March 14th, 2008
Editor’s Note: This is the third in a series of posts on health and health care disparities that Health Affairs Blog is publishing in conjunction with the new March/April issue of Health Affairs on Disparities: Expanding The Focus, published with support from the Robert Wood Johnson Foundation. Brian Smedley and Richard Epstein contributed earlier posts in the series, which will also feature Tom Miller and Robin Weinick and Nancy Kressin.
In February of 2007, a twelve-year-old boy from Clinton Maryland named Deamonte Driver died from a toothache. His family had no health insurance, and his mother, unable to afford an $80 tooth extraction, had trouble finding a dentist who would care for him for free. Deamonte received no medical attention until it was too late. The infection in his tooth had spread to his brain, and two operations and six weeks of hospital care totaling $250,000 could not save this young boy’s life.
Deamonte’s death is a tragic reminder that race, income, education, geography, and a host of other factors greatly influence health care access, quality, and outcomes. His story also underscores how much more needs to be done to close the health disparity gap in our country. In addition to legislation supporting programs and services for low-income Americans, the Congress has a history of championing minority-specific health legislation as well.
Minority Health Legislation In The 106th Congress
In November of 2000, the Minority Health and Health Disparities Research and Education Act (P.L. 106-525) was signed into law. This bill has led to many tangible achievements: The newly established National Center on Minority Health and Health Disparities at the National Institutes of Health has greatly expanded minority health and health disparity research. The National Academy of Sciences completed the mandated report Eliminating Health Disparities: Data and Measurement Needs (2004), which details federal data collection activities and provides recommendations for improvement. Last but certainly not least, the Agency for Healthcare Research and Quality now publishes annual reports on health care quality and health care disparities, which has allowed better monitoring and evaluation of trends in the care of minority and other underserved populations
Another notable legislative achievement in the 106th Congress was the congressional directive in the 2000 appropriations bill (P.L. 106-113) to the Institute of Medicine (IOM) that requested evaluation of potential sources of racial and ethnic disparities. This directive led to the landmark IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (2002), which is considered the premier study on racial and ethnic disparities and provides actionable recommendations for the medical, public health, and research communities.
These federal efforts have led to a wealth of knowledge about the root causes of disparities and how to identify and monitor such disparities. The next hurdle is greater translation of such knowledge into effective interventions to improve health and reduce disparities, which is the impetus for the most recent minority health legislative efforts.
History Of Recent Efforts To Pass Minority Health Legislation
In 2003, with leadership by Sen. Edward M. Kennedy (D-MA) and Rep. Donna Christian-Christensen (D-VI), Democrats in the Senate and the House introduced a democratic caucus minority health bill entitled the Healthcare Equality and Accountability Act (S 1833). This comprehensive bill included provisions relating to coverage, language access, workforce diversity, health data collection, environmental justice, and prevention and treatment of numerous diseases and health conditions. Sen. Bill Frist (R-TN) introduced Closing the Health Care Gap (S 2091) in early 2004, which, although more modest in scope, addressed many of the same concerns as the democratic caucus bill. Neither bill passed the Congress, and current efforts have focused on negotiation of bipartisan legislation.
Bipartisan Legislation In The Senate
Building upon their successful partnership in passing the 2000 minority health bill, Senators Kennedy and Frist negotiated a bipartisan minority health bill, the Minority Health Improvement and Health Disparity Elimination Act of 2006 (S 4024). A modified version of the bill (S 1576) was reintroduced this session of Congress with Sen. Thad Cochran (R-MS) serving as the Republican lead. Retaining only the provisions within the jurisdiction of the Health, Education, Labor, and Pensions (HELP) committee, the legislation seeks to reduce health disparities through improved education and training, health care quality and access, research, data collection, and public- and private-sector collaboration. Committee staff is currently negotiating this bill, and Senator Kennedy expects to move the bill through the HELP Committee by May, after which the bill must be voted upon by the full Senate. If successful, the negotiated bill would then go to the House for consideration.
House Members Divided On Senate Bipartisan Bill
Although Democrats from the Senate and House collaborated to introduce the Healthcare Equality and Accountability Act, House democrats remain divided on whether to support the democratic caucus bill, which has slim chance of passing the House or Senate, or the bipartisan Senate bill. Congresswomen Christian-Christensen, Carolyn Kilpatrick (D-MI), and Madeleine Bordallo (D-GU) asserted in a sharply worded letter to Majority Leader Harry Reid that the Senate bipartisan bill is “too modest and does not adequately reflect the urgency of the need to eliminate health disparities.” However, a number of House members are in favor of the bipartisan bill, including long-time minority health champion Rep. Jesse Jackson Jr. (D-IL), who has introduced the Senate bipartisan bill in the House (HR 3333), with twenty-eight Democrat and twenty-eight Republican cosponsors, including Congressional Black Caucus (CBC) chairwoman Kilpatrick and twenty-five other minority caucus members.
The prospects for a minority health and health disparities bill being signed into law in 2008 are uncertain. The opposition by some House Democrats as well as some Senate and House Republicans, the inevitable slowdown of congressional activity during election years, and the general difficulty passing any bill are significant challenges to moving the bill. Yet Senator Kennedy continues to rightfully argue that “the extraordinary advances in health care in recent decades have not been shared by all our citizens,” and that the Congress should not surrender any opportunity to pass legislation that is meaningful and beneficial to the health of underserved populations. His position is shared by many influential Senate and House members. But perhaps more importantly, more than thirty-six organizations representing minority and disparity groups, health professional societies, schools, and safety-net institutions have signed onto a letter demanding congressional action now. As expressed by Fredette West, chair of the Racial and Ethnic Health Disparities Coalition, which is leading the advocacy effort for minority health legislation.
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As you are keenly aware, despite medical advances, death and disease continue to take a disproportionate and devastating toll on communities of color across the nation; no region of the country is immune. . . . Vulnerable communities across the nation are counting on you and your colleagues in the Senate and the House to complete action in your respective chamber and to push for enactment, during this 110th Congress, of minority health legislation needed to help respond to this health crisis.