By Brian Smedley, Ph.D.
The U.S. Supreme Court decision upholding the constitutionality of the Patient Protection and Affordable Care Act (ACA) represents a significant advancement in the effort to repair the deeply broken U.S. healthcare system and promote equitable opportunities for good health for all. As long as its provisions are fully funded by Congress, the law will improve access to health insurance for more than 32 million Americans, prevent insurance companies from cherry-picking enrollees and denying claims because of pre-existing conditions, and incentivize more health-care providers to work in medically underserved communities. These are among the benefits that the law is already providing, in addition to what is expected as provisions of the ACA come into force over the next two years.
In addition to ruling that the law’s mandate requiring insurance coverage is constitutional, the Court’s decision ensures that other key provisions of the legislation remain intact, many of which hold great promise to address the needs of those who face the greatest barriers to good health—particularly people of color, who are the fastest-growing segment of the U.S. population.
Many people of color face poorer health than the general population in the form of higher rates of infant mortality, chronic disease and disability and premature death. Not only do these health inequities carry a tremendous human toll, but they also impose an enormous economic burden on the nation at large. A study released by the Joint Center for Political and Economic Studies found that the direct medical costs associated with health inequities—in other words, additional costs of health care incurred because of the higher burden of disease and illness experienced by minorities—was nearly $300 billion in the four years between 2003 and 2006. Adding the indirect costs associated with health inequities—such as lost wages and productivity and lost tax revenue—the total costs of health inequities to our society was $1.24 billion in the same time span.
How might the ACA change these dismal statistics?
By expanding access to private insurance through state health exchanges, improving access for more people who live in poverty through Medicaid expansions, and other reforms, more than 32 million uninsured Americans will gain coverage. All of these provisions would improve the current state of health care for people of color, who are disproportionately un- and under-insured and who face greater barriers than whites to receiving high-quality care, even when insured.
Many other provisions of the ACA have great potential to reduce the risks that make people sick in the first place. These provisions—particularly those that invest in prevention and improving the distribution of health care resources—can significantly improve opportunities for good health for all Americans, and particularly people of color.
A major reason why health inequalities persist is because of differences in the neighborhoods of minorities and non-minorities. Research shows that racial and ethnic minorities are more likely than whites to live in segregated, high-poverty communities, communities that have historically suffered from a lack of health care investment, so they have fewer primary care providers, hospitals, and clinics. To make matters worse, many of these communities face a host of health hazards—such as high levels of air, water and soil pollution, and a glut of fast food restaurants and liquor stores—and have relatively few health-enhancing resources, such as grocery stores where fresh fruits and vegetables can be purchased.
Several provisions of the ACA, such as the authorization to expand the National Health Service Corps, which provides incentives and removes barriers for health care providers who want to work in medically underserved communities, and the Prevention and Public Health Fund, the first mandatory funding stream aimed at improving the public’s health, will directly address these place-related barriers to good health.
Consistent with today’s ruling, efforts to improve opportunities for good health and improve health equity can—and must—be increased. Government at all levels can, for example, improve health opportunities by stimulating public and private investment to help make all communities healthier. They can do so by creating incentives to improve neighborhood food options, by aggressively addressing environmental degradation, and by de-concentrating poverty from inner-cities and rural areas through smart housing and transportation policy.
Given that by the year 2042, according to the U.S. Census Bureau, half of the people living in the United States will be people of color, it is imperative that we be prepared to address the health needs of an increasingly diverse population. Lawmakers should continue to focus on the goal of health equity – a goal that is not only consistent with the American promise of opportunity, but in our long-term economic interest, as well.