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Renée M. Landers
Renée M. Landers, Is Massachusetts Health Insurance Reform Legislation: An Effective Tool for Addressing Racial and Ethnic Disparities in Health Care?, 20 Hamline Journal of Public Law and Policy (Fall 2007) (311 Footnotes Omitted).
Researchers sometimes do not know, forget, or are unimpressed that Dante reserved the seventh level of hell for those who recognize a problem and do not attempt to do anything to solve it.
A vast and growing body of research documents the disparities in health care access, treatment, and outcomes experienced by non-white racial and ethnic groups in the United States. The release of the Institute of Medicine 2002 report on Unequal Treatment placed the issue on the mainstream policy agenda. Before and since the release of this report, numerous studies have verified, almost without exception, disparities in any number of disease and treatment settings. A study directed by Dr. David Satcher, a former United States Surgeon General found that more than 80,000 black Americans die every year because of continuing disparities in health care. The United States Centers for Disease Control and Prevention has reported that blacks are far more likely than whites to die from strokes, diabetes, and other diseases. Limited English proficiency (LEP) patients also suffer disadvantages in obtaining quality care.
Similarly, prescriptions of how health care payers and providers and government agencies should begin to address these disparity issues are not in short supply. In October 2006, a study panel convened by the National Academy of Social Insurance (NASI) issued a report on what Medicare can do to reduce disparities. Identifying the causes of health care disparities and strategies for reducing or eliminating such disparities is essential at this time as the public and policymakers focus attention on improving the quality of health care generally in the United States and on restructuring the delivery and financing of health care services. To paraphrase David Barton Smith's statement in Health Care Divided: Race and Healing a Nation, having recognized the problem, the time to try to solve it is now. Policymakers, activists, and commentators are watching the implementation of major health care reform legislation recently enacted in Massachusetts for any impact on the presumed causes of lack of access to health care services and racial and ethnic disparities in the quality of services received.
In April 2006, Massachusetts enacted, An Act Providing Access to Affordable, Quality, Accountable Health Care (the Act). This statute aims to address inequities in access to health care through several mechanisms. First, the Act requires every Massachusetts resident to obtain health insurance coverage or its equivalent, such as coverage through Medicare or Medicaid, by July 1, 2007. Second, the Act establishes reporting and goal-setting mechanisms aimed at improving the quality of health care services, including reducing racial and ethnic disparities and reporting on progress. Finally, the Act contemplates financial incentives for hospitals meeting these identified performance measures.
This article examines select provisions of the Massachusetts Act that establish programs or policies aimed at improving access to quality health care services delivered, and reducing racial and ethnic health care disparities. The first part of the article consists of a brief summary of the history of efforts to eliminate legally sanctioned discrimination in health care. In the second part, the article provides an overview of the types of health care disparities that persist despite the elimination of legal segregation and describes the groups adversely affected by such disparities. Next, the article examines efforts that have been undertaken to improve overall quality in the delivery of health care services in the United States and why such efforts, while salutary, do not address racial and ethnic disparities adequately. Following that description, the article reviews incentives used to improve performance from institutional and individual health care providers, and the impact of such incentives on performance. In light of that experience, the article then examines the likelihood that the measures and incentives that the Massachusetts statute provides will be successful in improving overall access and quality of health care, as well as eliminating racial and ethnic disparities. The article concludes that unless Massachusetts devotes sufficient resources to providing access to insurance and carefully structures incentives to reward overall improvement with a specific focus on addressing disparities, the statute will not meet its ambitious goals.