The Shaky Future of Health Care for All

With President Obama, historic gains were made in confronting racial differences in health care, but the GOP is threatening to roll them back. Here's a look at what's at stake.


It's well documented that African Americans and other ethnic minorities have disproportionately higher rates of poor health, including infant mortality and most chronic conditions -- heart disease, stroke, cancer, HIV/AIDS, asthma and diabetes, among others. Racial differences in health have persisted for so long that they're largely seen as a standard fact of life, even though, truth is, these differences are avoidable. So when President Barack Obama tasked Congress with sending a health care reform bill to his desk in 2009, the Congressional Black Caucus saw a huge opportunity.

"We'd already introduced a bill called the Health Equity and Accountability Act for the past several Congresses, so our work on this issue started long before the health care reform debate started," Virgin Islands Rep. Donna Christensen told The Root. In response to the president's charge, the CBC members promptly accelerated their efforts to tackle health disparities. They conferred with the National Medical Association and other black health groups, developed benchmarks that they wanted to see in the bill, formed a united front with other ethnic congressional caucuses and met on three occasions with President Obama.

Christensen, a physician and a chair of the CBC Health Braintrust, maintains that addressing race and ethnicity specifically in the legislation was critical because looking at differences in insurance coverage alone does not fully explain why blacks, on average, aren't as healthy as whites. Though pleased that the Affordable Care Act expands coverage through several means, including expanding Medicaid to include all people with incomes barely above the poverty level, she points out that health disparities persist regardless of insurance status. "Reports have shown that lack of insurance accounts for maybe 20 percent of what we see in health disparities," she says.

She also pushes back on the notion that health disparities are a matter not for government intervention but of individual behaviors -- that if black folks would just eat less fatty foods and exercise more, then most of the problem would be solved.

"To some extent, of course it's about personal behavior, but a lot of it is environmental," she says, explaining that poverty and residential segregation are among the issue's biggest drivers. "People of color tend to live in neighborhoods where environmentally polluting industries are located. We have communities with no grocery stores and [an] excessive [number of] liquor stores, sometimes beyond what city statutes allow. All of these things contribute to the socioeconomic determinants of health."

Although the Affordable Care Act comprises many measures that originated with the CBC, such as diversifying the health care workforce and expanding community access to services, it ultimately falls short of changing socioeconomic drivers of health. Christensen is still proud that it includes most of what the CBC asked for -- especially when, under the House Republican majority, those provisions are increasingly vulnerable.

What the Legislation Does …

Major aspects of the Affordable Care Act that CBC members fought to include are those that emphasize collecting health-disparities data and funding research. Federally supported programs, for example, are now required to collect demographic information. The legislation also elevates the National Center on Minority Health and Health Disparities to the more robustly funded level of an institute.

It may seem as if experts have been studying the numbers on and causes of health disparities for decades now, but the process has been inconsistent throughout the health care and public health systems. "If data is not uniformly collected, then we don't know where we are, and we can't monitor our progress," says Christensen.

The law also supports efforts to diversify the health workforce. African Americans are severely underrepresented, making up only 5.6 percent of all physicians. Research has shown that having providers from the same racial or ethnic background as patients in low-income communities tends to produce better health results (pdf). "There's an element of trust, and an understanding of where people are coming from, that produces better outcomes," says Christensen, citing the beneficial effects of knowing a community's language, cultural beliefs and traditions.