Repeal would dash hopes to reduce disparities

January 18, 2011|By Brian D. Smedley and John E. McDonough

The U.S. House of Representatives plans to vote soon to repeal the health care reform law that was enacted last year. While that effort is unlikely to go any further for the time being, it is important to consider what repeal would mean for the largest-growing segment of the population, people of color, and for a nation that has struggled to address the mounting costs of its health care system.

Even the prospect of "chipping away" at key elements of health care reform — as some congressional leaders have vowed to do — would damage the new law's potential for addressing longstanding racial and ethnic health inequalities. But in addition to the social justice consequences of perpetuating these inequalities, there are strong fiscal reasons why policymakers should want to keep health care reform in place.

Many racial and ethnic minority groups have poorer health, relative to whites, from the cradle to the grave — in the form of higher rates of infant mortality, chronic disease and disability, and premature death. These inequities exact an enormous cost on our health system and thereby place an enormous burden on the nation at large.

A recent study commissioned by the Joint Center for Political and Economic Studies and led by Dr. Thomas LaVeist of the Johns Hopkins University found that the direct medical costs associated with health inequities — in other words, additional costs of health care incurred because of the higher burden of disease and illness experienced by minorities — was more than $250 billion in the four years between 2003 and 2006. Adding the indirect costs associated with health inequities (such as lost wages and productivity and lost tax revenue), the total costs of health inequities for the nation was $1.24 billion in the same time span.

The new health care reform law addresses racial health inequalities in several ways. It will, for example, require insurance reforms to prevent insurance companies from cherry-picking enrollees and denying coverage to those with pre-existing conditions, practices that disproportionately hurt minorities in the private health insurance market. It will expand community health centers, which provide high-quality health care in low-income and minority communities.

On top of this, the law's more than 75 equity-specific provisions represent the most significant federal effort to eliminate health inequalities. Requirements for data collection and reporting will provide evidence to target and address disparities in health care delivery and outcomes. Workforce provisions will help create a more diverse and culturally competent corps of health caregivers and expand incentives for them to practice where they're needed most, such as underserved urban and rural communities. Research initiatives will ensure that racial and ethnic minority health issues are fully considered in understanding disease. Public health investments will address diabetes, obesity, unhealthy communities and health education. Quality of care programs will prioritize more equitable treatment for everyone.

Most importantly, the current health care reform law will address a significant share of the health insurance needs of America's racial and ethnic minorities, who make up about a third of the U.S. population and more than half of all uninsured residents. The law will expand Medicaid to include working families and adults who make barely above-poverty wages; this will disproportionately help people of color, particularly in states where minorities have faced the brunt of lack of insurance. For example, in Texas, 33 percent of all non-elderly adults are uninsured, and fully 74 percent of the uninsured are nonwhite.

Given the opportunity, these approaches will work. Health reform already implemented in Massachusetts over the past four years has eliminated disparities in health insurance coverage between whites and minorities, something never achieved before in any state. The new federal health care reform law has the potential to achieve similar major advances nationwide.

Given that by 2042, according to the U.S. Census Bureau, half of the people living in the United States will be people of color, it is imperative that we be prepared to address the health needs of an increasingly diverse population. There is no time like the present to begin focusing on the goal of health equity — a goal that is not only consistent with the American promise of opportunity but in our long-term economic interest as well.

Brian D. Smedley is vice president and director of the Joint Center for Political and Economic Studies Health Policy Institute. His e-mail is John E. McDonough is a professor at the Harvard School of Public Health. His e-mail is

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