Health Disparities

According to Health Care for America Now's report Unequal Lives: Health Care Discrimination Harms Communities of Color, over 100 million people of color in the United States suffer disproportionately in the nations' health care system. Other studies and reports have documented that racial and ethnic minorities are in poorer health, receive lower-quality health care, suffer worse health outcomes, and have higher rates of illness, injury, and premature death when compared to whites. RESULTS supports policies that will correct this injustice and inequality.

What Causes Disparities?

An individual may be more susceptible to health care disparities because of where they live, their race/ethnicity, who provides their care, and their insurance status. For example, common factors that contribute to health disparities include:

Lack of physicians in rural areas - residents of rural areas have less contact with physicians. While 20 percent of Americans live in rural areas, only 9 percent of American physicians practice there.
Lack of diversity in health care providers - while minorities represent 28 percent of the total U.S. population, only 3 percent are medical school faculty and 17 percent of city and county health officers.
Poverty and lack of insurance - people of low income are far less likely to receive preventative medicine, prenatal care, etc. Those in low-income neighborhoods also tend to live in areas that pose environmental risks such as lead paint and surrounding polluting areas.
Lack of employer support - racial and ethnic minorities are more likely to work in low-wage jobs, and thus are less likely to have employer provided insurance or employer support for health care costs.
Unequal Treatment - research shows that even when racial/ethnic minorities are insured at the same levels as whites, they still tend to receive lower quality of health care.

Are Disparities Pervasive?

Racial and ethnic minorities represent roughly one-third of the total U.S. population, but account for more than fifty percent of the nation's uninsured.

The number of people uninsured in the United States increased by 8 million between 2000 and 2006, and declined slightly in 2007. According to the U.S. Census Bureau, the number of uninsured rose to 46.3 million in 2008, from 45.7 million in 2007. The number of people covered by Medicaid and Medicare was up about 4.5 million in 2008.For more on the 2008 Census Data, see the Census Bureau summary page.
Nearly sixty percent of the twenty-five million non-elderly uninsured below 150 percent of FPL are racial or ethnic minorities.
The percentage and the number of uninsured Hispanics was 32.1 percent and 14.8 million in 2007, and decreased to 30.7 percent and 14.6 million in 2008.
The percentage and the number of uninsured African Americans was 19.5 percent and 7.4 million in 2007, and 19.1 percent and 7.3 million in 2008.
The Census page, Income, Poverty, and Health Insurance Coverage in the United States: 2008(PDF), shows the number of uninsured of Asian origin was up slightly from 2.2 million and 16.8 percent in 2007 to 2.3 million and 17.6 percent in 2008.
The same report shows that, based on a three-year average (2006-2008), 31.7 percent of people who reported American Indian and Alaska Native as their race were without coverage.
There were 7.3 million uninsured children in 2008, compared to 8.1 million in 2007. Hispanic and Black children were more likely to be uninsured than non-Hispanic Whites. The 2008 uninsured rate for Hispanic children was 17.2 percent, down from 20.0 percent in 2007; for Black children 10.7 percent, down from 12.2 percent in 2007; and for non-Hispanic White children 6.7 percent, down from 7.3 percent.

A thorough review of health quality data reveals that racial and ethnic minorities consistently receive lower-quality care than whites.

African Americans had poorer quality of care than whites for about 60 percent of quality measures, including not receiving prenatal care and recommended childhood and adult immunizations.
Hispanics had poorer quality of care than non-Hispanic whites for about 40 percent of quality measures, including not receiving screening for cancer or cardiovascular risk factors.
American Indians and Alaska Natives had poorer quality of care than whites for about a quarter of quality measures, including lacking a usual source of care and having problems with patient-provider communication.

The National Healthcare Disparities Report, 2008, shows that most core measures of quality of care are not improving for minority groups. For example, in measures of chronic disease management for diabetes, obesity, mental health, colorectal cancer, and home health, African Americans, Hispanics and poorer populations are still experiencing worsening care.

Minorities are at a greater risk for many health problems.

