National health reform is designed to help everyone who lacks medical coverage, but minority groups stand to benefit most — simply because they have the farthest to go.
One-third of Hispanics and more than 20 percent of African-Americans nationwide lack health insurance. But the law’s provisions — most of which take effect in January 2014 — will effectively cut by half the number of African-Americans who are uninsured, and significantly improve coverage rates for Hispanics.
“I think it’ll have the biggest impact in terms of reducing disparities in this country of any piece of legislation since the Civil Rights Act,” says Robert Restuccia, executive director of Community Catalyst, a Boston consumer advocacy organization that operates in 40 states. “I’ve worked 30 years on this stuff and there’s not anything [else] that even comes close.”
The benefits go beyond basic coverage. The federal Affordable Care Act — unlike Massachusetts’ 2006 health overhaul — provides preventive measures for free. That means no out-of-pocket costs for diabetes, HIV, and cholesterol screening, dietary counseling, immunizations, and mammograms.
Dr. Carl C. Bell, a Chicago psychiatrist long involved in the fight for equal care, says the focus on prevention will profoundly improve the quality of health care for nonwhites.
“If you look at the history of polio, there were enormous disparities regarding care,” he says, citing one example. “But when the polio vaccine came out, sooner or later, everybody got the vaccine.”
Comprehensive coverage is equally crucial, says Dr. Pano Yeracaris, chief medical officer and vice president of Network Health, a nonprofit insurer of low-income Massachusetts residents. It doesn’t much matter if someone has health insurance if they can’t afford to use it, or can’t find a doctor to see them, Yeracaris says.
In Massachusetts, health insurance reform provided this kind of substantial coverage, he says, as shown by the increased number of visits to primary care doctors after the law was enacted.
Part of Massachusetts’ success lies with its network of community health centers, which has been expanding over the past six years. Mattapan Community Health Center opened a new building in August, allowing it to double its capacity, says Azzie Young, the center’s executive director. It also offers on-site dental care and mammograms, removing more barriers for clients who might not have the time or means to travel far from home to more than one facility.
For Young, another crucial piece of the Affordable Care Act is its extension of coverage to people with preexisting conditions, and a provision — already in place — that allows children up to age 26 to be included on their parents’ plans.
The combination of all these efforts means 97.2 percent of Massachusetts residents now have health insurance, with whites and blacks covered at the same rate.
That shows tremendous progress, says John McDonough, a health reform specialist and professor at the Harvard School of Public Health.
“It is pretty remarkable and something never accomplished anywhere else in the United States, ever,” he says.
Many of those who remain uninsured here are Hispanic, because health care reform does not include illegal immigrants or legal immigrants who arrived within the last five years. Others who still don’t have insurance have either decided to pay a tax penalty instead of buying coverage, or fall into an economic gap – they earn too much money to receive state-subsidized care but are unable to afford an insurance plan offered by their employer.
Some states, however, are grappling with massive racial and ethnic disparities in coverage. In Texas, for instance, one-third of adults and more than half of minorities lack medical insurance.
“It’s just staggering, the dimensions of it,” McDonough says.
The way federal health care reform — often called Obamacare — was structured, it’s up to individual states and the local health care industry to locate people whose incomes qualify them for subsidized care, and to help them through the process of signing up. As part of the 2006 law, Massachusetts made a strong effort to find those residents, McDonough says.
It’s unclear whether that will happen in some other states.
Several Republican governors pledged during the summer that they would do nothing to help expand Medicaid — the government’s health plan for low-income residents. But President Obama’s reelection may shift that dynamic. For instance, governors in Florida and Louisiana recently dialed back their opposition to the federal health care law.
And in California, Democrats gained enough seats in the state Senate to overrule any attempts by Republicans to blunt implementation of health care reform, which should help Democratic Governor Jerry Brown more smoothly put its provisions in place, Restuccia says.
“The election has broken the dam” around the Affordable Care Act, says Restuccia. “There’s no question it’s going to be implemented and it’s really on the fast-track.”