CHART 1 Federal Health Reform: Whats in it for Me? Cara V. James, Ph.D. Director of Race, Ethnicity and Health Care Kaiser Family Foundation January 28,

CHART 1

Federal Health Reform: What’s in it for Me?

Cara V. James, Ph.D.Director of Race, Ethnicity and Health Care

Kaiser Family FoundationJanuary 28, 2010

CHART 2CHART 2

NOTES: Data do not include residents of Puerto Rico, American Samoa, Guam, the U.S. Virgin Islands, or the Northern Mariana Islands. Totals may not add to 100% due to rounding. All racial groups and individuals reporting “two or more races” are non-Hispanic.DATA: Table 3: Annual Estimates of the Population by Sex, Race and Hispanic Origin for the United States: April 1, 2000 to July 1, 2008 (NC-EST2008-03). Population Division, U.S. Census Bureau.

non-Hispanic White67%

Native Hawaiian & Other Pacific

Islander<1%

American Indian/Alaska

Native1%

Two or More Races

1%Asian

4%

Hispanic15%

non-Hispanic Black12%

(13.2 million)

(2.3 million) (0.4 million)

(46.9 million)

Total U.S. Population = 304.1 million

(4.5 million)

(37.2 million)

(199.5 million)

Distribution of U.S. Population by Race/Ethnicity, 2008

CHART 3

Nonelderly Health Coverage by Race/Ethnicity, 2008

74%

50%42% 44%

69%55% 59%

13%

26% 28%

12%28% 27%

13%21%

32% 28%19% 17% 14%

30%

White Black Hispanic AmericanIndian/Alaska

Native

Asian NHOPI Two or MoreRaces

Employer Medicaid or Other Public Uninsured

DATA: 2009 March Supplement, Current Population Survey.

SOURCE: Kaiser Family Foundation Analyses

CHART 4

Health Reform Goals

1. Expand health coverage

2. Reduce health care costs

3. Improve health care quality

4. Expand health care workforce

Where is the reduction or the elimination of health disparities? Where is health equity?

CHART 5

Disparities-Specific Provisions of the House Bill

• Largely focused on the provision of language appropriate services

• Requests CMS conduct a study on the availability and utilization of language services, and the potential to provide finance incentives to encourage their use.

• Requests a demonstration project to promote reimbursement for CLAS services.

• Asks IOM to produce a report on the impact of language access services on health and health care of LEP individuals

• Reauthorizes the Indian Health Care Improvement Act for the first time since 2001.

CHART 6

Disparities-Specific Provisions of the Senate Bill

• Focuses largely on data collection and reporting as a means to reduce racial and ethnic disparities.

• Requires the collection of data on race, ethnicity, language, geographic location, socioeconomic status (including income and education) and disability

• Wants the Secretary to develop curricula for cultural competency for individuals with disabilities

• Provides loan repayment and the development and implementation of strategies to recruit individuals from underrepresented minority populations, disadvantaged backgrounds and rural backgrounds

• Also reauthorizes the Indian Health Care Improvement Act.

CHART 7

Other Provisions Likely to Impact Communities of Color

• Medicaid Expansions

• Individual and Employer Mandate

• Premium Credits and Cost-Sharing Subsidies

• Workforce Provisions

• Funding for federally qualified health centers

• Prevention

CHART 8

Medicaid Expansions

CHART 9

White, non-Hispanic

47%

Black, non-Hispanic

15%

Hispanic31%

American Indian/Alaska

Native1%

Asian5%

Two or More Races

1%

NHOPI0.3%

Distribution of Nonelderly Uninsured by Race/Ethnicity, 2008

Total Nonelderly Uninsured Population = 45.7 million

DATA: 2009 March Supplement, Current Population Survey.

SOURCE: Kaiser Family Foundation Analyses

CHART 10

White, non-Hispanic

41%

Black, non-Hispanic

18%

Hispanic35%

American Indian/Alaska

Native1%

Asian4%

Two or More Races

1%

NHOPI0.3%

Distribution of Nonelderly Uninsured Below 133% FPL by Race/Ethnicity, 2008

Total Nonelderly Uninsured Below 133% FPL = 46.4 million

DATA: 2009 March Supplement, Current Population Survey.

SOURCE: Kaiser Family Foundation Analyses

CHART 11

Current and Projected Medicaid Coverage Rates by Race/Ethnicity

13%

32%28%

12%

28% 27%6%

13%

19%

16%

9%

11%

30%

8%

0%

25%

50%

Medicaid or Other Public Coverage Newly Eligible for Medicaid

DATA: 2009 March Supplement, Current Population Survey.

SOURCE: Kaiser Family Foundation Analyses

White Two or More Races

Black HispanicAmerican

Indian/Alaska Native

Asian NHOPI

CHART 12

Individual and Employer Mandate

CHART 13

Individual and Employer Mandate

• Changes to individual market:– Ban gender rating– Ban exclusion of pre-existing conditions– Ban variations in premiums based on health status– Identify maternity care as an essential benefit to be

covered by all plans in the exchange.

• Premium credits and cost-sharing subsidies will be helpful to many women purchasing coverage in the exchange

CHART 14

Percent of Nonelderly with Private Coverage by Race/Ethnicity, 2008

6.4%

2.7% 2.8%

6.5%

3.6%

White Black Hispanic AmericanIndian/Alaska

Native

Asian NHOPI Two or MoreRaces

NOTE: Estimate for AI/An and NHOPI unreliable due to sample size. DATA: 2009 March Supplement, Current Population Survey.SOURCE: Kaiser Family Foundation Analyses

N/A N/AN/A

CHART 15

Premium Credits and Cost-Sharing Subsidies

CHART 16

Poverty Status of Nonelderly by Race/Ethnicity, 2008

17%

41% 41% 40%

21%33% 29%

39%

40% 44% 39%

35%

37% 41%

43%

19% 15% 21%

44%30% 30%

White Black Hispanic AmericanIndian/Alaska

Native

Asian NHOPI Two or MoreRaces

Less than 133% FPL 133%-399% FPL 400% FPL or More

DATA: 2009 March Supplement, Current Population Survey.

SOURCE: Kaiser Family Foundation Analyses

166.4 million 44.7 million33.3 million 1.7 million 11.7 million 0.7 million 4.3 million

CHART 17

Other Provisions

CHART 18

• Workforce Provisions– Training programs, loan repayment programs, and cultural

competency efforts

• Funding for federally qualified health centers– Increase in funding by $33 billion over next 5 years

• Prevention Efforts– National strategy for prevention, grants for reducing

chronic disease, coverage of preventive services in Medicare, and incentives for wellness programs

Other Provisions

CHART 19

State Responsibility and Flexibility

CHART 20

Proportion of Nonelderly Who Self-Identify as a Person of Color, by State

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

TX

IL

FL

AL

U.S. Total = 37% Minority26 - 39% (13 states)16 - 25% (12 states)

40 - 80% (13 states and DC)

4 – 15% (12 states)

Source: Kaiser Family Foundation analysis of March 2009 Current Population Surveys, U.S. Census Bureau.

CHART 21

Concluding Thoughts

• Many provisions of the bills will impact everyone.

• The elimination of racial and ethnic health disparities is not a major focus of the bills, but the final bill will likely have a big impact on communities of color.

• The disparities-specific provisions of the proposed bills will likely have a limited impact on racial and ethnic disparities.

• Coverage expansions and disparities-specific provisions are a first step in the reduction of health disparities.

CHART 22

Thank You!

Contact InformationCara James, Ph.D.

Kaiser Family [email protected]