The Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D.

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1 The Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D. Director, Office of Minority Health Centers for Medicare & Medicaid Services April 22, 2013

2 The Affordable Care Act and Health Disparities

3 Aims of the Affordable Care Act Expand coverage Reduce health care costs Improve health care quality Improve population health Reduce health care fraud and abuse

4 Health Insurance Marketplace Place to purchase health insurance and determine eligibility for financial assistance One process to determine eligibility for Qualified Health Plan through the Marketplace New tax credits to lower premiums Reduced cost sharing Medicaid Children s Health Insurance Program (CHIP) Three types: Federally Facilitated Marketplace, State Based Marketplace, State Partnership Marketplace

5 Essential Health Benefits Covered by Qualified Health Plans Ambulatory patient services Prescription drugs Emergency services Rehabilitative and habilitative services and devices Hospitalization Essential Health Benefits Laboratory services Maternity and newborn care Preventive and wellness services and chronic disease management Mental health and substance use disorder services, including behavioral health treatment Pediatric services, including oral and vision care

6 Improving Health Care Quality National Quality Strategy Increased reliance on value-based purchasing Expansion of meaningful use of electronic health records Better care coordination Development of quality measures for Medicaid and Medicare Measuring quality in the Marketplace

7 Supporting Health Care Innovation Center for Medicare & Medicaid Innovation (CMMI) Section Develop and test models that reduce overall health care costs and/or improve health care quality Some of the existing demonstrations Strong Start -ACOs Nurse Managed Care -Community Care Transitions Health Care Innovation -FQHC Advanced Primary Care

8 Improving Population Health Quality of Care Improvements Employee Wellness Benefits Preventive Services for Medicare Beneficiaries Preventive Services for Women Dental Sealant Program for Children Community Transformation Grants

9 Strengthening the Health Care Workforce

10 Expanding the Workforce Through Training Increase Primary Care Workforce Grants to institutions to train physicians in family medicine, general internal medicine, and general pediatrics, as well as train physician assistants Increases funding for training in mental and behavioral health Removes cap on Commissioned Corps and National Health Service Corps

11 Increased Reliance on Nurses Provides $50 million to establish a grant program for clinics run by APNs to provide primary care and wellness care to underserved populations Improves access to nurse-midwife services Establishment of Community Health Teams Independence at home demonstration program Nursing student and faculty loan program, retention grants and demonstration project for education of APNs

12 Disparities Specific Provisions of the ACA

13 Distribution of Uninsured by Race/Ethnicity, American Indian/ Alaska Native 2% Asian 6% NHOPI 0.4% Hispanic 32% White, Non- Hispanic 44% Black 16% Total Uninsured = 49.3 million Source: People Without Health Insurance Coverage by Race and Hispanic Origin Using 2- and 3-Year Averages: and U.S. Census Bureau, Current Population Survey, 2009 to 2012 Annual Social and Economic Supplements.

14 Changes in Quality of Care Disparities Over Time: Summary by Race/Ethnicity, % 5% 10% 9% 90% 91% 84% 88% Improving Same Worsening 3% 4% 6% 2% Black vs. White Asian and PI vs. White American Indian/Alaska Native vs. White Hispanic vs. Non- Hispanic White NOTES: Improving means disparity is becoming smaller over time; worsening means disparity becoming larger over time. Data on all measures are not available for all groups. Totals may not add to 100% due to rounding. Time period differs by measure and includes oldest and newest years of available data. SOURCE: AHRQ, National Healthcare Disparities Report, 2011.

15 Recent Health Care Innovation Awards Addressing Disparities Delta Dental Plan of South Dakota Oral health improvements JoslinDiabetes Center, Inc. Will expand its On the Road program Duke University From Clinic to Community: Achieving health equity in the southeastern United States (aims to reduce death and disability from Type 2 diabetes) Ravenswood Family Health Center To create a disparities collaborative and train care managers to address chronic disease rates in San Mateo

16 New Data Collection Standards Required by Section 4302 or the Affordable Care Act for the following: -Race -Ethnicity -Primary Language -Sex -Disability Secretary has the authority to add other categories (e.g. socioeconomic status and sexual orientation)

17 Receipt of All Annually Recommended Services for Adults with Diabetes by Race/Ethnicity, % 19% 17%?? White, Non- Hispanic Hispanic Black, Non- Hispanic Asian Native Hawaiian and Other Pacific Islander NOTE: Recommended services include a dilated eye exam, a foot exam, hemoglobin A1C check and receipt of the flu shot. SOURCE: Table B National Healthcare Disparities Report. Agency for Healthcare Research and Quality.

