The Good, the Bad, and the Ugly: Overview of the Health Reform Law and Its Impact on Health-Care Disparities

Abstract

The passage of the Patient Protection and Affordable Care Act (PPACA or ACA) on March 23, 2010 has been hailed as simultaneously being a wondrous blessing that promises to uplift the delivery of health care for all; as a lukewarm and incomplete approach to the prodigious medical problems of the United States; and as a downright mistake that will hamper rather than help us to overcome what nearly everyone acknowledges as a crisis in medical care. Of course, there has been much subjective conjecture on this topic, with one’s orientation being influenced by political status, personal experience, level of education, geographical factors, racial and ethnic group membership, exposure to the issues, and frank bias. There has been a great deal of debate about what provisions are best for the country that has ranged from vitriolic to vapid, with no unifying perspective having been enunciated as yet. Some pundits say that there is no possibility of unification and that the issue of what kind of health care is best will remain perpetually divisive. There are ten major titles in the new national health-care reform program, each with its own separate agenda (The Patient Protection and Affordable Care Act, P.L. 111–148, 23 Mar 2010). They are as follows: 1. Title I: Quality, Affordable Health Care for all Americans 2. Title II: Role of Public Programs 3. Title III: Improving the Quality and Efficiency of Health Care 4. Title IV: Prevention of Chronic Disease and Improvement of Public Health 5. Title V: Health Care Workforce 6. Title VI: Transparency and Program Integrity 7. Title VII: Improving Access to Innovative Medical Therapies 8. Title VIII: Class Act 9. Title IX: Revenue Provisions 10. Title X: Strengthening Quality, Affordable Health Care for all Americans As the nation moves forward in complying with what is now health-care reform law, it is important to look at what we are in for and how we are going to deal with it. We also need to understand that the law is not immutable, and that we will need to examine the impact of certain policies and provisions that have been promulgated in order to determine what changes need to be made down the road. This gives us an opportunity to choose one particular entity, health-care disparities, to see how much has been included in the new law (or excluded from it) that might relate to this important area of health-care endeavor, and to examine it in an objective manner. None of the titles listed specifically aims at eliminating health-care disparities, although just about all of them contain sections that relate to this topic in one way or another. Some of these sections relating to ethnic and racial minorities and to disparities indicate an intent of beneficial action; others state mandated actions in the strongest terms, and many but not all list penalties for noncompliance as well as the level of appropriations to enable implementation. It appears useful, therefore, to put together a kind of road map that hopefully will help one to navigate through the complex waters of the new health-care reform law as it concerns health-care disparities and racial and ethnic minorities. Some of these will be discussed in detail, and others are presented in various chapters elsewhere in this book. They are not necessarily discussed in the order of importance or priority. For this report, the entire 906 pages of the health-care bill have been scanned and will be analyzed regarding the presence (or absence) of key provisions for reducing or eliminating health-care disparities. In this manner, we will be able to ascertain the extent to which concern over health equity has been taken into account by Congress and the Obama Administration.

R.A. Williams

Clinical Professor of Medicine, UCLA School of Medicine, President/CEO, The Minority Health Institute, Inc., Founder, The Association of Black Cardiologists, Inc., Chairman of the Board, Emeritus Institute for the Advancement of Multicultural and Minority Medicine, Washington, DC, USA