Disparities

With so much ruckus over what's in the House health reform bill, what's not actually in the bill and what imaginary horrors it will bring about , we'd like to highlight a feature not getting much attention -- namely a push to reduce or eliminate health disparities.

Here are some of the highlights from the House Tri-Committee bill, HR 3200:

• Medicare will reimburse for "culturally and linguistically appropriate services" to promote access for Medicare beneficiaries with limited English proficiency. (NOTE: This is not a codeword for covering illegal immigrants, as some foes of reform have contended).
• Reducing health disparities would be an explicit goal in the HHS Secretary's national priorities for quality improvement in health care.
• The Secretary of HHS and the Institute of Medicine would look at how providers utilize cultural and linguistic support services, design a demonstration program to pay for these services, and study the impact on reducing health disparities.
• Establish a CDC grant program for community-based prevention and wellness. Significantly, "At least 50% of these funds must be spent on implementing services whose primary purpose is to reduce health disparities."

Everyone has a stake in the health care reform debate. As the National Partnership for Women & Families pointed out in a recent issue brief, the stakes are particularly high for women.

Previously, we've discussed health disparities and barriers to care American women face. We've looked at health disparities facing racial and ethnic minorities. At an event this week, the Kaiser Family Foundation put these issues, literally, on the map.

More evidence about the health care crisis facing poor people and minorities. Health and Human Services Secretary Kathleen Sebelius this week released a report, Health Disparities: A Case for Closing the Gap, examining widespread and worrisome disparities.

We've noted the disparities in cost and coverage that women face in the health insurance marketplace before. The Department of Health and Human Services and the White House are taking notice too. Their report Roadblocks to Health Care: Why the Current Health Insurance System does not Work for Women highlights some worrisome statistics about women and health care.

Women often have a more difficult time finding health care coverage through an employer. Only 52 percent of women, as opposed to 73 percent of men, are employed full-time. Of those women, only 48 percent are able to get employer-sponsored health coverage, versus 57 percent of men. Women are twice as likely to be on a spouse's plan, and single women are two times more likely to be uninsured than married women.

Our nation's health care crisis affects all Americans in different ways. A new report from the Department of Health and Human Services details the health care challenges faced by the some 50 million people living in rural America.

So how's your health? And have you earned any good degrees lately?

American adults just aren't as healthy as they could be, a recent study by the Robert Wood Johnson Foundation Commission for a Healthier America found. Between 2005 and 2007, a little more than 45 percent of adults ages 25 to 74 reported being in less than very good health. And education levels seems to be a factor.

The study, Reaching America's Health Potential Among Adults: A State-by-State Look at Adult Health, found that the greatest indicator of health was education level. Nationally and on a state-by-state basis, people with higher levels of education were more likely to be healthy. Adults with a high school education were more likely to be unhealthy than college graduates. Adults who had not graduated from high school were more than three times more likely to be unhealthy than college graduates. The disparity between education level and health varied from state to state. Delaware was the best (only nine percent difference between overall adult health and overall health of adult college graduates) and California (with a nearly 20 percent difference) was the worst.

Earlier this week, the Robert Wood Johnson Foundation's Commission to Build a Healthier America released a new report titled: "Beyond Health Care: New Directions to a Healthier America."

The rising rates of unemployment and the growing numbers of uninsured people are exacerbating health disparities in low income and minority communities that already suffer from barriers to care and high rates of chronic disease. The Kaiser Family Foundation recently a hosted a webcast moderated by Cara James, Ph.D, the Foundation's Senior Policy Analyst on Race, Ethnicity, and Healthcare, to look at these all-too familiar patterns.

Howard University economist Dr. William Spriggs sketched out the economic backdrop. Nationally, the unemployment rate in February was 8.1 percent. For blacks, it's above 13 percent, and in Latino communities it ranges from 8 to 14 percent. Joblessness is a double-whammy, because it often means people also lose employer-sponsored health insurance.

Community health centers (Federally Qualified Health Centers) are an aspect of the recently enacted fiscal stimulus package that hasn't gotten much attention. Perhaps that's because they mostly serve a population we often overlook. Perhaps that's because they are misunderstood—and underestimated.