18 The Indian Health Care Improvement Act Provides authorization for hospice, assisted living, longterm, and home- and community-based care. Makes it easier for tribal-run facilities to recover costs from third parties Establishes a Community Health Representative program for urban Indian organizations to train and employ Indians to provide health care services. Directs the IHS to establish comprehensive behavioral health, prevention, and treatment programs for Indians

19 Sec of the ACA and the HHS Offices of Minority Health

20 HHS Action Plan to Reduce Racial and Ethnic Health Disparities Goal 1: Transform Health Care Goal 2: Strengthen HHS Workforce and Infrastructure Goal 3: Advance the Health, Safety, and Well- Being of the American People Goal 4: AdvanceScientific Knowledge and Innovation Goal 5: Increase Efficiency, Transparency, and Accountability of HHS Programs

21 Implementing the ACA

22 ACA Benefits Already in Place Ban on lifetime limits No denial of coverage for children with pre-existing conditions Children can stay on their parents coverage until they turn 26 years Pre-existing conditions program for adults Prevention and wellness benefits for seniors at no cost Help for seniors who reach the donut hole Preventive services for women

23 Improving Access to Preventive Services for Seniors 2011 Coverage of many preventive services with no cost sharing began Bone mass measurement Cervical cancer screening, including Pap smear tests and pelvic exams Cholesterol and other cardiovascular screenings Colorectal cancer screening (except for barium enemas) Diabetes screening Flu shot, pneumonia shot, and the hepatitis B shot HIV screening for people at increased risk or who ask for the test Mammograms Medical nutrition therapy to help people manage diabetes or kidney disease Prostate cancer screening (except digital rectal examinations)

24 Improving Access to Preventive Services for Women Covered services Well-woman visits Domestic violence screening Gestational diabetes screening Breastfeeding support, supplies, and counseling STI counseling HIV screening and counseling Contraception and contraceptive counseling HPV DNA testing

25 More Benefits to Come Marketplace Key Dates October 1, 2013 January 1, 2014 Application Assistance Navigators In-Person Assistance Personnel Certified Application Counselors Agents and Brokers

26 Where You Live Matters!

27 Nonelderly Persons of Color, by State, 2010 AK CA OR WA NV ID UT AZ HI MT WY CO NM U.S. Minority Population = 37% (99 million) NH VT ND MN NY SD WI MI IA PA NE OH IL IN WV VA KS MO KY TN NC OK AR SC MS AL GA TX LA FL 5 15% (12 states) 16-25% (13 states) 26-40% (13 states) 41-83% (12 states and DC) ME MA RI CT NJ DE MD DC Source: Kaiser Family Foundation analysis of March 2011 Current Population Surveys, U.S. Census Bureau.

28 Nonelderly Uninsured, by State, 2010 AK CA OR WA NV ID UT AZ HI MT WY CO NM U.S. Uninsured Population = 19% (50 million) ND SD NE KS TX OK MN AR LA WI IA IL MO MS NH VT NY MI PA OH IN WV VA KY NC TN SC AL GA FL 4 10% (3 states) 11-15% (13 states and DC) 16-20% (24 states) 21-30% (10 states) Source: Kaiser Family Foundation analysis of March 2010 Current Population Surveys, U.S. Census Bureau. ME MA RI CT NJ DE MD DC

29 What Can You Do?

30 Get Engaged and Stay Informed! For Region 1 Office information,

31 If Possible, Get in the Weeds

32 Conclusions Communities of color have much to gain from the Affordable Care Act. Getting America covered begins now, and it all begins with you. A journey of a thousand miles begins with a single step. (Lao-tzu, 604 BC -531 BC)

33 Thank you!

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