The U.S. can proudly boast of some of the highest quality healthcare and facilities worldwide. Ironically, we cannot boast that all Americans have equal access to that care. Health disparities---significant differences in health outcomes between one population and another---keep bragging rights out of reach. Racial and ethnic minorities experience the highest level of disparities.
The chasm between those experiencing disparities and those that don’t hasn’t closed significantly in 10 years, despite efforts by government, health and advocacy communities. Multiple barriers contribute to disparities in the Hispanic community, especially among older men and women raised outside the U.S. The extent of patient acculturation combined with cultural and language differences between patient and provider are major barriers. Mistrust of providers from different backgrounds, different approaches to care, and lack of cultural competence on the part of providers contribute to the challenge of eliminating disparities.
Additionally, some very basic factors undermine people’s ability to get appropriate care, like affordability, insurance, transportation, consistent sources of care, access to information, access to quality providers and limited diversity among providers. The Institute of Medicine identifies lack of insurance as the barrier with the greatest negative impact on minority populations. Census data for 2010 showed 30.7 percent of Hispanics were not covered by health insurance, compared to 11.7 percent of non-Hispanic Whites.
We see the results of disparities manifested in higher percentages of many diseases and illnesses among Hispanics compared to non-Hispanic Whites and other populations. For example, cervical cancer is twice as high among Latinas compared to non-Latina white women. Lack of healthcare access and education about the need for cervical cancer screening are contributing factors. Among adults 65 and older, only 54 percent of Hispanics received flu vaccinations in 2010 compared to 65 percent of non-Hispanic Whites, and only 39 percent received pneumonia vaccinations compared with 63 percent of non-Hispanic Whites, despite no out-of-pocket costs due to Medicare coverage. And Hispanics are one and a half times more likely than non-Hispanic whites to have diabetes and also have a 50 percent higher death rate from the disease.
Strategies to diminish and ultimately rid the U.S. of health disparities include elements of the Affordable Care Act (ACA), such as increasing coverage and access to care through Medicaid expansion and creation of health insurance exchanges (scheduled for implementation in 2014). Strengthening federal data collection efforts on race, ethnicity, language, disability and gender to more effectively understand and address barriers to good health will also help. And through ACA, the Health Resources and Services Administration (HRSA) Community Health Center Program is receiving a substantial funding increase. The program provides culturally competent, quality primary healthcare services to vulnerable populations. Of the people served by this program, 63 percent are racial and ethnic minorities and 92 percent have incomes below the federal poverty level.
All Americans deserve quality healthcare. The good health of a nation starts with healthy individuals. But to have healthy individuals, they must be informed and have full access and engagement with quality healthcare resources. That’s why AARP pushed hard for vital protections and benefits included in the ACA; particularly those that improve health care for older Americans and their families.
In the two years since the law’s passage, we’ve heard glowing praise from some corners and demands for repeal from others, but most Americans are mainly concerned with keeping themselves and their families healthy. So we’re working to help people understand how they benefit from this law so they can make informed decisions and make the most of its provisions.
Consider how consumers are already benefiting from ACA. People age 65 or older have access to free preventive care services through Medicare, like mammograms and colonoscopies. There’s also additional help for seniors struggling to pay for prescription drugs. Older persons are no longer subject to age discrimination in the form of significantly higher costs for the same level of health coverage provided to younger people for less. Insurance companies are no longer able to deny coverage to people 19 or younger who have pre-existing conditions. This will be true for everyone in 2014. And over time, action against waste, fraud and abuse in Medicare, will save millions of taxpayer dollars
Many people aren’t aware of these important benefits for older Americans. Families also benefit---parents can cover adult children on their family insurance plan until their children turn 26. And for some small businesses, there’s tax credit support, up to 35 percent, to help employers with less than 25 employees provide health insurance for workers.
Recently, AARP launched a personalized online tool, the AARP Health Law Guide, to help Americans understand the current and future benefits and protections of the ACA. Right now, it’s the only tool of its kind available in English and Spanish, and provides real-time information specific to each individual. The Health Law Guide is fast and easy to use. By answering six simple questions, the tool provides a personalized report that provides information about what is available now and over the next few years when the health care law goes fully into effect; explains benefits and protections such as expanded coverage for preventive care and screenings and protections against insurance cancellations and lifetime limits on health insurance coverage; and describes state specific programs and resources for people who are uninsured or who are having difficulty finding coverage.The tool is available at www.aarp.org/healthlawguide or www.aarp.org/guiadelaleydesalud.
Additionally, AARP joined forces last year with several national leading consumer and health organizations to form the Health Care and You Coalition, www.healthcareandyou.org. The Coalition is dedicated to educating Americans through consumer-friendly resources about the ACA. Education is critical if people are to understand the health care opportunities available to put to use in their lives. Our goal is to help make that happen.
Rocky Egusquiza is VP, Multicultural Markets of AARP
