Largely hidden from media coverage and public debate of the 900-page Patient Protection and Affordable Care Act, or the national health care reform legislation, are a myriad of provisions which have the promise of advancing health equity. 

Expanded Insurance Coverage 

Minority, low-income and underserved populations will benefit from the increased availability of health insurance, through elimination of many exclusions and cancellations from coverage, and from expansion of existing and new public insurance programs. 
 

Workforce Expansions

Improved “coverage” does not guarantee improved “access”, especially in areas of health professions shortages. Recognizing the need for an expanded health care workforce to serve the 32 million newly insured, there are significant investments under the legislation, including:

• Expanding the National Health Services Corps, offering loan repayment and scholarships for physicians practicing in health professions shortage areas
• Funding for Centers of Excellence to support minorities pursing health professions careers
• Expansion of medical residency programs in underserved community-based settings
• Funding for minority-serving institutions for science, technology, engineering and mathematics education
• Funding for training providers in cultural competency and elimination of health disparities

These efforts have the promise of re-shaping our health workforce to be more diverse, and more responsive to the needs of our underserved communities. 
 

Increased Roles for Communities

At the community level, there is significant expansion of funding for community health centers, including, “community transformation grants” which must include a disparities reduction focus, school-based health centers serving medically underserved children, and for community health workers who provide culturally and linguistically appropriate services. And, a Community Preventive Services Task Force will be established to recommend guidelines for community-level prevention, including reducing health disparities.  
 

Focus on Quality Improvement

There are also significant investments in quality improvement, which all must incorporate disparities reduction as an essential component. A first-ever “national strategy for quality improvement” includes disparities reduction as a national priority. Research, measures development, demonstration programs and technical assistance to support that strategy all will include disparities reduction. The US Department of Health and Human Services is also required to improve collection and reporting of race, ethnicity and primary language data.
 

Greater Federal Infrastructure 

Finally, the National Center on Minority Health and Health Disparities is elevated to a full Institute at the National Institutes of Health, the Office of Minority Health (OMH) is moved directly into the office of the Secretary of Health and Human Services (HHS), and OMHs are statutorily established at six critical HHS agencies: Centers for Medicare and Medicaid Services, Health Services and Resources Administration, Substance Abuse and Mental Health Services Administration, Centers for Disease and Prevention, Agency for Healthcare Research and Quality, and Food and Drug Administration. The Indian Health Care Improvement Act also is reauthorized. These infrastructure changes will ensure more permanence and internal attention to health disparities issues.

While the national health reform legislation promises some significant integration of equity issues, advocates for health equity must remain vigilant to ensure that such a promise becomes reality.

Author: Ignatius Bau, JD. 
Last Updated: June 24, 2010