Affordable Care Act addresses some health disparities, perpetuates others, experts say

Affordable Care Act addresses some health disparities, perpetuates others, experts say
The website that allows Americans to shop for health care plans opened for business Oct. 1.

Today uninsured Americans begin enrolling in state health care exchanges under the Affordable Care Act. The exchanges allow people who are buying insurance to compare different health plans and find one that is most affordable for them. In Illinois, the exchange is expected to eventually cover 1 million people who are currently uninsured, according to Gov. Pat Quinn’s office.

The health care law, known as Obamacare, goes into effect amid a government shutdown as Republicans in Congress block a federal budget bill in an attempt to defund the law. But in all of the hubbub over the shutdown and closing the government funding gap, there has been little talk of what the health care law could do to close a deadlier gap – that of health care disparities.

Despite its high spending on health care, the United States continues to have dismal health outcomes, even by global comparisons.  People of color have some of the worst health outcomes in the nation, partly due to economics. African-Americans in the United States account for only 14 percent of the population – but make up almost half of the HIV cases in the nation, according to the Centers for Disease Control and Prevention. Meanwhile, Latinos had higher rates of asthma than any other ethnic group.

In Chicago, health indicators for chronic diseases like asthma and diabetes are in some cases twice as high in low-income minority ZIP codes compared to those in wealthier, majority white areas. A 2011 study by the Northwestern University Feinberg School of Medicine found that the South Side had the highest share of unhealthy neighborhoods.

Doctors and health care experts are divided over how Obamacare will affect the nagging racial gap in health care.

Elizabeth A. Calhoun, a professor of health policy and administration at the University of Illinois at Chicago, is hopeful that offering everyone health care on the marketplace will ensure minimal coverage and will help address health care disparities.  For people who have been entirely outside the health care system, Calhoun says, this will make a huge difference.

However, she warns that an increase in the number of people receiving insurance could result in an initial jump in the number of reported cases of chronic diseases like asthma or breast cancer.  “It will take some time for some of those gaps to narrow,” she says, “but theoretically they can be closed and they should be closed.”

Other health experts paint a less rosy picture of Obamacare’s impact on health disparities. The most the health care law will do is address disparities, not solve them, says Dr. Susan Rogers, an attending hospitalist and internist at the John H. Stroger Jr. Hospital of Cook County. In particular, the cheaper plans offered under the exchange could come with hidden co-pay costs and deductibles, and a lower standard of care, Rogers explains.

With a subsidized premium, a low-income person taking the bronze coverage plan – the cheapest of four plan categories being offered – would have to pay the highest out-of-pocket costs.   “If we shift more of these costs on individuals,” says Rogers, “they are just going to defer care.” This, in turn, will continue perpetuating health inequalities, she says.

Rogers says if we want to narrow the health care gap, we need an equal health care system like single-payer, which died an unceremonious death early in the negotiations for the Affordable Care Act. “It’s the only solution there is,” Rogers says. “Everybody in, nobody out. Same benefits regardless of income.”

Whether the ACA can affect long-time cultural distrust of conventional medicine is another issue. The abuse of certain groups by medical institutions – from the infamous Tuskegee Study to the dozens of women who were sterilized in California prisons – is still a sensitive topic in American medicine.

In the weeks leading up to the implementation of the Affordable Care Act, undocumented immigrants have begun to worry that enrolling their U.S.-born children in health care plans could compromise their lives in the United States. And that’s on top of a general reluctance by minorities to visit a doctor or hospital, and incur costs, until a person is very sick.

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