The political processes surrounding the Affordable Care Act (ACA) offer valuable lessons about race and politics in the United States. In particular, the ACA underscores a critical tension between politics and policy in a racialized polity: even when policies are intended to target and address racial disparities, politics can undermine the steps necessary to do so. Close scrutiny of the ACA during its first decade reveals how race intersects with politics to render public policy less equitable and more vulnerable to erosion. Ultimately, this analysis points to the ways that racialized political processes are formidable barriers to equitable material outcomes. By examining such processes and making them visible, this article elucidates the possibilities, limits, and contours of public policy as a mechanism for achieving racial justice.