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Will Health Care Reform Harm Ethnic Minorities?

New America Media, Q&A, Paul Kleyman Posted: Jul 30, 2009

Editors Note: The national media is covering health care reform like the pennant race for the World Series, but the fates of real people especially ethnic minorities who are the least insured - hang in the balance. Paul Kleyman, associate director of NAM's ethnic elders beat, asked Maya Rockeymoore whether the health care reform debate is taking the interests of ethnic Americans into consideration. Rockeymoore is president and CEO of Global Policy Solutions, a Washington, D.C., policy consulting firm. She is the author of "The Political Action Handbook: A How-To Guide for the Hip Hop Generation" (Fourth Generation Press, 2004).

What are your concerns about national health care reform now that the House and Senate bills are taking shape?

My main concern is that Congress will put together a final bill that is politically feasible but fails to reduce costs or cover the uninsured in an effective and efficient manner.

For example, a version of reform that does not contain a viable, government-run public option will likely limit access to affordable coverage for many Americans. Private insurance companies need to be kept in check by a strong, competitive public health care coverage option.

It is disappointing that some conservative Democrats and Republicans are suggesting watered-down versions of a public option that will ultimately leave profit-driven private insurers in charge of Americas health. America already has experience with this failed, and too often tragic, approach.

I am also concerned about whether the Medicaid provisions for low-income individuals and families are sufficient and sustainable over the long term. For example, the bills seek to expand Medicaid so that more lower income individuals and families can receive coverage on the federal governments tab, but largely leave the existing Medicaid operational framework intact. This leaves coverage for existing Medicaid recipients vulnerable to future state budget cuts.

Under current health care reform proposals, the federal government picks up the cost of Medicaid coverage to newly eligible categories of people. But some people fear that the federal government will dump these costs -- or some portion of them-- onto the states in the future. Under this scenario, the expansion of Medicaid becomes another unfunded mandate for the states. This suggests that the future of healthcare coverage for low-income individuals and families remains uncertain.

What are your hopes for health care reform, and what must happen in order to realize those hopes?

It is laudable that the versions of the health care reform bills released thus far contain language that prevents insurers from discriminating based on gender and pre-existing conditions. It would also be ideal if the bills contained a comprehensive plan to address health disparities.

The proposals could also be much stronger if they contained a comprehensive, systematic way to support individuals -- regardless of income -- in their efforts to lead healthier lifestyles. Congress could pass the best possible bill, but if people continue to show up at the doctors office and in the hospital with expensive, preventable obesity and smoking-related illnesses, the country will not maximize the expected cost savings from reform.

Although the House and Senate bills contain important and unprecedented public health investments, including an expansion of community-based prevention programs, these investments are not structured to provide population-wide access to wellness services and supports, such as nutrition education classes, gym memberships, weight management courses, smoking cessation courses. Congress should consider how to create a national wellness insurance plan that can proactively help people from all income levels maintain a healthy weight and stop smoking.

Congress should also give more attention to addressing environmental factors that limit access to healthy, affordable foods and opportunities to engage in safe, physical activity in schools and communities across the country.

In the myriad of proposals now being debated in Congress, such as the surtax on upper income earners and the coverage mandates for individual and businesses, what one proposal especially concerns you?

Many medium-sized and small minority firms have a very tenuous grasp on financial success. To the extent that the proposals contain mandates for kinds of coverage, a surtax or fee on firms of a certain modest size, it is important to understand their likely impact on minority businesses.

As a small business owner, Im nervous about the House proposal that seeks to tax the 'wealthy' to pay for healthcare reform. When wealthy is defined as $280,000, that hits small businesses hard, particularly those who file their business earnings on their income tax forms as I do. If this moves forward, small businesses would get a double whammy, both mandated healthcare coverage and an extra tax.

It would be a shame if Congress undermined minority business ownership in an attempt to finance health care reform. Understanding the likely effects on smaller employers may lead to better ideas for effectively advancing both goals.

What consequences do you see in the current likely proposals for our aging nation, especially relating to ethnically diverse aging boomers?

The best-case scenario for health care reform is that it creates an efficient and effective mechanism for providing affordable, quality health care to the nations uninsured and underinsured. What most people do not realize is that racial and ethnic minorities are a majority of the nations uninsured population.

A prevention-oriented system focused on expanding coverage, improving quality of care and achieving better health outcomes for people of all backgrounds would be very beneficial for racially and ethnically diverse boomers. It would allow them to live healthier and more economically secure lives by preventing or more effectively managing chronic diseases.

As a result, they would likely enter the Medicare system in better health, with expected savings to the system, reduced out-of-pocket healthcare expenditures, and they would lead better quality lives.

The worst-case scenario is that a costly system is created that does not effectively expand coverage or improve health care quality or affordability. This outcome would be disastrous for racial and ethnic minorities, as they will likely be the ones still left without coverage under a 'reformed' system. They would also likely suffer from the continuation, and possible exaggeration, of health disparities leading to a poorer quality of life in retirement if they reach retirement age.

Related Articles:

Latinos Have a Stake in Health Care Reform

Blacks, Hispanics Biggest Losers if Health Care Reform Flops

Ethnic Healthcare Groups Prescribe Prevention and Access to Care

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