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Name:
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Barneget
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Subject:
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Interesting Commentary
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Date:
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11/17/2009 6:53:34 PM
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The House Bill includes $600 BILLION over 10 years to address racial and cultural disparities.
From Politico, 2 weeks ago...... At that time, copied all but the link, and not registered so I can't get into the archives.
Caucuses address racial disparities
By: Nia-Malika Henderson
November 2, 2009 04:55 AM EST
After years of falling short, Del. Donna Christensen (D-Virgin Islands) and the House’s three minority caucuses finally achieved success in adding to the House reform bill billions in federal aid to fix racial disparities in health care.
But that was the easy part.
Now Christensen knows they will have to fight to protect the funding in a bruising House-Senate conference, where negotiators will be looking to trim every dollar they can to keep costs down. And the Senate bills, in particular the Finance Committee version, are far less generous in fixing disparities than is the House bill.
On Thursday, Christensen picked up an ally — President Barack Obama — who told the caucuses in a White House meeting that he’ll back some items they’re seeking in the final bill and that he wanted to review others.
“We have the provisions in the bill, and we are continuing to work on members of the Senate to have them understand how important it is,” said Christensen, co-chairwoman of the Health and Wellness Task Force for the Congressional Black Caucus.
“We are concerned, but we figure if we have the president to weigh in on our side, they have a better chance of staying in, and we have asked the president as we go through conference to weigh in on the side of health equity.”
“There are initiatives that are in the House bill, like work force issues, linguistic competence, cultural training and the collection of data, that are points of worry in making it into final [legislation],” said Rep. Raul Grijalva (D-Ariz.), who is co-chairman of the Progressive Caucus and a member of the Hispanic Congressional Caucus. “It worries me a lot that the Senate is giving it minimal priority.”
The quest to correct racial disparities in health care — differences in the level and quality of treatment between whites and minorities — hasn’t been a focus of the health reform debate. But advocates are hoping to use the nearly trillion-dollar effort to remake the U.S. health care system to fix some of the inequities, by sending billions in federal aid to boost community hospitals, local clinics and other programs.
Obama himself hasn’t made fixing the disparities a major feature of his health reform pitch, speaking about it mainly in front of minority audiences, in speeches to the NAACP and a Congressional Black Caucus dinner. The White House convened a conference on fixing racial disparities last summer featuring health reform czar Nancy-Ann DeParle and Health and Human Services Secretary Kathleen Sebelius. And on Monday, Obama senior adviser Valerie Jarrett will host an online health care chat about how the legislation affects minority communities.
Advocates point out that any broad-based effort to expand affordability and access to health insurance through either a public plan or greater competition with the private sector will help all Americans. But they say there are specific obstacles to care in some communities — everything from cultural and language barriers to a lack of high-quality facilities — that need to be addressed.
An HHS report earlier this year found that blacks, Hispanics and Asians are less likely to have access to health care. Minorities get preventive treatment and managed care less often than do whites and suffer higher death rates from diseases like breast cancer, colon cancer and diabetes.
In addition, more than a quarter of blacks and half of Hispanics don’t have a regular doctor, resulting in more visits to the emergency room.
Now advocates see good news and bad news in the reform bills making their way through Congress.
In the House bill and Senate Health, Education, Labor and Pensions Committee bill, advocates see an array of community-based programs, data collection, language training and diversity initiatives that they say will go a long way toward closing racial, ethnic, gender and regional health care gaps.
The House bill released Thursday calls for a $12 billion increase over the next five years in funding for community health centers and $1.1 billion to fund a national prevention strategy, with reducing health care disparities as a major focus, as well as grants for health empowerment zones. The bill also includes millions of dollars in grants for community health workers in underserved communities and programs for reducing infant mortality and for starting school-based health care clinics.
Yet, the Senate Finance Committee bill has few provisions for addressing health care disparities. It doesn’t include funding for cultural and linguistic competency for providers, an approach to care that health care advocates think is key to delivering quality health care, or a specific fund for collecting and analyzing disparity data.
And according to a study by Community Catalyst, a national health care advocacy group, the finance bill could require low-income people to pay more than the other bills would because of a more limited expansion of Medicaid.
So making sure funding to fix health care disparities — estimated to cost almost $60 billion a year by a recent study — survives the budget ax will be a matter of concern when a handpicked conference committee hashes out the details of a final bill in coming weeks.
“Doing nothing to address health inequities is expensive. And given that people of color are a growing share of the U.S. population, it’s imperative — both for the nation’s health and economic growth — that we prioritize eliminating health inequities,” said Brian Smedley, vice president and director of the Health Policy Institute at the Joint Center for Political and Economic Studies.
More recently, the administration has focused on health care as a women’s issue, and the White House said that Obama understands that addressing inequities is part and parcel of reform.
“The president has made it clear that he is committed to making it easier to identify health care disparities, and with the health insurance reform, we will work to close them. It is a step that is long overdue,” said Linda Douglass, a White House spokeswoman. “The president understands that underserved communities need more quality care, more primary care and more preventive services, and that is a part of all the bills.”
Douglass declined to go into specifics about provisions that Obama supports. One provision — including American territories in a proposed health exchange in which the public would shop for insurance — got backing from the White House, Christensen said, which she interpreted as a sign that Obama is willing to put some muscle behind other key provisions.
Congressional members and advocates who pushed for addressing health care disparities are jockeying for a voice and a vote in the conference committee that produces the final bill, which will be decided by party leaders on each side.
“In the House, communities are reflected in the members. Who is on the Senate side who can do that?” said Rep. Mike Honda (D-Calif.), chairman of the Congressional Asian Pacific American Caucus. He added that the caucuses are asking Senate Majority Leader Harry Reid to take up the fight for the funding in the upcoming conference.
“We are talking to him and told him that the health disparities should be recognized, and he said he understood,” Honda sa
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