Editor's corner/ Over a cup of tea
Heidi M. Pascual*
Publisher & Editor
* 2006 Journalist of the
Year for the State of
Wisconsin (U.S.-SBA)
Health care reform and communities of color
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A Teleconference report
Health care reform is the hottest issue right now, driven by a growing concern for millions of
uninsured Americans and rising costs of health care. It was a top campaign promise by now President
Barack Obama that he has yet to fulfill.
When Pres. Barack Obama gave a deadline to Congress that a bill on health care reform should be
done before the congressional recess in August, many shook their heads, including a group of
Democrats who publicly stated — not in so many words — that Obama wasn’t helping them resolve the
complex health care issue by imposing an impossible deadline. Legislators apparently got concerned
when, on July 17, the Congressional Budget Office issued its analysis that HR 3200 would result in a net
increase in the federal budget deficit of $239 billion over the 2010-2019 period. Also, the disagreement
in the Senate revolves around the $544 billion income surtax on the wealthy to pay for the projected $1
trillion health care cost over 10 years. The President backtracked since then; meanwhile, discussions
about health care continues all over the nation.
On July 21, a teleconference for communities of color was hosted by the Center for American
Progress, with Karen Davenport, CAP director of Health Policy, as facilitator. People of color represent
one-third of the U.S. population, yet they’re more than half of the population of Americans who are
uninsured and 45 percent of people who are on Medicaid. Those who participated in the
teleconference were: Alice Dong (staff attorney for health law policy, Asian American Justice Center); Cara James (senior policy
analyst for the Race, Ethnicity and Health Care group, Kaiser Family Foundation); Jennifer Ng’andu (deputy director, Health Policy
Project, National Council of La Raza); Ahniwake Rose (policy analyst for Health and Education, National Congress of the American
Indians); and Hillary Shelton (vice president for advocacy/Washington Bureau director, NAACP).
I would like to share with our readers the gist of this discussion, hoping to impart the understanding of specific issues facing
communities of color and to rally in support of a common voice for us all.
All the presenters were in agreement that there is a need for meaningful health care reform in the United States. Each of them,
however, stressed their own group’s take on the issue, and proposed their inclusion in the current legislative consideration.
Karen Davenport observed that even with the ups and downs of the legislative process, the momentum was there and the public
has shown majority approval of the health care legislation now moving through Congress, particularly considering provisions
that can improve access to coverage and important subsidies for people who need help, improve health care delivery systems,
and control costs.
What does health care reform mean to communities of color?
Cara James highlighted the fact that communities of color had more problems even before the recession, and more so now.
Aside from higher unemployment rates, health reform is critical for them as they are more likely to be uninsured. She said it is
crucial that Medicaid coverage to low-income families be expanded to insure that communities of color who are on Medicaid
receive high quality, equitable care – something that is not happening today. Since chronic diseases are much higher among
communities of color, James suggested that health reform efforts include chronic disease management. She also wanted to make
sure that people have access to care that is delivered in a culturally competent manner.
Hillary Shelton stated that in the U.S., the color of your skin, background, and where you live not only influence your access to
quality health care but could very well determine it. He cited statistics in the African American community that showed apparent
health care disparities: infant mortality rate is 13.6 percent (national rate is 7 percent); African American women are four times
more likely to die during childbirth than White women; African Americans are twice more likely to have diabetes than White
Americans; African Americans are nearly 3.5 times more likely than Whites to have amputations as a result of diabetes; diabetes-
related death rates is almost double the national mortality rate; African Americans with colon cancer are 40 percent more likely
than White men with the same condition to receive major diagnostic and treatment procedures; and one-third of the annual
national AIDS cases (over 15.2 cases per 100,000 for all Americans) is African American. He proposed to eliminate this problem
by making sure that the provisions in HR 3090 (The Health Equity and Accountability Act of 2009), which was filed late June by the
Congressional Hispanic and Asian caucuses, be part of any comprehensive health care reform measure in Congress.
