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As of 2011, 37 million individuals living in the United States identified as Black or African American. One of the key goals of the ACA is to reduce the number of uninsured through an expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income individuals purchase coverage. The 37 million Blacks residing in the United States make up more than a tenth of the total population. While the majority of nonelderly Blacks are in working families, they are significantly more likely than Whites to be poor. As of 2011, there are over 7 million uninsured nonelderly Blacks, who make up about 15% of the total nonelderly uninsured population (Figure 4). Medicaid covers over half of Black children (51%), helping to substantially fill their gap in private coverage. Given the low incomes of uninsured Blacks, nearly all (94%) would be in the income range to qualify for the Medicaid expansion or premium tax credits. The ACA coverage expansions provide an important opportunity to increase health coverage and access to care for uninsured Blacks. Increasing health insurance coverage may significantly reduce disparities in access to care and health outcomes for Blacks. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California. Americans arrived in the northern cities, but also by public and private discriminatory actions. The Quantile classification gives the most accurate ethnic distribution throughout the continental US counties. To populate the PCTEDERLY field, select by attributes only the counties that have > 0 population in 2000. This will exclude two counties and then the field calculator will work to populate the field with the percentages.
Above is a chart showing the percent changes in population in just the 12 Northeast states. Much of the media buzz about the 2010 Census has focused on the role of Latinos and new immigrants in changing the face of the country. But equally influential in the South's rapidly-changing demographics is another story with a longer historical arc: The return of many African-Americans to Southern states after a decades-long exodus during the Jim Crow era. The Great Migration of some 6 million African-Americans from the South from between World War I and 1970 is one of the most significant demographic upheavals in U.S.
The civil rights movement didn't end racism, of course, but it did change the South enough to entice many African-Americans to come back, igniting a reverse migration movement that continues to gain steam.
During the turbulent 1960s, black population growth ground to a halt in the South, and Southern states claimed less than 10 percent of the national increase then. The shift could significantly strengthen the political power of African-Americans in the South, especially in the historic Black Belt stretching from the mid-Atlantic to east Texas. A glimpse of the political force this represents was seen in 2008, when record-breaking African-American turnout helped push Florida, North Carolina and Virginia into blue territory. It's also seen in Georgia, the epicenter of the Black Belt, where the African-American community grew by more than 579,000 since 2000 -- the leading ingredient in making it the seventh-fastest growing state in the country. The 2010 Census also offers a glimpse of how Southern African-American communities are changing. African-Americans moving South also tend to be young: 40 percent of those moving to Southern states in the 2010 Census count were ages 21 to 40.
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As pressure grows on power companies to move toxic coal ash out of leaky, wet impoundments and into dry, lined landfills, the experience of an African-American community near one such landfill in rural Alabama highlights the potential problems with that approach. A by-the-numbers look at how businesses in North Carolina and elsewhere across the South are opposing discrimination and intolerance against LGBT people and other vulnerable minorities. North Carolina's controversy over a state law pre-empting local LGBT protections brings into sharp relief a political battle underway between growing, progressive Southern cities and conservative state leadership. Blacks currently comprise the third largest racial or ethnic group in the United States after non-Hispanic Whites and Hispanics (Figure 1).
Many uninsured Blacks could benefit from these new pathways to coverage, which would help increase their access to care and promote greater equity in health care. In eight states, largely concentrated in the South, and the District of Columbia, Blacks comprise at least 20% of the total population, whereas they comprise a very small share of the population in many states in the Northwest and Midwest (Figure 2). Overall, 40 percent of all Blacks are under the age 26, compared to 30 percent of non-Hispanic Whites and 35 percent of all U.S. Over five in six (84%) uninsured Blacks are adults, while the remaining one million are children age 18 or younger. However, the likelihood of being uninsured varies widely across states, ranging from 9 percent of Blacks in Delaware to 30 percent in Louisiana. Reflecting their limited access to employer-sponsored insurance, less than half of nonelderly Blacks have private coverage compared to over seven in ten non-Hispanic Whites (Figure 6).
Medicaid plays a much more limited role for Black adults, leaving more than a quarter uninsured (26%).
Beginning in 2014, Medicaid eligibility will expand to adults with incomes up to 138% of poverty ($26,951 for family of three in 2013), in states that implement the ACA’s Medicaid expansion.
Nearly two thirds (62%) of uninsured Blacks have incomes at or below the Medicaid expansion limit of 138% FPL, while an additional 31% would be income-eligible for tax subsidies to help cover the cost of buying health insurance through the exchange marketplaces (Figure 7). This disparity, in large part, reflects that many Blacks do not have access to employer-sponsored insurance and cannot afford to purchase private coverage on the individual market due to their low incomes.
