The Black Freedom Struggle, Healthcare Activism, and the Affordable Care Act

At a recent press conference President Donald Trump remarked, “nobody knew that healthcare could be so complicated.” This statement was in response to questions about his administration’s efforts to repeal the Affordable Care Act (ACA), also known as “Obamacare,” and replace it with something “better.”  Trump’s statements were met with bewilderment by many, especially black activists who have been grappling with the complex nexus of healthcare and racism for years. In fact, black activists and intellectuals have made healthcare education and activism an integral part of the black freedom movement, developing many creative ways to help engage this complex system and make it more accessible for all people today.

Throughout the twentieth century, activists have simultaneously created community-focused grassroots healthcare infrastructures and compelled the federal government to support their health-related work. In the early 1900s, black club women fundraised and staffed black hospitals, such as the Provident Hospital and Nurses’ Training School in Chicago, to help train black healthcare professionals and provide care to neglected black communities. These club women also developed groups, like the Tuskegee Woman’s Club of Alabama, to engage in grassroots health education initiatives. Through these and other endeavors black women filled the gaps in healthcare access and education in their local communities.

Black club women’s private endeavors became public with the help of HBCUs like the Tuskegee Institute. Following Booker T. Washington’s lead, Tuskegee’s staff built on black women’s infrastructure to develop “Negro Health Week,” aimed at amplifying public health education and challenging segregated healthcare facilities. This programming eventually spread. Black nurses, doctors, and uplift clubs developed community programming to support these initiatives. Leaders of this movement—including Washington and sociologist Monroe Work—eventually lobbied the government for support. In 1921, the Surgeon General agreed to offer government facilities and funding. Although limited in scope, federal support for “Negro Health Week” reflected a direct instance in which the government-backed black healthcare education and access.

By the 1940s, black activists and intellectuals had pushed the government to establish the “Office of Negro Health Work” as part of President Franklin D. Roosevelt’s New Deal programs. Black healthcare activists had argued for decades that the government should be accountable to the black communities that they decimated in the past. In establishing this office, the government acknowledged that it had a role to play in supporting black health education and that it could finance black healthcare workers’ existing grassroots efforts. The office employed black doctors to expand the programs started by “Negro Health Week” activists. With the help of healthcare leaders like Dr. Roscoe Brown, the office broadened community campaigns aimed at improving communal living conditions, educating black communities about diseases and care, and “practical work” like check-ups and vaccines.

By the 1960s, grassroots activist groups had effectively pressured the government to fund community health centers in rural and underserved eras. During the 1964 Freedom Summer, the Medical Committee for Human Rights (MCHR) partnered with civil rights organizations in order to bring medical care to workers. A collection of black and white doctors, nurses, dentists, psychologists and social workers volunteered their services. The MCHR acted as a sort of medical wing of the Civil Rights Movement. By 1965, members had expanded programming, assisting local community health associations in establishing a series of rural health centers in Mississippi. The MCHR’s physician-activists lobbied the government, eventually securing Office of Economic Opportunity (OEO) funding to establish a set of health clinics in disadvantaged communities. A direct outgrowth of the Civil Rights Movement, these free clinics used government aid to provide healthcare to disadvantaged communities in cities like Boston, Denver, and Chicago.

Perhaps the most notable example of black activists’ contributions to national conversations about healthcare access and activism was the work of the Black Panther Party. The Panthers created free clinics across the country to supply black communities with basic healthcare needs. At the George Jackson Free Health Clinic, for example, black community members could get basic check-ups and medications as well as learn about the interrelationship between racism and the lack of access to medical care.

The Panthers also influenced national healthcare policy. In the early 1970s, the group launched a Sickle Cell Anemia initiative, which lead to increasing national awareness and ultimately millions of dollars to study and treat the disease. Their initiative had “two interdependent emphases”: health education and genetic testing. Members engaged in an ambitious campaign to educate the black community on sickle cell anemia and increase testing for the disease, connecting it to larger discourses of black suffering and state-sponsored racism. The Party was integral to raising awareness about sickle cell in black communities. As Alondra Nelson notes, it also “likely influenced the Nixon administration’s decision to allocate significant federal resources for research on the disease.”

Despite the president’s sudden epiphany, many have understood that healthcare is complex, particularly black activists and intellectuals who have continued to advocate healthcare as a basic human right. The administration is correct in stating that there are legitimate issues with the ACA and its implementation. However, the ACA has also reduced the uninsured rate and improved access, particularly among African-Americans. It seems, then, that part of the administration’s concerns are based on the fact that the law was passed by a black president and disproportionately helps black and brown communities, not “government overreach” or “one-size-fits-all spending.” As we continue to mobilize against authoritarian and anti-democratic practices, we must also view healthcare activism as part and parcel of our emancipatory visions. We must also make it clear that a significant part of its complexity lies in overcoming the discriminatory frameworks that undergird our current healthcare system, not in the idea of healthcare as a right itself.

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