only 7 percent. Nearly 14 percent of Black women remain uninsured, and for the Black women with health insurance, they can experience bias and compromised care.

In a Mothering Justice and the National Women’s Law Center’s online poll of 525 Black women who were likely and eligible voters in Michigan, around 8 in 10 reported having at least one adverse interaction with a medical professional, including medical professionals ignoring reports of pain, dismissing patients’ input, misdiagnosis and delayed diagnosis, and being talked down to and/or disrespected. How is it that ten years after the ACA’s passage, Black women are still lagging in both access to coverage and quality of care?

The answer is grounded in our history.

During Reconstruction, Southern hospitals that served Black people were under-resourced and often forced to close their doors. Racism and fear of dependency on the government-led white legislators to disregard the health-care needs of formerly enslaved Africans. This exclusion from the U.S. health system continued with the passage of the Social Security Act of 1935 when agricultural and domestic workers—occupations that employed up to two-thirds of Black people—were excluded from coverage and benefits.

A decade later, the Hill-Burton Act of 1946 provided federal grants for hospital construction and gave priority to rural communities—but it also allowed segregation. And it gave states the power to control the disbursement of funds, which often meant Black-serving hospitals and health clinics received only a fraction of the funding doled out to white-serving institutions.

When the ACA became law, it expanded the Medicaid-eligible population to include low-income childless adults. However, a harmful U.S. Supreme Court decision allowed states to choose whether to expand Medicaid coverage. Unsurprisingly, nine of the 14 states that did not expand Medicaid contain disproportionately high percentages of Black women, many of whom work jobs that do not offer insurance. These states include Alabama, Georgia, Mississippi, North Carolina, and South Carolina, among others.

Time and time again, federal policies that ostensibly seem groundbreaking have excluded Black communities, implicitly or explicitly, and reinforced that access to good health is reserved for a privileged few. Today, Black women and people of color receive less and/or worse health care. Black women have the highest rates of maternal mortality and breast cancer compared to women of other races. Racial health disparities are wider now than they were in 1850, and there is still an intense mistrust of medical institutions as a result of systemic racism, involuntary experimentation on Black communities, and medical bias.

No federal health-care policy has yet to undo all the systemic harms done to Black women or account for all the affirmative systemic policies that improved white people’s health. We’ve made great strides, like with the ACA, but what’s clear from the COVID-19 global pandemic is that health-care policy must center those pushed out to the margins. This begs the question: What would our health-care system be equipped to do in the face of COVID-19 had we centered Black women?

The answer is that we would have a system that divorces the concepts of health care and employment, and ensures that cost is never a barrier to care. Black women are less likely to have employer-offered health insurance and are more likely to be in low-wage jobs that don’t qualify for public coverage yet pay too little to afford private insurance. Black women are also more likely to be underpaid and to delay or deny themselves care due to costs.

Truly investing in the health and well-being of Black women would reform our system and obviate the inevitable scramble to address public health crises like COVID-19.

COVID-19 is a mirror, reflecting historical problems of the U.S. health-care system. It’s time for us to center the people pushed to the margins and do what should have already been done.