To Build Back Better, improving Black women’s health is a must

After winning the election, President Biden credited his victory to Black women’s support and activism, and now is the time we insist the president prioritize our needs as though our very lives depend on them. As Congress debates Biden’s Build Back Better agenda, lawmakers have the rare opportunity to make sweeping improvements to the U.S. health care system in ways that would improve the lives of all Americans, and especially Black women. 

In particular, lawmakers should prioritize policies that would address the maternal health crisis, increase access to coverage and make prescription drugs more affordable. Given that Black women are disproportionately harmed by the current system — in terms of access, affordability and culturally competent care — these long-overdue advancements could save Black women’s lives. 

Illustratively, Black women are around three times more likely than non-Hispanic white women to die from pregnancy-related complications. African American women have 15 times the AIDS rate as white women. And while African American women are not more likely than white women to contract breast cancer, they are 40 percent more likely to die from the illness. Black women also are more likely to be uninsured and underinsured and, even among those with insurance, are more likely to report difficulty in paying for care and prescriptions. Many of these inequities are the result of long-existing failures in our economy, housing and health care systems —failures that were only exacerbated by COVID-19.

Congress and the Biden administration have already made meaningful health care advancements. The American Rescue Plan, for example, included a new option for states to expand Medicaid coverage for postpartum people. People were given increased financial help to purchase private insurance, as well as additional time to enroll in this coverage. And, of course, there has been a significant focus on ensuring COVID-19 vaccination and testing are free and readily available. The bipartisan infrastructure package currently being considered could also have health implications by improving water quality and eliminating lead pipes —which frequently harm Black children and pregnant people — and addressing the crumbling bridges and roads that are a safety hazard in many Black communities. 

While these advancements are significant, no one policy can address decades of neglect and intentional discrimination.

For the past two years, the Black Maternal Health Caucus has introduced a comprehensive package of bills, known as the Momnibus. This legislation centers Black birthing people and would improve the quality of care; grow and diversify the birth workers available; address climate, housing and other social determinants of health; and meet the unique needs of pregnant people during the pandemic. The House of Representatives included these provisions in the Build Back Better Act, and the Senate should ensure that these critical policies are included in the final version of the bill. Lawmakers should also ensure that eligible people in every state can access Medicaid for at least one year postpartum, and the program should be required to cover doula services.

More than 10 years ago, President Obama signed into law the Affordable Care Act, which, among other things, sought to ensure more low-income people would be eligible for the no- or low-cost services that Medicaid provides. Unfortunately, 12 states — mostly Southern and Midwestern states with disproportionately large Black populations — have refused to expand eligibility. Due to pay inequities and systemic barriers to private coverage, Black women disproportionately fall into the Medicaid coverage gap, leaving many without an affordable coverage option. Congress should ensure that the ability to access coverage isn’t based on where you live by permanently and comprehensively closing the Medicaid coverage gap. Even more, Congress should extend the availability of financial help that is currently available – but will soon expire – to purchase private plans on the insurance marketplaces. 

Finally, it has been well documented that the United States overpays for drugs and therapies. By empowering Medicare to negotiate drug prices, this policy can save consumers and taxpayers hundreds of billions of dollars — savings that can be used to pay for other health care investments. Given that the vast majority of women use at least one prescription, this would yield both a health and financial benefit. Black women, in particular, rely upon prescriptions for life-saving therapies, given the disproportionate number of chronic illnesses they face.

The Build Back Better package should also include several provisions, such as paid family and medical leave and child care, that would improve both Black women’s health and economic security. These changes will not address every social ill that plagues Black women, but as the nation looks to rebuild the health care system following the pandemic and continue its long-overdue racial reckoning, now is the time to center the health and wellbeing of Black women. 

Jamille Fields Allsbrook is the director of women’s health and rights with the Women’s Initiative at the Center for American Progress.