A patient receives a skin exam at the Washington Cancer Institute at MedStar Washington Hospital Center. (T.J. Kirkpatrick for The Washington Post)

Black women were one of the biggest beneficiaries of the Affordable Care Act, but a new report argues that the Republican efforts to dismantle parts of the law threaten to undo many of the gains made, putting low-income women and women with chronic health conditions most at risk.

Under the ACA, the report found more black women were able to access to health care, including preventive screenings and treatment for chronic illnesses such as diabetes, HIV and hypertension. Because black women are disproportionately affected by chronic health issues, they may have been more susceptible to denial of coverage due to “preexisting conditions” before the ACA, which forbids insurance companies from rejecting people with such illnesses. Additionally, many low-income black women gained access to health care through the Medicaid expansion, the report found, allowing them to access critical health services at no cost.

Despite the gains, black women still experience numerous health disparities, including high rates of maternal mortality, preventable reproductive cancers and unintended pregnancies, according to the report, released Tuesday by In Our Own Voice: Nation Black Woman’s Reproductive Agenda. Black women are up to four times more likely than white women to die from pregnancy-related causes, represent 61 percent of new HIV infections, and are 43 percent more likely to die from breast cancer than white women, the report found.

To address these disparities, the report calls on legislators, activists and reproductive justice organizations to support policies that continue to expand health insurance coverage for black women while also addressing a myriad of social factors affecting their health, such as the criminal justice system and economic disparities. But the report’s lead authors fear little progress will be made on this front if the Republican-led health-care bill becomes law.

The report notes that some of the biggest threats to black women’s health care under the new bill are cuts to federally funded family planning service providers such as Planned Parenthood, reductions in Medicaid coverage and the removal of maternal health as a no-cost essential health benefit.

Of the 4.2 million people served by federally funded family planning programs, 92 percent are women and more than 20 percent are black, the report found. In addition, nearly one-third of black women of reproductive age are enrolled in Medicaid, and millions of black women gained access to maternal health screenings through the ACA.

“Barack Obama said it was a mean bill,” said Marcela Howell, one of the report’s lead authors and executive director of In Our Own Voice. “But it’s really catastrophic.”


Panelists Marcela Howell, Heidi Williamson, Deon Haywood, Marsha Jones and Masonia Traylor discussed the report on black women’s health at the National Press Club on Tuesday. (Bernard Harris)

Howell and Heidi Williamson, senior policy analyst for women’s health at Center for American Progress, a left-leaning policy institute, are the lead authors of the report entitled, “Our Bodies, Our Lives, Our Voices: The State of Black Women & Reproductive Justice.” Williamson and Howell worked in conjunction with reproductive justice organizations from across the country, including SisterReach, Black Women for Wellness, and SPARK Reproductive Justice Now. The groups center black women’s experiences in local and national campaigns for reproductive justice.

Reproductive justice, Howell says, encompasses more than just issues of reproductive health and health care.

“Most people think reproductive justice is just about the womb, but it actually looks at all of the intersections of our lives,” Howell said during a panel on Tuesday in which she discussed key findings from the report. The goal, she added, is for “all women and girls to have the social and economic power to make decisions about their health and their bodies.”