Health Care Reform and African Americans

Thomas Britt, MD., MPH

For some time now, the American health care system has maintained an interesting dichotomy. You could argue that we have the best as measured by medical/surgical and technological capabilities, yet the worst in actual health care delivery. We currently spend about 17% or more of our GDP on health care (more than all other developed nations) but have poorer outcomes as measured by infant mortality and life expectancy. Americans report more morbidity from common chronic diseases than their European counterparts. Mortality from heart disease is 18% in the U.S. compared to 11% in Europe. Wealthy U.S. adults have poorer health outcomes than wealthy Europeans. Moreover there is more health disparity in the U.S. than in Europe. Twenty percent of African Americans are without health insurance. African Americans spend 16.5% of their income on health care, compared to 12.2% for whites.

On March the 21st, 2010 at 9:45 pm Central, the 111th Congress passed H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), by a vote of 219-212. All Republican Representatives and 34 Democrats voted against the bill. In Illinois, Democrat Daniel Lipinski along with Republicans Biggert, Johnson, Kirk, Manzullo, Roskam, Schock, Shimkus all voted Nay. President Obama signed the bill into law on the 23rd of March 2010 (Pub. L. 111-148). The Health Care and Education Reconciliation Act, H.R. 4872 was also passed by the 111th Congress (220-211). The president signed this bill into law 30 March 2010 (Pub.L. 111-152). These two Acts together comprise health care reform.

Passage of this historical legislation is reform, however it is not universal care, nor a single payer system that is present in Europe and Canada. There are immediate and long-term benefits as well as shortcomings. The prevailing initiative was to provide coverage for all citizens, nearly 45 – 50 million uninsured. This health care reform will only cover about 32 million, leaving more than !3-18 million Americans uninsured in 2014 … provided a potential change in Congress during the mid-term elections and 2012 are unwilling or unable to repeal or minimize the tenets of health care reform.  Immediate benefits of health care reform available within the first year after enactment are as follows:

  • Tax credit of 35% of premiums available to small firms that offer coverage
  • No pre-existing coverage exclusions for children
  • Insurers are prohibited from dropping policy holder when they get sick
  • Insurers are prohibited from charging co-payments or deductibles for Level A or Level B preventive care and medical screening on all new insurance plans
  • Closes the coverage gap in Medicare Part D
  • Protects patient’s choice of physician by allowing plan members to pick any participating primary care provider
  • Insurers must permit children to stay on family policy until age 26
  • No lifetime limits on coverage
  • Medicare beneficiaries will receive free annual wellness visit with cost-sharing waived for preventive services
  • Group health plans are prohibited from establishing eligibility rules that have the effect of discriminating in favor of higher wage employees
  • Expansion of Medicaid where states place the level of eligibility to 133% of the federal poverty level

Even-though our current health care system is market-based, the PPACA provides effective penalties for violating its provisions … marking a paradigm shift. By avoiding confrontational terms, what has been considered a privilege is becoming a de facto right.

If you look for specific language or the word, African American – you will be disappointed. However African Americans are not left-out of this sweeping legislation. Look instead for non-confrontation language, i.e., low income, underserved, uninsured, minority and health disparity. While these groups are inclusive of non-African Americans, they and the latter two include a preponderance of African Americans. A review of the lengthy health care reform legislation, especially Title IV and Title V, provide guidelines and details that will have positive impact on the health and well-being of African Americans.

Title IV, Sec. 4001 of H.R.3590 establishes a National Prevention, Health Promotion and Public Health Council  to be chaired by the U.S. Surgeon General. This council shall:

  • Provide coordination and leadership at the federal level, for the provision of prevention, wellness, and health promotion practices and integrative health care in the U.S.
  • Develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status and reduction of preventable illness and disability
  • Provide recommendations to the President and Congress concerning the most pressing health issues in the U.S.
  • Propose evidence-based models, policies, and innovative approaches for promotion of transformative models of prevention, integrative health and public health

Title V, Sec. 5001 of H.R. 3590 establishes a Health Care Workforce. The purpose of this title is to improve access and delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity and rural populations by:

  • Gathering and assessing comprehensive data in order for the health care workforce to meet the health care needs of individuals, including research on the supply, demand, distribution, diversity, and skills needs of the health care workforce
  • Increasing the supply of a qualified health care workforce to improve access and. delivery of health care services for all individuals
  • Enhancing health care workforce education and training to improve access and delivery of health care to all individuals
  • Provide support to existing health care workforce to improve access and delivery of health care services for all individuals

This is landmark and historical legislation, not universal care, not single-payer, not a public option, but much better than our existing health care system. The Patient Protection and Affordable Care Act is a great start which can be improved over time with effective advocacy from an informed population.