Ahniwake Rose talked about some of the barriers facing American Indians and Alaska natives. She cited statistics that
showed high health care discrepancies for Native Americans, particularly the issues of diabetes (highest rate in the world), heart
disease (leading cause of death), mental health and alcoholism. Rose further highlighted that their youth, ages 15-24, make up 40
percent of all suicides in the population and are thrice more likely to commit suicide than any other population. She said it’s
important to understand that the Indian health system is part of a trust responsibility, because the Indian tribes ceded millions of
acres of land which now constitutes the United States, in return for which, tribes — via treaties — were promised certain things,
including education and health care. While Indian Country is strongly supportive of health care reform, they seek to ensure that
Indian health delivery system is strengthened and improved, said Rose. She stressed that any health care reform should ensure
that Indian Country can support it and that tribal governments will continue to be respected as sovereign nations. Specific Indian
Country recommendations include: American Indians must be exempt from any financial penalty; that Indian health providers must
be given protection to ensure they are reimbursed fully for their services; and that the Indian Health Care Improvement Act be
reauthorized and made permanent.
Jennifer Ng’andu focused on two core areas to ensure that the reform reflects the new and changing demographics of the
United States: access to affordable quality health coverage and improved quality of the health care system. Ng’andu said that
Latinos have poor access to health coverage, representing about 1 in 3 or 33 percent of the uninsured persons in this country.
Despite a very robust presence in the workforce, Latinos have very low health coverage in the workplace. She said that
streamlining coverage for workers and making coverage more affordable for employers and employees are essential to reform.
She talked of worsening health care disparities – in quality and access – which also creates considerable inefficiencies that
contribute to high health care costs. In addition, even if Latinos have enough information to seek treatment or are eligible for
coverage, they are confronted by a health care system that is essentially culturally incompetent. She strongly proposed that any
health care reform now cover all children, remove the restrictions that keep legal immigrant adults away from health coverage,
make health care more equitable, and systematize data collection. She stressed key policy changes that promote culturally
competent educational materials, increased access to language services, monitoring enforcement of civil rights, and promotion
of health care that is coordinated, patient and family-centered and culturally and linguistically competent, as well as
diversification and extension of the health care work force.
The presentation of Alice Dong unfortunately didn’t turn out audibly well due to technical reasons, so I have decided to go to
the website of Asian American Justice Center, specifically to Alice Dong’s page and read her organization’s proposals to the U.S.
Senate to ensure integration of a comprehensive quality care for immigrants in the current health care reform bill.
The proposed “enhancements” to the bill, in brief, are as follows:
-Elimination of the five-year waiting period imposed on legal immigrants which delays their enrollment in essential health
programs such as Medicaid and CHIP
-Streamlined coverage for children of individuals qualifying for health coverage
-Enrollment of employees for coverage and removal of additional documentation requirements for health coverage must not
be imposed on employees for entry into the Gateway system
-Ensured federal funding for community health centers and other safety net providers
-Community health team grants and patient decision aids that support linguistic needs of patients
- Increasing the diversity of the public health care workforce will provide great advances in the quality of care racial and
ethnic minorities receive.
My message
In essence, all communities of color agree that there is a need to revamp the present health care system. It is important that
their voices be heard, seriously considered, and made part of any health care reform in Congress. The political process in a
democracy is extremely complex and sometimes frustrating, but we have to speak up to protect our right to freely express
ourselves, and hopefully, influence our elected officials in a significant way.
As a minority business enterprise, I have this to say about health care reform: health care costs have become too costly for
MBEs like me. President Obama, we are up in arms. This is war, because health care – in terms of costs and accessibility to
quality care – is a matter of life and death to us. Wasn’t this your campaign promise, Mr. President — to enact a health care reform
bill that will cover ALL Americans? Now that you are in office, make use of your power to help us all. Those who are for the status
quo are actively campaigning against any reform that will obliterate the health insurance industry’s obscene profits. They have
poured a lot of money in big TV ads, showing off their monstrous power over our elected government.
To you, Mr. President, and our Congressional leaders, heed our call. If you remove the government-funded option, no
meaningful health care reform will happen. Many more small and minority businesses will have to let go their employees, and
many more will have to close shop.
Please, Mr. President; show those people who are against health care reform who’s in charge here!