Last year, over the Fourth of July weekend, America commemorated its independence, and my younger brother turned 26 years old. After a couple rounds of phone tag late in the evening, I finally caught up with him. It was just before midnight. He was preparing to leave his second job and head home for a few hours rest before beginning his early morning shift.

“Hey, old head.” I jeered at him, playfully, holding the phone closer to me. “You’re getting up there, love.”

“Hey, what’s up Mia?” His voice on the other end laced with fatigue behind the ear-to-ear grin that I knew stretched awake underneath his curly, full beard — a hallmark of Muslim men living in Philadelphia.

It’s the same grin that, when my brother was little, would turn his then hairless cheeks round and red, as if he ate crimson-colored secrets. If you tickled him just right, those secrets would eventually spill out in a fit of giggles too big for his then tiny torso. It’s the same smile that his young children — my niece and nephew — offer their father when he hugs and holds them tight. These are my favorite smiles.

My baby brother and I chatted for a brief moment more. I recall wishing him the highest blessings in his new year. He replied gratefully. “Insha’Allah.” We exchanged “I love yous,” “be safes,” and various versions of “take care in these streets.” Because this is what you say to a young, black man in America. After our call, mine was a complex, contemplative smile because I realized that my brother — one year beyond his mid-twenties — was now also uninsured.

Under the auspices of the Patient Protection and Affordable Care Act (aka the ACA, bka “Obamacare”), young adult children may remain on their parents’/parent’s health insurance until the age of 26. This measure was put into place to safeguard the health care status of younger persons perhaps just recently acclimating to adulthood, after being in school, or otherwise recovering from the economic precariousness that often characterizes one’s early 20s. For my brother — the eldest son of a nurse and a long-time educator — this meant that his annual checkups and medical care were all paid in full by extension of our parents’ coverage.

Since its inception in 2010, the ACA has expanded healthcare coverage to almost 20 million previously uninsured people and newly uninsured young adults, many of whom represent historically uninsured or underinsured people. For blacks, the uninsured rate has dropped from 21 percent in 2013 to less than 13 percent in 2016. The ACA is clearly making inroads toward more equitable health coverage rates for historically medically underserved peoples. People like so many black boys turned working class black men. Men like my own brother have the opportunity to be well for many seasons.

Fast forward to several months later on November 8, 2016 when the nation went to sleep and were jarred awake on the dawn of a new political era (except those who stay woke, of course). Since his election and during this his almost first full year in office, Trump has been on a full out hunt to sink the ACA. By extension, he has initiated open season on the uninsured, the historically underinsured and underserved, and the sickest among us. His recent intentions to sabotage and destabilize the ACA Marketplace — the crux of the ACA — cannot make this any clearer.

1. Trump has declared an end to cost reduction subsidy payments to insurers as of Tuesday October 31.

These are monies the government must give to insurance companies, which enables them to provide medical coverage to low-income and moderate-income individuals and families. By ripping away this critical financial support for American families living on the economic brink, and from those who have historically faced barriers to obtaining comprehensive insurance coverage, Trump is creating a crippling climate wherein those most in need of medical care will now face higher premiums (paid monthly for insurance) and deductibles (set out-of-pocket costs before insurance kicks in).

2. Trump has drastically reduced federal investment in Marketplace insurance outreach resources that community based organizations use to help individuals and families to sign up for healthcare.

60 percent of blacks visited the Marketplace in 2016 and received personal assistance (compared to 46 percent whites). Arguably, these outreach efforts are imperative to insuring communities of color, as well as other historically marginalized populations. Without this support, many organizations have had to scale back outreach efforts, and lay off critical personnel, including community navigators and in-person interpreters who connect limited English proficient consumers with medical coverage. By divesting in efforts that help bolster the number of insured, uninsured numbers are almost sure to spike back to pre-ACA rates, unless health organizations spread the word double-time.

3. Not only has Trump cut the dollars to support Marketplace enrollment outreach, but he has also dramatically cut the Marketplace open enrollment period by six weeks, compared to last year.

Again, this callous move undermines all insurance gains under the ACA. November first marked the start of the annual Open Healthcare Marketplace Enrollment, which ends on Friday December 15 for health insurance beginning on the New Year 2018. The Marketplace only stays stable when younger and healthier people sign up for health insurance. Their participation helps to keep expensive healthcare costs down for everyone, especially those who are the sickest. Without a stable Marketplace, health insurance companies are more likely to leave the Marketplace, leaving many consumers without affordable options. Such a move would assuredly topple the insurance Marketplace, leave many medically adrift, without access to care, and therefore at risk of greater sickness and, in many cases, earlier mortality. And so begins, again, the cycle of health disparity and inequity.

Do not be confused. The Marketplace is not shut down or broken. The ACA has not been repealed. Actually, the ACA is doing the damn thing by significantly reducing the national rate of uninsured, expanding medical care access to historically uninsured and ushering in culturally and linguistically competent, quality care standards.

If you or a loved one have previously acquired insurance through the Marketplace website (HealthCare.gov) you simply have to re-enroll or update your policy to reflect any changes in your medical needs. If you do not yet have coverage, now is your season! You have until Friday December 15th to sign up for medical, dental, vision and specialty care insurance. The website is quite user friendly. In the event you have trouble and need assistance, you can contact a navigator online or via the phone.

My brother has to apply for a federal Marketplace insurance plan so that his health coverage will not be interrupted. This is his time to make sure the extensive dental work he had done while on our parents’ insurance is now maintained by routine visits to the dentist. This is his season to demonstrate healthy habits to his own children by regularly visiting his medical provider for check-ups. By signing up for health insurance through the Marketplace, my brother will also avoid a tax fine associated with being uninsured (this fine was about $700 this year). In fact, having health insurance is highly correlated with greater financial security, better health outcomes and overall peace of mind.

Most important to me is the well-being of my loved ones. As for my brother, and as for you, reader, I wish health and prosperity into every season. Make sure to start your season by signing up for health insurance.

National Institutes of Health

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