Will health reform address the racial disparity of the uninsured?

For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take us?

By mandating individual health insurance coverage and expanding the list of covered preventative services, ACA legislation should, theoretically, improve the quality of health care for those populations at disproportionate risk of being uninsured and having low incomes. In advance of the January 2014 start of major health reform initiatives, some estimate that more than half of the uninsured will gain insurance coverage.

However, research has shown that having health insurance itself does not have a substantial impact if people cannot find a doctor to see them, do not have proper information about accessing resources, or are not treated in a culturally and environmentally competent manner. Moreover, when the number of uninsured could be decreased by more than half, but being uninsured is not equitable across racial and ethnic groups in the US, what happens to our countries most vulnerable?

It has been well documented that low-income individuals and those without employee-sponsored insurance (ESI) are more likely to be people of color. Kaiser and US Census estimates indicate that there are significant differences in insurance rates by race and ethnicity, with national averages approximating there are almost three times as many uninsured Hispanics as whites. In Louisiana, for example, it is believed that more than 50% of the state’s Hispanics are uninsured, while only 18% of whites are. In the same state, it is estimated that 30% of blacks are uninsured, reiterating just how unbalanced our country remains and how terribly far we have to go to eliminate inequalities.

The oft-cited example of health reform success is Massachusetts, where Blue Cross Blue Shield 2013 estimates indicate that about 97 percent of the state’s population has health insurance thanks to health reform. While this is a grand feat for gaining an insurance card, insurance alone does not constitute affordable, quality care, or improved long-term health and equity. The real successes come from improved statistics on accessing care, preventative care and disease reduction.

For those looking to Massachusetts, data does support a slight improvement in overall access to care by showing that whites, blacks and Hispanics all had increases in the number of insured, and further that the percentage of the state’s population that had “any doctor visit in prior year” between 2006 and 2009 rose by more than five percent.

Unfortunately, as many have argued, those for and against health reform, Massachusetts is not necessarily a good representation of other US states or populations, as anyone who has been to Massachusetts knows that the state population looks and behaves very differently from places such as southern California or the southside of Chicago. Furthermore, even in Massachusetts the number of blacks and Hispanics that remain uninsured is two and three times that of whites, respectively.

Many of those who will be left uninsured will be blacks, immigrants and Hispanics, who will continue to use emergency departments for critical care or, worse, go untreated.

Additionally, there are those who are lower middle class (a growing group in this nation) who fall into the economic gap where they cannot afford the employer/exchange insurance offered to them, but earn too much to receive subsidies for offsetting the mandatory cost of insurance, which are often people of color.

Other groups of concern are those minorities who do not have the knowledge of where to access care, do not have the financial or transportation means to access care or still distrust the system due to systemic problems with culturally competent care.

Although the ACA takes us a step forward in giving many of the countries uninsured an insurance card, the US must address what to do about probable provider shortages that will result from a lack of primary care physicians and different utilization in care. We must be prepared to understand both to cultural differences in demand and pent-up demand of the previously uninsured, as well as start to really face how to deal with persistent racial and ethnic inequality in this nation that shows itself in our health care system every day.

In the coming weeks, months and years the US citizens have to do more than champion or attempt to repeal the ACA. Party lines and moderate attempts at change will never fix our broken health care system. We have to start addressing the real issues our country faces, those of injustice, unequal access and treatment and how we properly care for and address the needs of those who are not white and wealthy.

Brad Wright is an assistant professor of health management and policy who blogs at Wright on Health.

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  • Anthony D

    ObamaCare will fail and fail disastrously. And that is what it is designed to do. We’ve been told that Obama is the smartest man in the room…and I very much believe that to be the case. So, if the smartest man in the room, a man MUCH smarter than me cannot see what is glaringly obvious to the vast majority of Americans who are certainly not as smart as this man, then he must be creating and implementing this disaster on purpose.

    So when ObamaCare fails spectacularly, what’s the back up plan? When it fails, the American people who have the memory of a gnat will go running to the government for help, completely forgetting that it was the government that created this problem in the first place! And Obama will come riding in on his off white horse and save the day with socialized medicine because only the government can solve this problem…that will be his go to line.

  • Guest

    Democrat “solutions” to poor peoples’ problems have an awesome track record. Just ask the poor of any given Democrat-controlled city. Chicago, Detroit, DC…..

    • Guest

      This is what happens when Democrats are given charge of taxpayer money to look after poor people’s health: they give all the health contracts to their well-connected Democrat friends, and eff the poor:|

      “Until this month, Chartered Health Plan was the city’s dominant Medicaid
      contractor, managing the health care of more than 100,000 low-income
      city residents. The company’s collapse has
      raised questions about its politically connected owner, its precarious
      finances and government oversight of a key component of the city’s
      health-care system.”

      http: //articles. washingtonpost. com/2013-05-25/local/39519389_1_federal-medicaid-officials-health-care-providers-watkins

  • charles_beauchamp

    There is a very significant difference between African American / Hispanic men versus Caucasian men/women, African American / Hispanic women in 24 hour blood pressure control. Evidence-based chronotherapy of hypertension is one way to decrease disparities in outcomes between minorities and other groups.

    In addition, there is a much earlier onset of endothelial dysfunction in African Americans than non-African Americans. Attention to rational and safe treatment of endothelial dysfunction could decrease health care disparities in outcomes of patients with hypertension and/or diabetes mellitus.

    Endothelial dysfunction is treatable, in part, with the rational application of evidence-based chronotherapy.

    If the ACA leads to more access to chronotherapy then it can have significant effects on reducing disparities in health care outcomes.