Americans from racial and ethnic minorities will gain much from the Affordable Care Act. The nation’s new health care law will improve health coverage and access to health services for all Americans, especially people of color. These Americans are often sidelined in our current health care system. They are more likely to be without health insurance coverage—they make up more than half of America’s uninsured—and to be poor. They have higher rates of infant mortality, disease, and disability than the general population. They are more likely to have the risk factors such as obesity that predispose them to chronic illnesses, and are less likely to receive the preventive screenings, regular care, and necessary medications that could prevent or ameliorate their chronic conditions.
Being uninsured often means postponing needed health care services, and chronically ill, uninsured patients are four to six times more likely than sick patients with insurance to have problems accessing care. That’s why people of color in our nation are diagnosed at more advanced disease stages, and once diagnosed, they receive poorer care. Many of these Americans do not have a usual source for health care and rely on hospital emergency rooms, have substantially higher unmet health needs than their insured counterparts, and have higher out-of-pocket costs. They run the risk of disabling and expensive health consequences. Inevitably, they live sicker and die sooner.
Closing the disparities gap would save more than 84,000 lives every year. Instead, these racial and ethnic differences in health care are actually worsening in some cases. We can ill afford to ignore the high cost in dollars and human life that the nation pays each year as a result of these health care disparities. The total annual cost of racial and ethnic health disparities, including direct medical costs and indirect costs such as lost productivity, lost wages, absenteeism, family leave, and premature death, is of the order of $415 billion.
Measures in ACA that will help address racial and ethnic disparities in health care include:
- Expanding coverage to 32 million people who currently have no health insurance, and providing financial assistance to help those with lower incomes purchase coverage
- Improving access to primary care and “medical homes” to ensure a regular source of care and care coordination
- Expanding access to community health centers
- Focusing on disease prevention and promotion
- Enhancing the quality of health care services
- Improving the health care workforce’s distribution and cultural competency
- Collecting data to better measure the effectiveness of these initiatives
The new Center for Medicare and Medicaid Innovation established under ACA will develop and expand the medical home model for Medicare and Medicaid patients. Medical homes—health care settings that provide patients with timely, well-organized care and enhanced access to providers—are associated with a reduction in health care disparities for adults and better access to preventive services.
Patients from racial and ethnic minorities receive a lower quality and intensity of care than other Americans who present identical health problems. African Americans and Hispanics are significantly less likely than whites to receive needed therapeutic procedures, even after controlling for patient age, severity of illness, health insurance, and hospital type. There are a number of provisions in ACA that will address disparities in treatment, health care quality, and safety. Identifying priorities in health care quality and developing quality measures and performance indicators will help improve health care services and patient outcomes for all Americans, but improvements will disproportionately benefit those segments of the population which are least likely to get quality care.
ACA addresses other aspects of the health care system that compromise care for people of color. For example, because minorities are very underrepresented in the health care professions, it is significantly more difficult for them to find a doctor that they trust to provide regular care that is culturally competent, without bias, and respectful of their dignity. The problems are magnified if there are language barriers, which place patients at increased risk of medical errors.
ACA will increase the number of minority health care professionals and ensure more culturally sensitive care by:
- Providing additional scholarship and loan repayment opportunities for disadvantaged students from minority communities who commit to working in medically underserved areas and serving as faculty in participating institutions
- Reauthorizing and expanding programs to support the development, evaluation, and dissemination of model curricula for cultural competency at health professional schools and in continuing education programs
- Providing grants to states, public health departments, clinics, and hospitals to promote the use of community health workers. Community health workers create a bridge between providers of health, social, and community services and the underserved and hard-to-reach populations they serve. In particular, they can help with language problems and provide culturally appropriate health education and information.
Defining and measuring health care disparities is a prerequisite for addressing them. High quality data are essential to helping health care providers understand and remedy racial and ethnic disparities in health care.
ACA has provisions to:
- Require federally funded programs to collect and report data on race, ethnicity, socioeconomic status, health literacy, and primary language. It also requires that federally funded population surveys collect statistically reliable data based on race, ethnicity, primary language, and disability in order to compare health disparities populations.
- Extend the existing requirements for the collection of Medicare health disparities data to Medicaid and the Children’s Health Insurance Program.
- Formally establishes the Office of Minority Health at the Department of Health and Human Services and a network of minority health offices located within HHS. It also elevates the Office of Minority Health at the National Institutes of Health directly into the Office of the Secretary of Health and Human Services. This raised profile will help with the implementation and evaluation of minority health programs.
Through effective implementation of the Affordable Care Act, all Americans, regardless of race or ethnicity, will ultimately get the quality health care services they need when they need them. It represents an important milestone toward the ultimate goal of eradicating racial and ethnic disparities in health and health care in the United States.
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