Native Americans

Legislation to Improve Health of Racial and Ethnic Minorities:
The Healthcare Equality and Accountability Act of 2003

Too often, racial and ethnic minorities receive a lower standard of health care than other Americans.  The federal government has recognized this serious problem and has set the goal of eliminating racial and ethinic health disparities by the end of the decade.  House and Senate Democrats introduced legislation, the Healthcare Equality and Accountability Act of 2003, that takes an important step toward making this national goal a reality.  The bill has been referred to the Senate Health and Labor and Pensions Committee.  

The health care needs of minorities are often greater than those of white Americans.  Minority populations are inflicted with a number of serious diseases at a disproportionate rate.  Minority groups have higher rates of acute conditions (e.g., tuberculosis and HIV/AIDS), chronic diseases (e.g., diabetes, heart disease, and stroke), and many forms of cancer.  In addition, minority women are at greater risk than white women for pregnancy-related complications and their babies are at higher risk of dying during their first year of life. 

Despite a clear need for quality health care, minority groups often encounter obstacles in obtaining access to such care.  Minority groups are less likely to have health insurance and are less likely to receive appropriate health care services.  In June 2003, the Kaiser Family Foundation announced the following findings:

• Minority populations – Hispanics (35 percent), Native Americans (27 percent), African Americans (20 percent), and Asian/Pacific Islanders (19 percent) – all have substantially higher rates of uninsured individuals than white Americans (12 percent).
• While racial and ethnic minorities represent only one-third of the non-elderly U.S. population, they represent more than half of the total number of uninsured Americans.
• Hispanics (30 percent), Asian/Pacific Islanders (21 percent), African Americans (19 percent), and Native Americans (19 percent) are less likely to have a consistent source of health care than white Americans (15 percent).
• Hispanics (27 percent), Native Americans (21 percent), Asian/Pacific Islanders (20 percent), and African Americans (17 percent) are all less likely to have visited a health care provider in the past year than white Americans (15 percent).
• Racial and ethnic minorities are also less likely to receive prenatal care or begin prenatal care late in a pregnancy; have visited the dentist in the past year; receive certain diagnostic procedures and treatments for heart disease; and receive a mammogram.

The health-related disparities found among minority Americans have multiple causes.   Lower socioeconomic status and a lower rate of insurance are major contributors to the health disparities experienced by minority Americans.  Other factors also play an important role.  The Institute of Medicine (2002) concluded that racial and ethnic minorities “tend to receive a lower quality of health care than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.”  Similarly, a recent analysis of hundreds of clinical studies by Physicians for Human Rights (2003) found that many minority groups receive lower quality evaluation and treatment than white Americans for a wide range of medical conditions, even when each has health insurance. 

House and Senate Democrats are working to improve the health of minority groups.  The Healthcare Equality and Accountability Act of 2003 would reduce health-related disparities and improve the quality of care for racial and ethnic minorities by:

• Expanding health coverage.  To reduce the number of minorities without health insurance, the bill would give states the option of expanding eligibility and streamlining enrollment in Medicaid and the State Children’s Health Insurance Program.  Specifically, the bill would allow states to cover uninsured parents who have children eligible for Medicaid and CHIP; pregnant women; children through age 20; residents at or below the federal poverty line; and legal immigrants.  It would also guarantee adequate health care funding for Native Americans.
• Removing language and cultural barriers.  Because language and cultural differences create barriers to health care, the bill would help patients from diverse backgrounds, including those with limited English proficiency, by codifying existing standards for culturally and linguistically appropriate health care, assisting health care professionals provide cultural and language services, and increasing federal reimbursement for these services.
• Improving workforce diversity.  The bill would expand existing programs and create new ones to address the shortage of minority health care providers.  Increasing the number of minority health care providers will improve access to care because these providers are more likely to serve low-income, uninsured, and minority patients.
• Funding programs to reduce health disparities.  In addition to disease-specific initiatives, the bill would create programs with the overall goal of reducing or eliminating health disparities, including by providing grants for community initiatives, funding programs to help patients with cancer and chronic diseases to navigate the health care system, and establishing health empowerment zones.
• Improving data collection.  Better information is needed to identify the sources of health disparities, implement effective solutions, and monitor improvement.  With appropriate safeguards to protect privacy, the bill would require federal agencies and recipients of federal funds to collect and report data on race, ethnicity, and primary language.
• Promoting accountability.  To reduce health disparities and combat discrimination, the bill would expand the Office of Civil Rights and the Office of Minority Health in the Department of Health and Human Services (DHHS), create minority health offices at the Food and Drug Administration and the Centers for Medicare and Medicaid Services, and establish compliance offices in federal health agencies.
• Strengthening health institutions that serve minority populations.  The bill would establish loan and grant programs, as well as quality improvement initiatives, for health institutions that provide substantial care to minority populations.