August 9, 2014, Michael Brown, an 18-year-old African American teen, killed by police in Ferguson, Missouri.
November 22, 2014, Tamir Rice, a 12-year-old African American child, killed by police in Cleveland, Ohio.
April 4, 2015, Walter Scott, a 50-year-old African American man, killed by police in Charlotte, North Carolina.
November 15, 2015, Jamar Clark, a 24-year-old African American man, killed by police in Minneapolis, Minnesota.
July 6, 2016, Philando Castile, a 32-year-old African American man, killed by police in Falcon Heights, Minnesota.
The list of Black men and women killed by police goes on and seems to grow by the week: Eric Garner, Keith Lamont Scott, Amadou Diallo, Manuel Loggins Jr., Ronald Madison, Kendra James, Sean Bell, Alton Sterling.1
The shooting of Michael Brown in Ferguson sparked protests and demonstrations, ignited the Black Lives Matter movement, and prompted national media to report other stories of police shootings of Black2 children, teens, women, and men. The ongoing protests have forced a national conversation about race, bias and justice in America.
Much of that conversation has focused on the immediate context of policing and criminal justice: in Ferguson, Missouri, where Michael Brown was shot, the city supported itself on traffic and misdemeanor tickets issued to African Americans.3 More than 80% of Black residents had outstanding traffic tickets, and the city's jails were full of African Americans jailed for failure to pay these tickets.4 Police aggressively stopped African Americans and cited them for minor violations.5 Those who got traffic tickets and did not have the money to pay in full at their court hearing were arrested and sent to jail.6 Those who failed to appear in municipal court, which many did because they knew the outcome was likely to be jail, were subject to arrest warrants and jailed anyway.7
As Ferguson illustrates, racial bias operates at many levels: structural, institutional, and personal.8 Racial bias permeates the structure of a criminal justice system in which those with money make bail and those without money remain behind bars while awaiting trial.9 Racial bias infects institutions, like police departments, when routine stop and frisks are standard operating policy in Black neighborhoods but not in white ones.10 Racial bias influences even well-intentioned individual police officers when officers react differently to a Black man wearing a hoodie sweatshirt than a white man.11 Black men are more likely to be stopped by police.12 Black men are more likely to be arrested.13 Black men are six times more likely to be incarcerated than white men.14 Since Michael Brown's shooting in Ferguson, Americans talk publicly about how Black men are more likely to be killed by a police officer.
Racial bias takes a toll on Black Americans. As Ta-Nehisi Coates says in his award winning book Between the World and Me, for Black people in America racism is a visceral experience, . . . it dislodges brains, blocks airways, rips muscle, extracts organs, cracks bones, breaks teeth.15 The book is a moving letter from Mr. Coates, a Black man, to his 15-year-old son. Mr. Coates describes growing up Black in America and how powerfully, adamantly, dangerously afraid everyone was of the police, white mobs, and neighborhood gangs who redirected their won fear into rage.16 He talks about how the need to be on guard was exhausting.17 He tells of the toll it takes upon the body for African Americans to constantly be on guard so as to not lose their body to violence, be it the police, school, neighborhood, or other.18 Researchers have documented the toll living in America extracts on Black health, both physical and mental.19
This article focuses on racial bias, its impact on African American health and health care, and the new legal tools that the Affordable Care Act (ACA) creates to redress racial bias and discrimination. Section I explores the role that racial bias plays in harming African American health and creating health disparities between Black and white Americans. It also explores the structural, institutional, and interpersonal biases that operate in the health care system and that exacerbate Black/white health disparities. Section II describes how health equity advocates fought to include provisions in the ACA designed to identify and eliminate racial and other disparities in health and health care. Section III describes Section 1557 of the ACA, a new civil rights law, and how it provides an important new legal tool for redressing health care discrimination. The article ends with a call to action to use implementation of Section 1557 as an opportunity to engage in a community-wide conversation about race, health, and health care.
Sidney D. Watson, Lessons from Ferguson and Beyond: Bias, Health, and Justice, 18 Minn. J.L. Sci. & Tech. 111 (2017).