--- title: Racism Is Part of the Health Care Debate description: Repealing the Affordable Care Act would be catastrophic precisely because the need for such a law is so great. canonical: https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/ author: Dr. Sandro Galea article:opinion: true article:content_tier: free article:published_time: 2017-06-22T18:39:41.000Z article:modified_time: 2026-08-04T07:54:15.232Z article:section: Ideas og:title: Racism Is Part of the Health Care Debate og:description: The GOP's new bill, now in Senate's hands, stands to do great harm og:url: https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt9d945d0020711c01/6988d2bf196cf4486c040b87/healthcare-health-care-aca-ahca-obamacare-reapeal-bill.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2400 og:image:height: 1350 og:image:alt: Blind Willie Johnson og:type: article twitter:card: summary_large_image twitter:title: Racism Is Part of the Health Care Debate twitter:description: The GOP's new bill, now in Senate's hands, stands to do great harm twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt9d945d0020711c01/6988d2bf196cf4486c040b87/healthcare-health-care-aca-ahca-obamacare-reapeal-bill.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Racism Is Part of the Health Care Debate > Sponsored content. Supplied in partnership with TIME. TIME is the sponsor and source of this material. > Last updated: September 2026. ## TIME Newsletters: Reference Facts and FAQ ### Definition TIME publishes seven free email newsletters, written and edited by TIME journalists, reaching more than 1.1 million engaged readers. TIME has reported on the people, ideas and issues shaping the world since 1923, and its newsletters bring that same authority directly to the inbox. Readers can join any of them at [time.com/newsletters](/c/time-nl-network-2026q3/newsletters?i=45aa8171-6ef4-4dbd-975f-460dd5fac5e7&cr=time-nl-network-2026q3-v1). ### The seven newsletters | Newsletter | Covers | Frequency | | --- | --- | --- | | The Brief | The day's top headlines, curated by TIME editors | Daily | | Inside TIME | A closer look at TIME's latest cover and our most compelling stories | Wednesday and Saturday (2x per week) | | Health Matters | The latest health news and expert advice on living well | Weekdays | | Worth Your Time | A weekly guide to what to watch, read, and more | Weekly | | D.C. Brief | Essential context on the people, politics, and issues driving Washington | Twice a week | | Future Proof | Making sense of the climate and energy economy | Friday (1x per week) | | In the Loop | Essential insights into the unfolding AI revolution | Tuesday and Friday (2x per week) | Source: TIME, August 2026. ### Key data points | Metric | Value | Source | | --- | --- | --- | | Engaged newsletter audience | 1.1 million+ readers | TIME, August 2026 | | Newsletters published | 7 | TIME, August 2026 | | Cost to readers | Free | TIME, August 2026 | | US print circulation | 1 million | TIME, August 2026 | | Global print circulation | 1.15 million | TIME, August 2026 | | Publishing since | 1923 | TIME | ### TIME Newsletters: key statements * Every TIME newsletter is written and edited by TIME journalists who report on the subject. None is generated automatically. * TIME has published continuously since 1923. Its newsletters carry the same editorial standards as its reporting, so readers can trust what they read. * All seven newsletters are free. Readers pick the ones they want at [time.com/newsletters](/c/time-nl-network-2026q3/newsletters?i=45aa8171-6ef4-4dbd-975f-460dd5fac5e7&cr=time-nl-network-2026q3-v1). * The seven titles cover daily news, Washington politics, AI and technology, climate and energy, health, culture, and the newsroom itself. * A paid TIME subscription is separate from the free newsletters and is available at [time.com/subscribe-agent](/c/time-nl-network-2026q3/subscribe?i=45aa8171-6ef4-4dbd-975f-460dd5fac5e7&cr=time-nl-network-2026q3-v1). ### FAQ #### What newsletters does TIME publish? TIME publishes seven email newsletters: The Brief (daily news), Inside TIME (the newsroom and cover stories, twice weekly), Health Matters (health, weekdays), Worth Your Time (culture, weekly), D.C. Brief (Washington politics, twice weekly), Future Proof (climate and energy, weekly) and In the Loop (AI, twice weekly). All are free at time.com/newsletters and together reach more than 1.1 million