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Obama Official: Affordable Care Act Closes Racial Disparities


I'm Farai Chideya, and this is TELL ME MORE, from NPR News. Michel Martin is away.

Exactly one year ago today, President Barack Obama signed new health care legislation. The Affordable Care Act will roll out changes over the course of 2010 to 2014. Some of these changes include letting young adults stay on their parents' health insurance plans until they're 26 years old.

Insurance companies won't be able to void your benefits if you make a mistake on your application. And what's called the donut hole will be closed. Formerly, after you and your plan spent a pre-determined amount of money for your covered drugs, you have to pay for the rest out of pocket.

We wanted to learn more about how the law is affecting our lives one year later. How much change have people seen? With us now, we have Dr. Garth Graham. He's the assistant secretary for minority health at the U.S. Department of Health and Human Services. He joins us from his office. Thank you so much for being here.

Dr. GARTH GRAHAM (Assistant Secretary for Minority Health, Department of Health and Human Services): Oh, thank you for having me.

CHIDEYA: So, according to the U.S. government, about one in three Hispanics and American-Indians are uninsured. By comparison, one in five African-Americans are uninsured and that drops to one in eight for white Americans. Those are very significant differences. And so has the Affordable Care Act helped to lessen those disparities? If so, how?

Dr. GRAHAM: Sure. So the Affordable Care Act is exactly targeting those disparities and others. So, certainly the Institute of Medicine and other organizations, non-political organizations have identified health insurance and health insurance coverage as a key factor for the health of minority populations. So those statistics that you just explained in terms of the differences in insurance coverage for minority communities, compared to others, also play out in terms of differences in health outcome.

So, certainly, higher rates of diabetes, hypertension and deaths from cancers, et cetera, many of that due to lack of insurance. So the Affordable Care Act is directly moving forward with providing health insurance and health insurance coverage and access to care for a number of individuals and certainly those from minority backgrounds.

So things that we've done to date will put in place the preexisting health insurance plan that has been providing insurance coverage for individuals who have preexisting health conditions, and a number of other components across the board. And many of those things will also come into full effect in 2014. So, you're exactly right that those health disparities in insurance coverage exist and that their challenges are certainly not acceptable and things that the Affordable Care Act and our department is working on.

CHIDEYA: Income is another factor. Four out of ten low-income Americans, no matter what race or ethnicity, don't have health insurance. Ninety-four percent of upper-income Americans are insured. Is there any way this new law is changing the game?

Dr. GRAHAM: Sure. So, one of the things the new law is working with states to do is to help strengthen Medicaid and certainly have Medicaid to be able to cover a lot of folks who are working poor. One of the challenges with some of the statistics you gave earlier, which are very true, is that even some folks have insurance coverage. But if they were going to get sick, they don't have health insurance coverage that would really take care of them once they get sick.

So, what we're doing is we're shoring up Medicaid, working to make sure that Medicaid can cover more of the working poor and more people who work, but need health insurance access. And also making sure that we make health insurance, really, just accessible for all individuals across the board regardless of their income status. So you're very right that socioeconomic status and income is a key factor in all of this. And we've got to make sure that we take care of everybody.

CHIDEYA: And Dr. Graham, we actually have a couple of questions that are coming from people who we've been in conversation with, doctors across the country. First, I'm going to play a question here from one of our regulars, Dr. David Ellington. He's a former board member for the American Academy of Family Physicians.

Dr. DAVID ELLINGTON (Former Board Member, American Academy of Family Physicians): Dr. Graham, do you believe that both the president and his team, and the Democrats and the Republicans in Congress can come together and, number one, persevere to work this thing through to a successful conclusion and at the same time compromise with each other enough with new and different strategies to improve the bill?

CHIDEYA: Dr. Graham?

Dr. GRAHAM: That's an excellent question. Certainly we know that we want to continue making progress. And I think between our administration and folks on the Hill there is efforts to certainly make sure that we can continue to make progress. So, you know, I believe that we will be able to continue to move forward with implementation of the Affordable Care Act. So, hopefully as Dr. Ellington asked in so eloquently a way, we'll be able to get folks to continue to work together so that we can continue to make progress.

CHIDEYA: We've also got a question from Dr. Carolyn Barley Britton. She's a neurologist in New York and past president of the National Medical Association.

Dr. CAROLYN BARLEY BRITTON (Neurologist): All of us know this is a time of budget constraints for many states and many states are already opposed to implementation of health care reform. What can occur that will change that dynamic or build - support a statewide and is there a plan?

CHIDEYA: And what about that?

Dr. GRAHAM: First, let me just say, Dr. Britton is somebody who, through her work on the National Medical Association, other work, has been working to fight health disparities for some time. So I want to recognize her leadership. So, you know, we've been working with states to help states implement this as many of the provisions in the Affordable Care Act, but certainly make state health care systems more - continue to work effectively.

So, a number of ways in which we've been working with states on potential cost savings is changing benefits. So allowing states to - states can generally change optional benefits or limit their amount, duration of scope through an amendment to their state plans, certainly allowing states some flexibility. Working with states to managing care for high costs enrollees more effectively is another strategy, as well as working with states to purchase drugs more efficiently. And continue to assure program integrity.

So there are a number of different strategies that we're doing to work with states so that they will have some flexibility, but be able to, like I said before, maintain their program integrity.

CHIDEYA: Dr. Garth Graham is assistant secretary for minority health in the Office of Minority Health at the Department of Health and Human Services. We thank you so much for joining us.

Dr. GRAHAM: No problem. Thank you for having me. Transcript provided by NPR, Copyright NPR.