The New Health Dialogue

Health reform won't just expand coverage. It will also help reduce or eliminate the health disparities and care inequalities that face racial and ethnic minorities. A brief from Families USA , Moving toward Health Equity: Health Reform Creates a Foundation for Eliminating Disparities, highlights the provisions of the Patient Protection and Affordable Care Act that move us toward this goal.

Improving Community-Based Prevention and Public Health. Prevention can play a role in bringing down costs and improving health in the long term. The issue brief argues that racial and ethnic minorities are more likely to face barriers to good health in the form of community-based factors like substandard housing, unemployment, and transportation difficulty. To change this, the law calls for the “community transformation” grants to test strategies for addressing chronic disease and prevention at a local level. Transforming communities to promote public health can be about the little things that go a long way -- for example, one way to combat childhood obesity could be making sure that all children have a safe place to walk and play outdoors, and that all families have access to stores or markets that sell fresh, healthy foods. As we've written before, studies demonstrate that these social determinants of health really do have a significant impact on community health and risk factors for disease. (Read our earlier discussions here and here.)

Additionally, the law calls for the creation of a national prevention and public health strategy, the formation of a prevention council and an advisory group, and $15 billion over 10 years to help fund these efforts. 

Expanding Access to Care. According to the report, minorities account for just over a third (35 percent) of the US population but more than half (54 percent) of the uninsured -- and the economic downturn has made things worse. When insurance market reforms go into effect in 2014, everyone will have increased access affordable, high quality health care coverage, but the expansion will have a disproportionally positive affect on minorities, because they face a disproportionately high lack of coverage. These new provisions include a Medicaid expansion (childless adults under 133 percent of FPL will now be eligible) and the launch of state-based health insurance exchanges to allow consumers to comparison shop for health insurance.

Increased Funding for Community Health Centers. Community health centers (CHCs) provide an important health care safety net, especially in providing primary and preventative care. According to the issue brief, about two-thirds of those using CHCs were racial or ethnic minorities. Between fiscal year 2011 and 2015, community health centers will receive $11 billion in federal funding for construction and renovation.

Other Provisions to Address Disparities. Starting in 2012, health data collection will be required to specify race, ethnicity, sex, and primary language of patients in all federally supported or associated health programs. Better data will help us improve our understanding of health disparities, so we can better fight to eliminate them entirely. The law also strengthens and funds the Office of Minority Health within HHS, and establishes permanent Offices of Minority Health in other key agencies, such as the CDC and CMS. (Check out the report for the full list -- it looks a lot like alphabet soup when we list it here.) Additionally, the new law targets minority applicants in its efforts to expand the health care workforce, and supports funding and training for community health workers, promotes access to culturally competent care and language services, and permanently reauthorizes the Indian Health Improvement Act.

As we’ve written before, minorities in the US are not only statistically more likely to suffer from higher rates of chronic disease, such as diabetes, cancer, or HIV, but are less likely to have adequate health insurance and receive quality care. Studies show that medical treatment varies by race -- even when controlling for all other factors -- which means even when minorities seek care, they are more likely to remain sick. These inequalities are unacceptable. We don’t expect health reform to make health disparities disappear overnight, but we’re glad to see the some of the provisions in the new law take a step in the right direction -- forward.