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Published: July, 2013; Vol 10, Num 2


PPACA Addresses Health Disparities

The Patient Protection and Affordable Care Act (PPACA) – now law – includes provisions that aim to overcome health care coverage and treatment disparities for minorities.

Federal Infrastructure to Reduce Health Disparities:

Offices of Minority Health will be established at the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid, the U.S. Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition, the Indian Health Care Improvement Act, which provides support to Indian Health Services, has been permanently reauthorized. These Offices will work to improve the status of minority populations, monitor trends and evaluate programs and initiatives.

Data Collection, Quality Improvement and Research:

To improve delivery of health care services, federally funded population surveys and health care programs will enhance collection and reporting of data on race, ethnicity, sex, primary language, disability status and those living in rural and frontier areas.

Medicaid Expansion:

Medicaid provides coverage for poorer populations in which minorities are heavily represented. For example, Medicaid covers nearly 40 percent of African American and Latino children. Although states may opt out, starting in January 2014, individuals who are at or below 133 percent of the federal poverty level ($15,282 for a single person in 2013) will be eligible for Medicaid in most states.

Insurance Regulation:

The law prevents insurance companies from denying coverage to people who have pre-existing conditions or charging higher premiums to those individuals. It also prohibits higher premiums based on gender and determining insurance rates and coverage according to race and ethnicity.

Health exchanges are intended to provide choices to consumers in selecting health coverage while filling the gap for those who do not have employer-sponsored insurance or qualify for Medicaid. Premium assistance will be provided to individuals up to 400 percent of the federal poverty level ($45,960 for a single person in 2013 and $94,200 for a family of four).

Health Care Workforce and Cultural Competence:

The law aims to increase workforce diversity within the fields of primary care, dental, mental health and long-term care. Collection of workforce diversity data is required, and workforce diversity grants are expanded to include nurses. With the expectation that providers who participate can improve the quality of care given to diverse populations, the law requires development and evaluation of culturally competent curricula in educational training over the next five years. Other support is given for cultural competence training to primary care providers. In addition, loan repayment preference will be given to individuals who have cultural competency experience.

Community Health Centers:

Community health centers will continue to play a key role in providing primary care and preventive services to low-income minorities and other underserved populations. The law provides $11 billion over the next five years to expand community health centers and to double the number of patients to 40 million by 2019.

Prevention and Wellness:

The law requires private insurance plans to cover preventive services and prohibits co-payments and deductibles for preventive services. It also invests in community health teams which can allow providers to offer more culturally appropriate care to patients in managing chronic diseases. Also included are prevention initiatives such as a five-year national oral health campaign with an emphasis on disparities.

Maternal and Child Health:

The law provides funding – $1.5 billion over five years – for the Maternal, Infant and Early Childhood Home Visiting Program. Such programs enhance health literacy and, ultimately, improve health outcomes by providing patient-centered support and education to individuals in their homes.