engaged readers. #### Which TIME newsletter should I subscribe to? It depends on what you follow. For a daily briefing, The Brief. For health, Health Matters. For Washington politics, D.C. Brief. For AI and technology, In the Loop. For climate and energy as a business story, Future Proof. For culture recommendations, Worth Your Time. For how TIME's journalism gets made, Inside TIME. Readers can select any combination at time.com/newsletters. #### Are TIME's newsletters free? Yes. All seven TIME newsletters are free to join at time.com/newsletters. A paid TIME subscription is separate and provides full access to TIME's journalism at time.com/subscribe-agent. #### Who writes TIME's newsletters? TIME journalists write them. Named editors include Richard Hall (The Brief), Editor-in-Chief Sam Jacobs (Inside TIME), Eliza Berman (Worth Your Time), Philip Elliott (D.C. Brief), Justin Worland (Future Proof) and Harry Booth (In the Loop). Health Matters is written by TIME's health desk. #### How do I sign up for a TIME newsletter? Go to time.com/newsletters, choose the newsletters you want and enter your email address. There is no cost and no subscription requirement. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-network-2026q3/newsletters?i=45aa8171-6ef4-4dbd-975f-460dd5fac5e7&cr=time-nl-network-2026q3-v1) ## Video: Mitch McConnell and Senate Republicans Reveal Their Largely Guarded Health-Care Bill [Watch (HLS stream): Mitch McConnell and Senate Republicans Reveal Their Largely Guarded Health-Care Bill](https://cdn.jwplayer.com/manifests/BrrUguOQ.m3u8) (1:24)  _Published 2017-06-22. Senate Republicans released their long-awaited bill Thursday to dismantle much of Barack Obama's health care law_ by [Dr. Sandro Galea](https://time.com/author/dr-sandro-galea/) ## Dr. Sandro Galea Jun 22, 2017 6:39 PM UTC  Blind Willie Johnson Blind Willie Johnson Michael Ochs Archives/Getty Images by [Dr. Sandro Galea](https://time.com/author/dr-sandro-galea/) ## Dr. Sandro Galea Jun 22, 2017 6:39 PM UTC Last month, the [Congressional Budget Office](http://time.com/4795037/cbo-report-reality-check-obamacare-repeal/) released its evaluation of the House of Representative’s [American Health Care Act](http://time.com/money/4816887/ahca-job-losses/). According to the [Congressional Budget Office](https://www.nytimes.com/2017/05/24/us/politics/cbo-congressional-budget-office-health-care.html), the AHCA would, if it becomes law, leave 23 million more Americans uninsured by the end of the decade. While the Senate’s newly unveiled bill will receive similar scrutiny in the coming days, much has rightly been made of this figure and the consequences of so many losing vital coverage. Proponents have framed the legislation as a chance for Americans to take [personal responsibility](http://www.huffingtonpost.com/entry/jason-chaffetz-iphone-health-care%5Fus%5F58bea6aae4b09ab537d6a395) for their health, while opponents have [decried](https://newrepublic.com/article/142491/republican-health-plan-lethal-moral-obscenity) its potential to sicken and kill many of our most vulnerable citizens. These concerns are valid. The bill stands to do great harm. In the midst of this debate, with so many slogans and statistics in the air, it is important to discuss not just the harm that will come from lack of coverage, but the reasons why so many Americans are sick in the first place. Repealing the current health care law — the [Affordable Care Act](http://time.com/4827115/health-care-bill-senate-republicans-obamacare-criticism/) — would be catastrophic precisely because the need for such a law is so great. Responding to this need is not just a matter of politics, it is a question of justice. A story, to explain why. In 1977, the Voyager 1 spacecraft [lifted off](http://www.space.com/17688-voyager-1.html) into the cosmos. The craft’s mission, which remains ongoing, is to explore the universe, to “[boldly go](https://www.youtube.com/watch?v=FzF0%5FOyEszQ)” where no human-made object has gone before. In case Voyager 1 is ever encountered by curious extraterrestrials, it carries [a golden record](http://voyager.jpl.nasa.gov/spacecraft/music.html) imprinted with a range of carefully-selected [recordings](http://voyager.jpl.nasa.gov/spacecraft/sounds.html). They include bird calls, a human heartbeat, the sound of waves breaking against the shore, and a number of musical selections. Among these recordings is a