This week began and ended with legal challenges to the constitutionality of the provision in the nation’s new health care reform law that would require individuals to carry health insurance. On Monday, a federal judge in Virginia ruled that the mandate is unconstitutional; on Thursday, a federal judge in Florida began hearing arguments.
Also on Thursday, the Washington-based Center for American Progress released two reports that explore the Affordable Care Act’s impact on racial and ethnic minorities who suffer from chronic illnesses and how the legislation can improve efforts to address gaps in the data that measure health care disparities.
“There has been considerable debate this week around efforts to dismantle health care reform,” said the reports’ author, Dr. Lesley Russell, a senior fellow at the think tank, during a conference call with reporters. “Unfortunately, we’ve not heard in that noisy debate the voices of [all of the racial and ethnic groups] whose current health care is currently substandard and who will gain so much from the provisions in the Affordable Care Act.” Russell added that she hopes her reports will change that and make their case.
One report, “Easing the Burden,” focuses on the provisions that would improve access to health insurance coverage, primary care and patient literacy and those that would address disparities in treatment and quality of care.
“In particular, chronically ill Americans from racial and ethnic minorities have much to gain from the Affordable Care Act. They are more likely to be without health insurance coverage. They make up more than half of America’s uninsured and suffer higher rates of chronic illness than the general population,” Russell said. “They’re more likely to have risk factors, such as obesity, that predispose them to chronic illnesses and they’re less likely to receive the preventive screenings, regular care and necessary meds that could prevent or ameliorate their conditions.”
Jacqueline Ayers, legislative director for health and education at the National Urban League, said that the bill’s investment in community health centers will enormously benefit minorities and others who are medically underserved and will help to increase responsive and timely care that can improve disease management while controlling costs.
The second report, “Measuring the Gaps,” highlights provisions in the bill to expand requirements for collecting and analyzing data on health care disparities and how that can help drive efforts to understand and address those disparities.
“We need to understand why people of color are significantly less likely than Whites to receive needed therapeutic procedures and more likely to receive a lower quality and intensity of care than other Americans who present with identical health problems,” Russell said. Such efforts should explore why immigrants who don’t have health insurance coverage or much money generally are in better health than racial and ethnic minorities who were born in the United States. In addition, a much greater effort must be made to ensure that these groups actively participate in clinical trials and to bridge any existing language barriers.
It has been widely documented that patients feel most comfortable with doctors with whom they have some affinity, such as their racial or ethnic background. But because minorities are underrepresented in the health care professions, it’s difficult for them to also find culturally competent providers.
“It’s 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,” Russell explained. “The problems are magnified if there are language barriers. Better data and robust implementation of the provisions in the [legislation] will tackle all of these issues.”
Kathy Lim Ko, president and CEO of the Asian & Pacific Islander American Health Forum, also participated in the call. She said that, in addition to requiring data collection using standardized categories, the new law also requires all federally funded population surveys to collect enough data to allow for reliable reporting of racial and ethnic subgroups. This is particularly important for the groups that her organization represents whose heritage can be traced to more than 50 countries and to dozens of distinct ethnic groups.
“These provisions will greatly improve the ability to document racial and ethnic disparities, especially among some of the smaller populations in our communities who are typically either excluded from the reporting of survey findings or grouped as the greatly feared ‘other’ category,” Ko said.
Russell said that her work highlights the inadequacies of the current data. “I’ve found it’s almost impossible to track changes in health care over time. It’s a small wonder that reports on health care disparities mount even as the gaps widen,” Russell said. “The ultimate goal must be that all Americans, regardless of race or ethnicity, get the health care services they need when they need them.” Health and health care disparities cost the nation approximately $415 billion each year, through medical costs and indirect costs such as lost productivity and wages, absenteeism and premature death.
