Health Care: What Will Obama Do Next?
As we count down to a second term, a look at his record on addressing racial health disparities.
(The Root) -- Between now and the inauguration on Jan. 21, The Root will be taking a daily look at the president's record on a number of policy issues, including his first-term accomplishments and what many Americans hope to see him accomplish in a second term. Today: Addressing health disparities and African Americans' health care needs. See previous postings in this series here.
Background: In 2004, the Sullivan Commission on Diversity in the Healthcare Workforce found that "the civil rights movement of the 1960s ended the more visible racial and ethnic barriers, but it did not eliminate entrenched patterns of inequality in healthcare, which remain the unfinished business of the civil rights movement." Former U.S. Surgeon General Dr. David Satcher told Crisis magazine at the time that the health disparities that existed were a matter of life and death and a lot of unnecessary pain and suffering.
Fast-forward a decade and not much has changed.
Nearly 50 percent of African Americans suffer from some type of chronic disease -- including diabetes and certain cancers -- compared to 39 percent of the general population. The life expectancy of African Americans is five years less than that of whites due to conditions such as heart disease and stroke. Blacks have a higher prevalence of high blood pressure or hypertension than any other group. African Americans are twice as likely to have diabetes than whites and more likely to be overweight and obese than their white counterparts.
Even the nation's first black president has taken note of what the Centers for Disease Control and Prevention describes as the striking health disparities between African Americans and other racial groups.
"We know that even as spiraling health care costs crush families of all races, African Americans are more likely to suffer from a host of diseases but less likely to own health insurance than just about anyone else," President Obama said in July 2009.
Currently an estimated 20 percent of African Americans are uninsured (pdf), contributing to the growing health disparities that exist in America's communities. Rep. Danny Davis (D-Ill.) introduced legislation to create an annual report on health disparities.
"Every person," said Davis, "should have access to high quality comprehensive health care that is affordable to them without regard to their ability to pay."
First-term accomplishments: President Obama signed the historic Affordable Health Care Act in 2010, which extended health care coverage to 7 million African Americans.
"There's a lot in this law for people of color," said Brian Smedley, vice president and director of the health policy institute at the Joint Center for Political and Economic Studies, in an interview with The Root.
Smedley pointed to many provisions that are already in effect. For example, insurance companies can no longer deny claims based on pre-existing conditions, and young adults can now stay on their parents' health care plan until they reach age 26. That means 230,000 black women and 180,000 black men between the ages of 19 and 25 can continue to have health insurance under their parents' plan. The legislation also raised the eligibility requirements for Medicaid, providing 4 million more African Americans access to health insurance coverage. Seniors will now be able to get annual wellness exams, diabetes screenings and colorectal cancer screenings.
But even more importantly, said Smedley, the Affordable Care Act tackles the structural inequalities that disproportionately hurt highly segregated communities of color, the conditions in neighborhoods that lead people of color to be sicker in the first place. He points to the inequality in education, employment and housing in segregated communities where neighborhoods are food deserts, overrun by fast-food restaurants and convenience stores that sell unhealthy deli and junk food.
The Affordable Care Act addresses these issues with the Prevention in Public Health Fund and Community Transformation Grant. In 2011, the new Prevention and Public Health Fund distributed $300 million to states and communities to increase preventive care. The administration notes that 5.5 million African Americans can now get blood pressure and cholesterol screenings, screenings for breast and cervical cancer, annual mammograms for women over 40 and colon cancer screenings for people over 50 -- at no cost.
The Community Transformation Grant provides support for community initiatives that reduce health disparities. For example, the grant provides resources for programs that improve nutrition and increase physical activity. In addition, the legislation provided $11 billion for infrastructure enhancements to community health centers, which are often the first stops to preventive care. The Office of Minority Health will be charged with monitoring and evaluating the success of these programs at the state and federal level.
"For the first time there's a dedicated source of federal investment into things like community-based primary prevention," Smedley said. "In public health we call these 'upstream interventions' that allow us to hopefully tackle some of the very community conditions which lead people of color to be at risk for poor health in the first place."
Second-term hopes: As the administration looks ahead, it hopes that the Affordable Care Act will be able to provide health insurance coverage to an estimated 3.8 million African Americans who otherwise would not have any by the year 2016, said Anton Gunn, director of external affairs in the Office of Intergovernmental and External Affairs at the U.S. Department of Health and Human Services.
"That's what we know we're working towards going forward," Gunn told The Root.
The Affordable Care Act also calls for more diversity in the health care workforce, said Gunn. The legislation triples the number of people in the National Service Health Corps. The administration hopes that growth will lead to an increase in the number of physicians of color in the nation. Currently African-American physicians are about 18 percent of the National Service Health Services Corp, compared with only being 6 percent of all providers in the workforce.
"So that's three times as many African Americans in the National Health Service Corp being trained, getting their loans repaid and getting scholarship money to go to school to become doctors because of the Affordable Care Act," said Gunn.
Gunn also notes that about 4 million African Americans will no longer have a lifetime limit on health care coverage.
"Let's say you have a health insurance policy, and when you signed up for the policy, the policy said you have $1 million in coverage," said Gunn. "God forbid you got breast cancer, and you're in the middle of chemotherapy and you get a letter from your insurance company telling you you've reached the maximum lifetime limit on your coverage, and so they stop covering your chemotherapy for your breast cancer. So there are many people who are caught in that bad place where they had a lifetime limit of a million dollars or $2 million, and they had a really bad illness during that time and their coverage was yanked away from them when they needed it the most. That can't happen anymore, thanks to the Affordable Care Act."
Gunn says there are tremendous benefits that are available to communities of color through the Affordable Care Act and hopes African Americans will take full advantage of them.
Smedley called the law an important first step that addresses many of the needs of communities of color. But it cannot be the only step. "We've got to keep pressing forward for more comprehensive strategies, including strategies that address inequality in many sectors of American life outside of health care."