How health reform can eliminate health disparities

As millions of Americans gain health care coverage under the Affordable Care Act, we have an unprecedented opportunity to work on eliminating health disparities based on race, income and insurance status. Several states, including California, soon will begin marketing their Health Benefits Exchanges (in our state it’s called “Covered California”). Through these exchanges, millions will enroll in health plans and expanded Medicaid programs for coverage that takes effect in January 2014.

In our diverse nation, including California – a “majority minority” state – ensuring that outreach is culturally aware, accessible in needed languages, and able to surmount logistical barriers will be key. So-called “minorities” now comprise 57 percent of our state’s population and 35 percentof the nation’s total. In addition, a Migration Policy Institute report shows that nine percent of Americans have limited proficiency in English. We support efforts by California’s Exchange, Department of Health Care Services and the Managed Risk Medical Insurance Board to address these issues, as described in their outreach and marketing plan. We encourage other states to follow suit.

Because of a complex mix of a lack of coverage, income inequality and other social inequities, Latinos, African Americans, Native Americans, Asian Americans, Pacific Islander Americans and others are disproportionately represented among the uninsured. Researchers at the Urban Institute estimate that nationally, with implementation of health care reform, the eight-percentage-point difference between the number of African Americans and whites with insurance could be cut in half. They predict the 19-percentage-point difference between Latinos and whites could be cut by a quarter. These aren’t sufficient changes, but they’re an important start.

Getting people insured is the first step. Ensuring they receive excellent, culturally responsive, coordinated care is next. Research by the Institute of Medicine found that people of color receive lower-quality health care even when their insurance and income are the same as whites’. In California, the Office of Statewide Health Planning and Development has confirmed significant racial and ethnic disparities in health. Effectively addressing these disparities will require more than providing interpreters and translated materials when needed, although these are critical first steps. The specific languages spoken are not always the source of the problem. More broadly, physicians and the entire health care team must work to ever better understand our patients and partner with them to deliver care that takes into consideration their beliefs, values and unique contexts.

In a diverse nation in which health care delivery is often fragmented, moving to the Patient Centered Medical Home model will also help improve health outcomes. Team-based medical home efforts across the country have proven that this model of coordinated, patient-focused care improves health while decreasing costs. As millions more patients enter the nation’s health care system, which already struggles with a primary care physician shortage, this type of effective, efficient, coordinated care will be essential. At the same time, recruiting new physicians from racial and ethnic groups historically under-represented in medicine will help remedy the shortage and improve cultural proficiency.

As family physicians, we look forward to health care reform and the opportunities it affords to work toward eliminating health disparities.

Steven A. Green is President, California Academy of Family Physicians.

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