Health care reform shows great promise to address health disparities

Last week I blogged about the important research from the Wilder Foundation and Blue Cross Blue Shield Foundation on the connections between health outcomes, neighborhood incomes, and race. The deep disparities in the Twin Cities are troubling.

But the positive news is that the federal Patient Protection and Affordable Care Act, which become law on March 2010, will help address racial and economic health disparities.

Two major provisions of the law expand medical coverage, which should have a positive impact in reducing disparities because low-income people and people of color are more likely than others to lack health coverage.

Tax credits to help individuals and families buy health insurance. Efforts to enable more people to access private health insurance will help to ease disparities in health care coverage. The federal law will provide tax credits to households with incomes below 400 percent of the poverty line to purchase health insurance - today, 400 percent of the poverty line is $73,240 for a family of three. About 80 percent of non-elderly blacks, Hispanics, and American Indians and Alaska Natives have incomes below that level, according to Families USA.

Simplified and expanded eligibility for Medicaid (called Medical Assistance in Minnesota), which provides insurance coverage to people who can't afford it on their own or can't get it through their jobs. Starting in 2014, Medicaid will cover individuals and households with incomes up to a third higher than the federal poverty line - measured against today's poverty guidelines, that means single people with incomes up to $14,403 would be covered.

But Minnesota does not need to wait until 2014. We should take advantage of the opportunity in the federal law to implement this improvement early, and should act now to cover individuals with incomes up to 75 percent of the poverty line under Medicaid. These Minnesotans had been served by General Assistance Medical Care (GAMC) until Governor Pawlenty eliminated its funding in 2009. A compromise was passed in the 2010 Legislative Session, but only four hospitals - all in the metro area -  currently participate in the scaled-down version of GAMC, leaving thousands with no medical coverage and only hospital emergency rooms as a place to receive treatment.

Covering the GAMC population under Medicaid would be an important step in minimizing racial and economic health disparities. In 2008, around 70,000 Minnesotans received health care through GAMC; all had extremely low incomes and over 40 percent were people of color.

Implementing this option would also mean higher reimbursement rates for health care providers and a more clearly defined set of health care benefits for participants (30 percent of whom have chronic medical conditions and 60 percent of whom struggle with mental health problems or chemical dependency). The federal government would cover about half of the cost of health care services now - bringing an additional $1.4 billion in federal dollars for health care - and a much greater share of the costs starting in 2014.

Other provisions in the health care reform legislation that will help address health disparities include:

• Investments in communities that have had only limited access to quality health services. The law increases funding for Community Health Centers, which serve low-resource areas and communities of color, and updates and reauthorizes the Indian Health Care Improvement Act.
• Opportunities to work in the health care field. The law recognizes the need for a diverse health care workforce and provides scholarships, grants and loan repayment programs that will open the door for more people of color to enter good jobs in the health care field.
• Better information through new data collection requirements that will allow for a greater understanding of health disparities and better monitoring on progress to address them.
• A number of grant opportunities and demonstration projects are available from federal health care reform and other recent legislation on issues ranging from childhood obesity to preventive oral health care to community health teams. As states and communities use these resources, addressing health disparities should be an explicit goal, and low-income communities and communities of color should play a lead role in the decision-making and implementation of these initiatives.