African Americans and poorer patients have higher rates of avoidable hospital admissions (i.e., hospitalizations for health conditions that, in the presence of comprehensive primary care, rarely require hospitalization).
While death rates (age-adjusted) from all causes have gone down for all Americans, regardless of race, African Americans continue to have a 30 percent higher risk of death than Whites, a disparity greater than in the 1960s.
A study released by Pew Hispanic Center in August 2008 showed that more than one in four Hispanic adults in the United States lack a usual health care provider. A similar proportion report obtaining no health care information from medical professionals in the past year.
American Indian/Alaska Natives have diabetes rates that are roughly three times the rate for the nation overall.
Many racial and ethnic minorities and persons of lower socioeconomic position are more likely to die from HIV. Minorities also account for a disproportionate share of new AIDS cases.
Hispanic, Asian American, and American Indian/Alaska Native women are significantly less likely to be screened for breast cancer than white women.
Minorities are much less likely to receive adequate screening for specific types of cancer, including prostate, cervical, and breast cancer, and have lower 5-year survival rates for lung cancer.
Women of racial and ethnic minorities are less likely than white women to receive Pap tests, which can prevent cervical cancer by detecting precancerous changes in the cervix.
Death rates from breast cancer are higher among African American women than white women.

The numbers are no better in terms of children's health coverage.

Infant mortality rates for African American and American Indian/Alaska Natives are more than two times higher than that for whites.
Addressing health disparities among children is vital to ensuring the economic security of the nation. Between 1998 and 2008, 41.5 percent of those entering the workforce will be minorities. By 2030, close to 50 percent of workers will be African American and Latino, while Whites will account for 74 percent of retirees.
As much as 75 percent of uninsured children are eligible for public health care, but are not enrolled. Many families face barriers such as required documentation when applying for coverage.
In June 2006, The Children's Defense Fund's report Improving Children's Health, Children's Health Disparities and Promising Approaches to Address Them stated that:
- African American children are 50 percent more likely to be uninsured than White children.
- African American children are 26 percent more likely to have delayed medical care due to cost and 81 percent more likely to have no usual place of health care.
- Hispanic children are three times more likely to be uninsured than White children.
- African American children from 5 to 14 years of age are five times as likely to die from asthma as are White children of the same age bracke

2010 Health Reform Legislation Addresses Health Disparities

The most sweeping reform of America's health care system passed the House of Representatives on March 21! The House passed the Senate health bill, the Patient Protection and Affordable Care Act, by a vote of 219-212. They then followed up that vote by passing the Reconciliation Act of 2010 (H.R.4872), which amends and improves upon the Senate health reform bill, by a vote of 220-211. These reforms expand coverage and access to care for millions of low-income kids and families and provides a critical foundation for addressing racial and ethnic health disparities.

In particular, health reform expands coverage and access for underserved communities. In 2014, the Medicaid health program will expand to cover all persons earning up to 133 percent of the federal poverty line (in 2010, $29,326.50 for a family of four). This expansion is expected to provide 16 million uninsured persons with coverage by 2019. Payments to doctors who provide primary care services to Medicaid patients will be raised to the same level as Medicare payments in 2013 and 2014. This is expected to increase access to care as more doctors take on Medicaid patients. The federal government will pay 100 percent of the cost for these increases. Funding for community health centers (CHCs) increases by $11 billion over five years (2011–2015); $9.5 billion for expanding services and $1.5 billion for facilities and construction. It is estimated that this expansion will allow CHCs to serve an additional 20 million people. The National Health Service Corps will get $1.5 billion over five years. The NHSC provides loans and scholarships to medical students who agree to serve in areas where there are physician shortages after graduation, many times in CHCs. This funding is expected to help train 15,000 new primary care providers.

The legislation also invests in community-based prevention and data collection, and expands the Office of Minority Health, key provisions to address health disparities for communities of color. For a more thorough summary of provisions in the health reform bill, see FamiliesUSA's backgrounder: Moving toward Health Equity: Health Reform Creates a Foundation for Eliminating Disparities.

TAKE ACTION: Thank members of Congress by writing letters to the editor to thank Congress for passing health reform. Use our online Letter to the Editor Action Alert and the March 2010 Action sheet to brush up on the benefits of reform. Also, as noted above, reimbursement rates for doctors treating Medicaid patients will increase in 2013. However, this increase only takes place for two years, just as the Medicaid expansion is getting under way. After that, they will decrease again unless Congress extends the new payment rate. When following up with members of Congress, urge them to work with their House and Senate colleagues to make these increases permanent. You can use our e-mail alert to contact them about this issue.

