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The enactment of the Affordable Care Act provides a unique opportunity to address the health care disparities that communities of color experience in the United States. The House Republicans’ "Pledge to America" plans to repeal health care reform and replace it with a grab bag of isolated measures that mostly benefit those who already have health care coverage. These piecemeal measures will do nothing to address the hurdles such as lack of health insurance, lack of access to preventive care, and language and cultural barriers that Hispanic families face in getting access to the care they need.
The Republican "Pledge to America" will not improve access to health insurance coverage for Hispanic Americans
Hispanics have the highest uninsured rates of any racial or ethnic group within the United States, and the percentage of people of Hispanic origin without health insurance coverage is increasing every year. In 2009, 32.7 percent were uninsured, an increase of 1.26 million people over the previous year. The uninsurance rate for Hispanics aged 18-64 years rate was 41.5 percent. And Hispanics are less likely to be able to afford insurance. They are more likely to be poor—25 percent live in poverty—and the median annual income of an Hispanic household is almost $10,000 less than that of the average American household.
The House Republicans have no plan to expand coverage to help those who cannot afford health insurance. They want to repeal Medicaid expansions, repeal financial help to small businesses struggling with the costs of employee coverage, and repeal the tax subsidies that will help working families purchase coverage through health insurance exchanges.
The pledge contains a claim that Republicans will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a preexisting condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick. They never mention, however, that all of these protections are already enacted in the ACA.
The Republican "Pledge to America" will not rein in the excesses of the health insurance industry to protect Hispanic Americans
People of color, and indeed all Americans, need the protections that the ACA offers to counter the excesses of the health insurance industry.
Conservative proposals do nothing to rein in the discriminatory practices and price-gouging behavior of the health insurance industry, such as those that recently saw one insurer attempt to increase premiums by 39 percent in the nongroup market. Nor do they attempt to ensure that health insurance plans spend premium dollars on health care. In contrast, the ACA requires that at least 80 percent of premium costs are returned in benefits.
The Republican "Pledge to America" will not improve access to a primary care provider and usual source of care for Hispanic Americans
Half of Hispanic Americans do not have a regular doctor, compared with only one-fifth of white Americans, and almost half of low-income Hispanics lack a usual source of care. A primary care provider and a facility where a person receives regular care substantially improve health outcomes. The ACA’s emphasis on primary care will particularly benefit people of color, especially those who live in areas that are currently medically underserved.
Conservatives have no plan to improve primary care or increase the primary care workforce. They want to repeal the provisions in the ACA that will boost primary care capacity and workforce, establish more school-based clinics and more community health centers targeted to the needs of the communities they serve, and develop and expand the medical home model for Medicare and Medicaid patients. Medical homes—health care settings that provide patients with timely, well-organized care and enhanced access to providers—are associated with a reduction in health care disparities for adults and better access to preventive services.
The Republican "Pledge to America" will not provide better preventive health services for Hispanic Americans
Older Hispanic Americans have a higher incidence of certain chronic diseases such as diabetes, heart disease, and arthritis than the rest of the U.S. population. Twenty-one percent of Hispanic elders have diabetes compared to 14.3 percent of non-Hispanic whites. Hispanic elders are much more likely to be hospitalized for diabetes due to poor diabetes control, and they are far less likely to receive pneumonia or flu shots or participate in cancer screening services. Better access to prevention and early interventions would help keep the Hispanic population healthier throughout their lives.
Despite this, the Republicans will repeal the provisions in the ACA that will enhance preventive care and remove the co-payments and deductibles for approved preventive services such as immunizations, screening for colorectal cancer and diabetes, and mammograms. Among the programs that Republicans want to repeal are demonstration projects to develop comprehensive models for reducing childhood obesity and increased funding for a nurse home-visiting program to help improve the health and well-being of mothers and their children.
The Republican "Pledge to America" will not improve the lower health quality and health care disparities communities of color experience
People of color are less likely than white Americans to get timely access to care and good quality care. They may also face language and cultural barriers when receiving care. Defining and measuring health care disparities is a prerequisite for understanding and addressing them.
If the Republicans repeal the ACA, they will repeal requirements that federally funded programs collect and report data on race, ethnicity, socioeconomic status, health literacy, and primary language, using methodologies that will ensure health care disparities can be measured. They will also undo the provisions that establish the Office of Minority Health at the Department of Health and Human Services and a network of minority health offices located within HHS that elevate the Office of Minority Health at the National Institutes of Health directly into the Office of the Secretary of Health and Human Services.
Conclusion
The ACA makes significant advances for Hispanics’ health coverage, quality of care, and access to health care services. It represents an important milestone toward the ultimate goal of eradicating racial and ethnic disparities in health and health care in the United States. The Republicans’ "Pledge to America" represents a devastating roll-back of much-needed changes to our nation’s health care system—a step backward that will ensure that communities of color continue to receive poorer care and live in poorer health than the rest of the nation.
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Lesley Russell is a Visiting Fellow at the Center for American Progress.