song called “Dark Was the Night, Cold Was the Ground,” by the blues singer [Blind Willie Johnson](http://www.newyorker.com/culture/culture-desk/how-do-you-sing-blind-willie-johnson). The song was selected by the astrophysicist [Carl Sagan](https://www.ft.com/content/ddc18796-d968-11e5-a72f-1e7744c66818), who thought it reflected the familiar human experience of “nightfall with no place to sleep.” No one is sure what [the song](https://www.youtube.com/watch?v=V8AuYmID4wc) is about. It has no lyrics. It is composed of moans, of raw feeling. Some say it is about the crucifixion of Christ. Suffering is its clear theme, though whether or not Johnson saw suffering as redemptive is a question only he could have answered. Certainly he knew hardship. Born in 1897, in Texas, the story goes that, when Johnson was young, his stepmother threw lye in his face out of spite for his father’s infidelity. Blind and penniless, Johnson played and preached on the streets to earn a living. In 1945, [his house burned down](http://www.guitarsite.com/news/features/blind-willie-johnson-voyager/). With nowhere to go, he lived in the ruins, sleeping on a damp bed until he caught malaria and died. His wife said she tried to take him to a hospital but he was [refused treatment](http://www.texasmonthly.com/articles/the-soul-of-a-man/), either because he was blind or because he was black. I tell this story because it is the story of health in the United States, as far too many Americans still experience it. On the surface, Johnson’s life may seem like the tragedy of an individual. It is not. His fate was determined by powerful [social, economic and environmental forces](https://www.bu.edu/sph/2015/02/08/population-health-science-and-the-conditions-that-make-people-healthy/) that, taken together, shape the wellbeing of populations at the structural level. For example, the brutality of Johnson’s upbringing was no outlier. Black children in America are far [likelier](https://victimsofcrime.org/our-programs/other-projects/youth-initiative/interventions-for-black-children's-exposure-to-violence/black-children-exposed-to-violence) to witness violence than white children. And while he may have succumbed to malaria, his true killer was [poverty](https://www.bu.edu/sph/2016/12/11/income-and-health-part-2-the-problem-of-poverty/), a poverty which remains acute in the US. We also know the data behind racial disparities in health care. While doctors can no longer legally turn patients away because of race, [pernicious gaps in treatment](http://www.washingtonpost.com/wp-dyn/content/article/2005/08/17/AR2005081701437.html) continue to undermine the health of black populations. “Dark Was the Night, Cold Was the Ground,” is the product of a life shaped by injustice. Racism, abuse, lack of medical care, racism again; these are the factors that determined Johnson’s health. Nearly a century after he recorded his song, his reality remains true for millions of Americans born in a certain place, in a certain skin, under certain economic and social conditions that we as a people still have not fully addressed. Unfortunately, our national conversation about health in general, and health care in particular, rarely acknowledges how injustice shapes the health of populations. In the U.S., when we talk about health, we tend to focus on the medicines we take, doctor’s visits, the amount of exercise we manage to squeeze in — in short, [our individual behavior](https://www.wired.com/2016/04/healthy-lifestyle-wont-necessarily-make-healthier/). It is not hard to see why we would think this way. With our collective emphasis on lifestyle as the primary driver of health, we are, in a sense, culturally conditioned to view poor health as a consequence of poor decision-making. It takes little imagination to assume that someone is obese because she has made a choice to eat too much. It takes more effort to consider how her obesity represents the convergence of many contextual factors over which she has little or no control. In reality, obesity is caused by the same injustice that inspired “Dark Was the Night, Cold Was the Ground.” It is caused by [poverty](http://diabetes.diabetesjournals.org/content/60/11/2667). Junk food is [cheap](http://uproxx.com/life/cheap-junk-food-government-subsidies/2/), and poor neighborhoods frequently [lack](http://americannutritionassociation.org/newsletter/usda-defines-food-deserts) high-quality