The Affordable Care Act and Health Equity

By Ned Calonge, MD, MPH, The Colorado Trust

Saturday, March 23, represents the third anniversary of the passage of the Affordable Care Act (ACA). The occasion of the anniversary presents an opportunity to reflect on the law itself, as well as the specific aspects that address health equity. These areas include coverage expansions, where 39 percent of those newly eligible for Medicaid and nearly half of uninsured adults eligible for subsidized coverage through the health benefit exchange (nationwide) are racial/ethnic minorities. Services for the 20 million people who receive their care through safety-net agencies, two-thirds of whom are racial/ethnic minorities, will be expanded in terms of facilities, capacity and health care coordination. Public health programs to address disparities in birth outcomes and sexually transmitted illnesses, which represent some of the greatest disparities in health outcomes in our state, will receive new funding.

In addition to expansions in services, implementation of the ACA offers an opportunity to better address issues related to health equity in terms of systems. All federally-funded health programs and surveys will collect data on race, ethnicity and language. Research, education and demonstration projects supporting culturally-competent health care services will be funded, including loan repayment programs providing preference to students with cultural competency training. There are additional supported workforce development activities including training for low-income individuals as home health aides and other care providers, investing in historically minority colleges, scholarships and loan forgiveness for primary care providers, and strategies to recruit more racial/ethnic minorities into health care provider and leadership positions.

Finally, the ACA promotes the generation of new knowledge regarding health disparities and health equity. The National Center on Minority Health and Health Disparities has been elevated to Institute status at the National Institutes of Health, providing new resources for this critical research work. The new Patient-Centered Outcomes Research Institute (PCORI) has been created and funded, with specific directions to examine differences in health outcomes based on race and ethnicity, all with community engagement and stakeholder input. The Centers for Disease Control and Prevention’s Community Preventive Services Task Force, on which I serve, has been charged with developing our topic areas for interventions with consideration of the social determinants of health.

All of these features of the ACA are described in detail, along with a discussion of what specifically Colorado is doing in these areas, in our report, Health Equity and the Affordable Care Act.

The ACA will generate benefits for Coloradans in all communities across the state. We at The Colorado Trust are excited about the benefits to be realized by some of our most vulnerable and underserved residents.