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.