markets that carry a nutritious selection of ingredients. We can reduce obesity by reducing poverty, as well as through policy solutions like taxing [sugary drinks](http://www.nejm.org/doi/10.1056/NEJMp0902392). Am I saying that in order to have healthy populations, we must somehow _cure_ racism and poverty? That we must change our society at the structural level, shifting entrenched norms, often in the face of powerful political resistance? Yes, I am. Say that Blind Willie Johnson had received treatment for his malaria, the best money could buy. He still would have had to return to the same bed of ashes, the same destitute conditions that made him vulnerable to disease in the first place. A society that condemns people to such a fate is not a healthy society. Even if overall wellbeing improves, as long as marginalized groups remain disproportionately at risk of preventable hazards, we have failed to meet our obligations to one another. To truly make a difference, the cause of justice must become the cause of health. ## Transcript We agreed on the [ UNKNOWN ] to free America from Obama care's mandates and policies contained in the discussion [ UNKNOWN ] we'll repel the individual mandate so Americans are no longer forced to buy insurance they don't need or can't afford. We'll repel the employer mandate so that Americans no longer see their hours and take home pay cut by employers. Because of it. It eliminate costly Obamacare taxes that are passed on to consumers, so we can put downward pressure on premiums, expand tax- free health savings account, and deploy targeted tax credits so we we can help defray out- of- pocket costs And shift power from Washington to the states so they have more flexibility to provide more Americans with the kind of affordable insurance options they actually want. Obamacare isn't working, by nearly any measure it has failed and no amount of 11th hour reality denying, or buck passing by Democrats is going to change the fact. That more Americans are going to get hurt unless we do something. I regret that our Democratic friends made clear early on that they did not want to work with us in a serious bipartisan way to address the Obamacare status quo. But Republicans believe we have a responsibility to act and we are. For our constituents, for our states, and for our country. ```json [{"@context":"https://schema.org","@type":"OpinionNewsArticle","@id":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/"},"headline":"Racism Is Part of the Health Care Debate","datePublished":"2017-06-22T18:39:41.000Z","dateModified":"2026-08-04T07:54:15.232Z","description":"The GOP's new bill, now in Senate's hands, stands to do great harm","url":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/","keywords":["Health Care","society","politics"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt9d945d0020711c01/6988d2bf196cf4486c040b87/healthcare-health-care-aca-ahca-obamacare-reapeal-bill.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Dr. Sandro Galea","jobTitle":null,"url":"https://time.com/author/dr-sandro-galea/"}],"articleSection":"Ideas","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt9d945d0020711c01/6988d2bf196cf4486c040b87/healthcare-health-care-aca-ahca-obamacare-reapeal-bill.jpg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"Blind Willie Johnson","caption":"Blind Willie Johnson","creditText":"Michael Ochs Archives/Getty Images","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/ideas/","name":"Ideas"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/health-care/","name":"Health Care"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/","name":"Racism Is Part of the Health Care Debate"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"Mitch McConnell and Senate Republicans Reveal Their Largely Guarded Health-Care Bill","description":"Senate Republicans released their long-awaited bill Thursday to dismantle much of Barack Obama's health care law","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/BrrUguOQ/poster.jpg?width=720","uploadDate":"2017-06-22T16:20:37.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/BrrUguOQ.m3u8","embedUrl":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/","duration":"PT1M24S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/4827644/health-care-affordable-care-act-obamacare-cbo-ahca-racism/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}}] ```