Given that most uninsured Blacks are in low-income families, the majority would be in the income range to qualify for the ACA coverage expansions, particularly the Medicaid expansion. Census Bureau, about half of the nation's growth over the last decade was driven by growth in the Latino community, much of it in Southern states. The South has increasingly claimed a greater share of black population growth since -- about half the country's total in the 1970s, two-thirds in the 1990s and three-quarters in the decade that just ended. Atlanta echoes a trend found across the South and country, where suburban black neighborhoods are growing at the expense of the urban core. Meaning that the political force of the latest phase of African-American reverse-migration South will be felt for years to come.
Phil Bryant's decision to sign into law the "Protecting Freedom of Conscience from Government Discrimination Act" has nothing to do with freedom or conscience and everything to do with discrimination. While it is projected that the nation will become increasingly diverse and the Black population will grow over the next few decades, Blacks are anticipated to maintain a consistent share of the population. Over half of all Blacks live in just eight states, including Texas, Florida, Georgia, New York, California, North Carolina, Illinois, and Maryland. For example, while some African American families have been in the United States for many generations, others are more recent immigrants from places such as Africa, the Caribbean, or the West Indies. However, the large majority of Black workers (70%) are employed in blue-collar jobs that typically provide low wages and are less likely than white collar jobs to offer health insurance coverage. More than two-thirds are in a working family, including half who have at least one full-time worker in the family. Medicaid coverage helps fill some of the gap in private health insurance, covering nearly one in three of all nonelderly Blacks (32%).

These coverage patterns reflect the fact that states have significantly expanded children’s eligibility for Medicaid and CHIP, while Medicaid eligibility for adults remains very limited in most states.
In addition, beginning in 2014, new health insurance marketplaces will become available through which individuals will be able to purchase coverage, and premium tax credit subsidies will be available to help moderate income individuals without access to affordable employer coverage pay for coverage offered through these marketplaces.
Given limited access to private coverage and low incomes, Medicaid is an important source of coverage for 9.4 million Blacks, many of whom would otherwise go uninsured. As such, state decisions to implement the ACA Medicaid expansion have particularly important implications for Blacks.
Conversely, coverage gaps, especially in states that do not move forward with the Medicaid expansion, may lead to widening disparities in coverage and care over time. According to author Isabel Wilkerson, at the turn of the century 90 percent of all African-Americans were living in the South.
The Institute for Southern Studies typically does not include DC, DE, MD and OK in its definition.
The Affordable Care Act (ACA) has important implications for Blacks as they face longstanding and persistent disparities in health and health care. Reflecting both lower full-time employment rates and higher concentrations of Black workers in blue-collar jobs, African Americans are two and half times more likely than Whites to have family income below the poverty level (Figure 3). However, the majority have low incomes (below 138% of poverty), including over a third who have very low-incomes below half the poverty level. However, Medicaid does not fully offset the difference leaving more than one in five (21%) nonelderly Blacks uninsured, compared to 13% their White counterparts.
While the ACA intended for the Medicaid expansion to occur nationwide, the June 2012 Supreme Court decision on the ACA effectively made this expansion a state option. However, Medicaid eligibility levels for adults remain limited in most states today, particularly in the South, where Blacks are more likely to live. If a state does not implement the expansion, poor uninsured adults will not gain a new coverage option and will likely remain uninsured. By the end of the Great Migration, nearly half were living outside the South, mostly in the cities of the North and West. In addition, there is diversity in educational attainment, socioeconomic status, and other characteristics. In addition, Blacks comprise a large share of the uninsured population in the District of Columbia (52%), Mississippi (48%), and Louisiana (42%). Given that the majority of uninsured Blacks have incomes below the Medicaid expansion limit, they will be significantly impacted by state decisions to expand Medicaid. Currently, Blacks are at the highest risk of continuing to face coverage gaps due to state expansion decisions.
Aggregate data can obscure many of these socio-demographic differences within the Black population. In the absence of the expansion, poor uninsured adults will not gain a new coverage option and likely remain uninsured. Even with the coverage expansions, targeted outreach and enrollment assistance will be important for ensuring eligible individuals enroll in coverage.
The ACA will help address many historical procedural barriers to enrollment through new streamlined, data-driven enrollment processes that will go in place in 2014.
However, targeted outreach and one-on-one application assistance from trusted individuals within the community will remain key for facilitating enrollment of eligible individuals.

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