With round-the-clock coverage of U.S. health care reform and thousands of journalists, commentators, “experts” and bloggers who dissect every word that key policymakers say or write about the issue, it is amazing that any part of the proposed reforms could be ignored altogether. But that is indeed what has happened with a key element of the legislation that is currently before Congress: the attempt to reduce health disparities.
The United States has vast disparities in health care quality and health outcomes across race, ethnicity, socioeconomic status, gender, place of residence (especially urban vs. rural) and language skills, as outlined in Institute of Medicine’s groundbreaking 2003 report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. However, while pending House and Senate health care reform proposals actually include elements designed to significantly reduce health disparities, those elements – and the need to address health disparities – have been lost in the shuffle of heated ideological discussions surrounding the “public option,” “death panels” and the “government take-over of health care.” Unless you study health policy for a living or you have read the entire House Tri-Committee bill, you probably don’t know that one of its stated goals is to reduce health disparities or that it has an entire section devoted to the issue.
The House bill (H.R. 3200, America’s Affordable Health Choices Act of 2009) contains several mechanisms designed to address health disparities. For example, the bill provides that:
- The Secretary of Health and Human Services shall ensure that reducing health disparities is an explicit goal in her national priorities for quality improvement in health care (sec. 1441)
- Health care quality improvement measures should be designed to assess disparities, especially those associated with race, ethnicity and language (sec. 1441)
- Medicare will provide reimbursements “for culturally and linguistically appropriate services” in order to promote access to medical services for Medicare beneficiaries with limited English proficiency; this provision (sec. 1222) has actually been referenced by some opponents of health care reform because it is purported to give Medicare coverage to illegal immigrants, which is plainly not in the legislation
- The Centers for Medicare and Medicaid Services (CMS) will fund and carry out a demonstration project where grants will be given to eligible Medicare service providers to improve effective communication between providers and Medicare beneficiaries in underserved communities; these demonstration projects are intended to improve access to care, utilization of services, efficiency, patient satisfaction and health outcomes for disadvantaged and low English proficiency populations (sec. 1222)
- The Secretary of Health and Human Services and the Institute of Medicine shall study, analyze and publish a report on the impact and cost of providing of culturally and linguistically appropriate services to limited English proficiency populations (sec. 1223)
- The Centers for Disease Control (CDC) establish a program for the delivery of community-based preventive and wellness services. At least 50 percent of the funds for this program must spent on planning or implementing wellness services whose primary purpose is to achieve a measurable reduction in one or more health disparities (sec. 2301).
In America’s Affordable Health Choices Act, the House of Representatives has clearly recognized that improving health equity must be a priority if policymakers want to improve overall health care delivery and health outcomes in the United States. The above provisions in the bill are an excellent starting point in the struggle to reduce and eventually eliminate health disparities. Unfortunately, improving health equity does not engender derisive sound bites or screaming matches at town hall meetings, so this crucial aspect of health care reform has been ignored by opposition politicians and the mainstream media. As a result, American policymakers, media and the public are losing a critical opportunity to understand, debate and address persistent health disparities.