Historical Racial Oppression and Healthcare Access: Unveiling Disparities Post-ACA in the American South

This study investigates geographical disparities in the implementation and effectiveness of the Affordable Care Act (ACA) by linking them to the historical legacy of racial oppression in the American South. Using a cross-border regression discontinuity design that leverages variations in racial oppression intensity, we find that bordering counties in states with less oppressive regime experienced significantly greater benefits from the ACA compared to neighboring counties in more oppressive states. This divergence in insurance outcomes, which did not exist before the ACA, underscores the influence of historical racial regimes on contemporary policy efficacy. Furthermore, we demonstrate that political preferences from the Jim Crow era are correlated with the observed variations in ACA effectiveness. Our findings suggest that the racialization of the ACA is deeply rooted in the historical context of racial oppression in the American South.