The president’s proposed 2011 federal budget comes at a time when congressional leaders are regrouping on health care reform legislation. In the meantime, many sick Americans must battle our broken health care system every day. That battle is particularly difficult for racial and ethnic minorities, who are disproportionately represented among the poor and the uninsured. The proposed health budget’s inclusion of a number of provisions that will address health care disparities is therefore most welcome. These provisions will help build the foundation for health care reform and work in tandem with proposals pending in Congress.
As a recent report from the Center for American Progress shows, there is much to be done in the context of the budget, health care reform, and beyond to provide equal health care for all Americans. Half of Hispanics and more than a quarter of African Americans do not have a regular doctor, compared with only one-fifth of white Americans. And 28 percent of Latinos and 22 percent of African Americans report having little or no choice in where to seek care, while only 15 percent of white Americans report this difficulty. The inevitable consequence is a form of “medical apartheid” and a gap in health outcomes that is growing, not diminishing.
The budget has additional funding of $290 million for community health centers to expand the provision of primary health care to people in need, including preventive and mental health services. There is also $25.5 billion in additional federal Medicaid assistance to the states to support current programs targeted at poor Americans.
The funding for primary care is significant because good primary care is associated with better physical and mental health. Research shows that preventive care, care coordination for the chronically ill, and continuity of care—all hallmarks of primary care medicine—can deliver improved outcomes and cost savings. Community health centers reduce or even eliminate health disparities among their patients by providing comprehensive, affordable care that is responsive and customized to the communities they serve.
More primary health care also requires more health care workers, so it’s crucial that the budget adds 400 more clinicians—doctors, nurse practitioners, and dentists—to the National Health Service Corps, which works in medically underserved communities.
However, much more will need to be done to address the primary care workforce issue. It’s not just about getting clinicians into areas where they are most needed, but also about ensuring greater diversity and cultural awareness among these clinicians. The lack of minority health professionals is compounding the nation’s persistent racial and ethnic health disparities.
For example, at least 66 million patient-provider encounters occur across language barriers each year, and as many as one in five Spanish-speaking Americans report not seeking medical care because of language barriers. Research suggests that health care providers’ diagnostic and treatment decisions, as well as their feelings about patients, are influenced by patients’ race or ethnicity. Racial concordance—defined as shared racial or ethnic identities between clinicians and patients—is positively related to patient satisfaction and trust in the health care system.
Another problem is that approximately 1.9 million American Indians and Alaska Natives rely on the Indian Health Service, or IHS, for their health care, but the funding that has been appropriated to the IHS in recent years has been only half that needed to ensure mainstream personal health care services to Native Americans using the system.
No wonder this population has diabetes rates that are twice the national average, climbing death rates from cardiovascular disease, and high youth suicide rates as a consequence of untreated mental health disorders and substance abuse. The budget does something about this by funding the IHS at $4.4 billion—an increase of almost $1 billion over funding in 2009. This will enable the needed expansion of IHS services and staffing.
The president’s budget includes proposals to fund Medicare payment reform demonstrations to align provider payments with costs and outcomes and improve management of chronic diseases, to invest more in comparative effectiveness research, and to expand prevention and wellness activities, including community-based demonstrations. Closing the gap in racial and ethnic health care disparities should be a central priority in the application of these new funds.
The provisions in the president’s proposed budget that will help close the health care disparities gap are welcome, but more needs to happen. The social and economic costs to individuals and the nation of reduced life expectancy, high rates of infant mortality, and increased incidence of disease and disability that result from current health care disparities are too high to ignore.