Action in Previous Congresses to Address Health Disparities

The 110th Congress adjourned in December 2008 without passing either the House or Senate disparities bills described below, though many provisions were included in the 2010 health reform legislation. Rep. Hilda Solis (D-CA), author of the House bill, was named by President-elect Obama as his choice to head the Department of Labor. The two main bills in the 110th Congress were:

The Health Equity and Accountability Act of 2007 (H.R.3014) would improve the health and health care of racial and ethnic minorities by means of promoting cultural and linguistic competency in the medical profession; offering grants to improve access to health information technology in underserved communities; enhancing diversity in the health care workforce; supporting research initiatives to improve data collection, analysis and reporting; strengthening health services in community and rural health centers, promoting environmental justice and enforcing accountability.

The Minority Health Improvement and Health Disparity Elimination Act of 2007 (S.1576) would improve the health and health care of racial and ethnic minorities by means of increasing the diversity of the health workforce, developing cultural competency training for providers, increasing health awareness and health care access, and increasing data collection related to minority health and health disparities. The legislation also calls for a National Plan for the Office of Minority Health to establish quality measures and short and long-term goals to improve minority health and reduce racial health disparities.

In July 2008, Congress overrode the president's veto to pass the Medicare Improvement for Patients and Providers Act. According to Families USA, this bill includes some provisions to reduce disparities. Families USA notes that the bill has laid out three key areas for further study and monitoring:

Improved Data Collection for Measuring and Evaluating Health Disparities
Outreach to the Previously Uninsured
Compliance with Cultural Competency Standards

Senate Approves Reauthorization and Overhaul of Indian Health Care Improvement Act. In February 2008, the Senate overwhelming voted 83-10 to approve the Indian Health Care Improvement Act Reauthorization bill (S.1200). The bill would authorize $35 billion over the next decade for the Indian Health Service to expand health coverage and services for around 1.8 million American Indians and Alaska Natives. The bill would:

increase the number of American Indians in the health care professions
increase funding for cancer and diabetes screenings, mental health/prevention programs
prompt construction and modernization of health clinics on reservations
expand tribal access to Medicare and Medicaid

"It's about time, and I applaud the Senate for this historic vote," said president of the National Congress of America Indians Joe Garcia. He added, "Federal prisoners continue to receive better health care than native people, and this is a major step in reversing that alarming statistic." The Senate also voted to approve an amendment that would create a resource of money for health facility construction to be distributed among all tribes, instead of directing it to specific tribes. Although this bill did not make it out of committee during the 110^th Congress, the health reform bill passed recently by the House would reauthorize the Indian Health Improvement Act for the first time since 2001.

National Business Group on Health and HHS Office of Minority Health Launch Initiative to Reduce Racial and Ethnic Health Disparities. In February 2008, The National Business Group on Health (NBGH) and the U.S. Department of Health and Human Services' Office of Minority Health (OMH) announced a new two-year effort to strengthen ongoing partnerships and build new business-community coalitions to reduce racial and ethnic health disparities and improve the quality of health care for minority populations. This collaboration is part of the National Partnership for Action, a broader effort by HHS and OMH to bring continued national emphasis on ending health disparities.

Rules that took effect in mid-2006 require that individuals provide proof of citizenship when applying for or renewing coverage under public health insurance options such as Medicaid. The rules are intended to prevent undocumented immigrants accessing government-funded health care. In fact, many American citizens have been adversely affected, particularly minority citizens, because they have difficulty producing required documents. The Commonwealth Fund released a report January 12, 2009, Getting and Keeping Coverage: States Experience with Citizenship Documentation Rules, that shows federal rules have made it more difficult for families to get and keep health coverage. Examples:

In Alaska, enrollment among Alaska Native children, all of whom are citizens, declined by more than 10 percent in the six months following the policy change.
Kansas reported a substantial decline in enrollment for HealthWave, which includes both the Medicaid and SCHIP programs, after the citizenship documentation rules were implemented. The decline was much greater for non-Hispanic than Hispanic enrollees.

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