Health Care Reform - A Step Forward But Long Road Ahead

Health Care Reform - A Step Forward But Long Road Ahead

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 Now that the health care reform bill has been signed into law, President Obama and the Democratic Congress have a significant legislative victory to call their own. While many are relieved that the United States has finally been able to gain a foothold on reform—an accomplishment that has eluded presidents for almost 100 years—plenty of others are still wondering what the changes will mean for their lives.

This “health reform anxiety” is especially prevalent among racial and ethnic minorities, who--as a majority of the nation’s uninsured--have a disproportionate need for access to quality health care.

Although the law falls short of what many supporters of reform wanted—it doesn’t cover every single individual and doesn’t contain a public coverage option—all in all, it does represent a good beginning for tackling America’s worse health insurance abuses and provides a promising framework for prevention.

Prior to the bill’s passage, low-income individuals and families, those with pre-existing conditions, small business employees and individuals looking for insurance coverage were largely out of luck or at the mercy of rapacious insurance companies seeking to minimize risk and maximize profit. Now these vulnerable populations, disproportionately low-income and black and brown, have a basic guarantee against the health care discrimination that previously excluded or took advantage of them.
Embedded in the 2,073-page law (plus the second “reconciliation” package signed this week to fix earlier problems with bill) are myriad measures promising to generate reams of discussion. For now, though, racial and ethnic groups should find some provisions of special interest.

Among the health care law’s affordability and access provisions, new tax credits should help middle and working class Americans, who aren’t eligible for the low-income Medicaid program. This tax assistance is designed to offset the costs of health care premiums.

Because people of color disproportionately have lower incomes, they will also find help in the statute’s expansions of Medicaid coverage across states for those at or below 133 percent of the federal poverty level. Legal immigrants, however, will have to wait five years to be eligible.

Seniors of color, who are more likely to report being in poor health, will find relief in the gradual closure of the “donut hole” in Medicare’s Part D prescription drug benefit.

Elders and people with disabilities with serious (and costly) medication needs, must now bite into the donut hole after Medicare’s initial help paying for their drugs. At that point, they must pay the full cost of their medicines until they reach a level of drug spending considered economically catastrophic before Medicare picks up the cost again. Medicare will provide significant help this year and next, and close the hole completely by 2020.

In addition, the new state insurance exchanges will give businesses and individuals a place to purchase affordable health insurance options.

Measures in the law that support disease prevention—backed by an unprecedented $15 billion investment--are as important for racial and ethnic minorities as the health care access provisions. That’s because they suffer excessively from health disparities, particularly obesity-related chronic diseases, such as heart disease, hypertension, type 2 diabetes and renal disease.

The new law will target prevention efforts largely at community-based services and interventions that support public health and wellness. It also provides free clinical preventive services, such as cancer and eye screenings through Medicare and other health insurance plans.

The legislation also includes incentives to bring more doctors and other health workers and providers—especially racial and ethnic minorities—into traditionally underserved areas. Backing this provision are Medicaid reimbursement increases aimed at increasing the number of providers willing to serve Medicaid patients.
Furthermore, several aspects of the law focus on eliminating health disparities. Among these are wider support for community health centers, minority health professionals and the collection of data by race, ethnicity, sex, primary language and disability status.

What are the disappointments?

Small business owners wanting to provide health insurance for their employees may be discouraged by provisions that give tax-credit assistance only to the very smallest of small businesses among them.

Additionally, the state and regional exchanges that the law allows states to establish will lack the same economies of scale that a national exchange would have given to individual and small business purchasers. That national option would have generated insurance-market competition and driven down premium costs significantly.

Critical to our aging population is that although the new law eliminates discrimination based on pre-existing conditions and gender (women have been subject to higher insurance rates than men), it continues to allow age-based discrimination. The legislation allows companies to charge older adults three times what they charge younger adults.

While this is likely to have significant implications for seniors on a fixed income, older adults in moderate and lower-income households can still qualify for tax credits or Medicaid assistance to offset their costs.

Despite its unprecedented investment in prevention, the implementation of this law by itself is unlikely to spawn a wellness revolution that keeps Americans healthy and reduces their need for acute care.

At the end of the day, health care reform represents a solid step forward in expanding health care access and affordability. Although it is not a radical departure from the existing system—after all, it does keep the basic infrastructure of employer-based and for-profit care intact—the law does a lot to defend and protect Americans’ right to life—a human right that has been too long ignored.

Maya Rockeymoore is president and CEO of Global Policy Solutions—a social change strategy firm in Washington, D.C.