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QUALITY: Health Reform Will Work To Eliminate Health Disparities

With so much  ruckus over what's in the House health reform bill, what's not actually in the bill and what imaginary horrors it will bring about , we'd like to highlight a feature not getting much attention -- namely a push to reduce or eliminate health disparities.

Here are some of the highlights from the House Tri-Committee bill, HR 3200:

  • Medicare will reimburse for "culturally and linguistically appropriate services" to promote access for Medicare beneficiaries with limited English proficiency. (NOTE: This is not a codeword for covering illegal immigrants, as some  foes of reform have contended).
  • Reducing health disparities would be an explicit goal in the HHS Secretary's national priorities for quality improvement in health care.
  • The Secretary of HHS and the Institute of Medicine would look at how providers utilize cultural and linguistic support services, design a demonstration program to pay for these services, and study the impact on reducing health disparities.
  • Establish a CDC grant program for community-based prevention and wellness. Significantly, "At least 50% of these funds must be spent on implementing services whose primary purpose is to reduce health disparities."

Many health advocates are excited about these provisions in the bill. Last week, our Health Policy Program Director, Dr. Len Nichols, discussed them at an event held by The National Partnership for Action to End Health Disparities.

To combat health disparities, we need to start by acknowledging and understanding them -- and making their reduction a high priority in legislation.  It is a central part of access equity, and it's germane to quality of care. Our reformed health care system should not tolerate disparities.

What kind of problem do health disparities present? The IoM in its 2002 study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that all other things being equal -- insurance status, income, age, and severity of conditions -- medical treatment varied by race. This means that racial and ethnic minorities are more likely to stay sick even when they seek care. They don't get the same quality of care, they are less likely to have health insurance coverage, or they have limited or substandard coverage  -- the kind that leaves them with bank-breaking deductibles when they do get sick. No single factor explains this phenomenon, but patient attitudes, provider biases, and unconscious stereotypes all play a role.

Linguistic and cultural barriers can frustrate patients and doctors. Not all doctors are great at breaking down medical jargon into terms their patients can understand -- even when both speak the same language. Even for skilled translators, it can be daunting to communicate the complexities of medical diagnosis, treatments and follow up procedures. Doctor and patient should be able to work as a team to accomplish mutual goals for patient care. That means, too, the ability to understand and communicate a patient's values and goals of care. The linguistic and cultural support services provided by health reform legislation will help.

As we've mentioned previously, a recent Health and Human Services study found that racial and ethnic minorities face higher rates of disease, especially chronic disease such as cancer, diabetes, or HIV. Of the approximately 46 million uninsured, about half are poor and one-third suffer from chronic disease, according to For more detailed statistics on health disparities, check out the group health profiles on the Office of Minority Health website or the Kaiser Family Foundation's

The challenges of health disparities deserves our attention. We've written frequently about how it is morally unacceptable for hard-working American to be sicker, die younger, and receive poorer care than his or her fellow Americans because they lack insurance. We cannot allow our fellow Americans to suffer from such problems more frequently simply because they are a member of a racial or ethnic minority.

If we want to eliminate health disparities, we must commit to an honest dialogue. Race, inequality, and discrimination are complex subjects that can be difficult to discuss, but they cannot be glossed over or ignored. Honest dialogue includes discussions about eating and exercising habits, possible incentives, as well as community-enhancing investments in access to fresh foods and walking-friendly physical environments. (The Robert Wood Johnson Foundation's Commission to Build a Healthier America has done a lot of work on healthy neighborhoods, and we've written about it several times, including here.)

As Americans, we have to commit to solving this problem on all levels -- in both the private and public sector, and especially in our communities. The provisions in the House health reform bill are a good step forward, but they alone aren't going to solve the problem of health disparities.

Healthcare reform, let's actually read the bill

All these viral Emails about healthcare reform out there, not a single one of them actually refers you to the text of the actual bill. Do you think that is unusual?

This is 3 pages of information that should provide you some actual insight to what is surely should debunk some of the nonsense you are hearing in the media.

Yes the bill is 1200 pages long and everyone is counting on the fact that no one has the time to read it, but everyone has enough time to complain and argue about things that they have not done the research on, they have not checked their facts they just keep forwarding on the same silly emails. The fact is that is what the insurance company lobby wants you to do. However before you forward on one more of these ill informed emails, read this one. This one that shows you the language in the bill by linking you to the ACTUAL bill so then you can decide for yourself.

If you don’t have the time to read these 3 pages of info then you don’t have time to keep forwarding all the emails of misinformation.

Either read the bill and be informed or keep carrying on as an uninformed American just like the private insurance company lobby wants you to.

Lie #1: The Health Care bill would set up government death panels

Their claim is that language in the bill relating to “advance care planning consultations” would set up mandatory meetings in which government “death panels” would force senior citizens and others to sign some sort of early death pact. In reality, the bill language seeks to require Medicare to cover the cost of counseling sessions with doctors on end-of-life issues if a person chooses to have one. Currently, these kinds of sessions aren’t covered by Medicare, and people without extra money often can’t afford to have them.

The link below is the actual text from the bill, READ IT

Lie #2: The bill would make private health insurance illegal

This falsehood comes from a widely circulated Investor’s Business Daily editorial claiming that a provision on page 16 of the bill would “outlaw individual private coverage.” The portion of the bill they are referencing, Sec. 102 (a), defines “grandfathered health insurance coverage” and reads as follows: “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law."

Again here is what the bill ACTUALLY says:

Lie #3: The bill will give free health care to illegal immigrants

A viral email has been going around that claims to be a page-by-page analysis of the bill, but is actually just a bunch of made-up non-sense. The email persists in dozens of intentional misreadings and unfounded, unverified claims, but to knock down just one of them — one of the lines reads, “Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise.”

Again here is what the bill actually says:

It states: “Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.”
Now, the only section of the bill that could possibly be interpreted as “free health care” is Subtitle C, the “Individual Affordability Credits” section. The subtitle sets up a system of income-based credits for helping low-income people buy health insurance. At the end of the subtitle, it states clearly, “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” Going back to the section of the bill that was highlighted in the email, this prohibition on funds for illegal immigrants clearly qualifies under the language, “Except as otherwise explicitly permitted by this Act.” The email’s claim otherwise is demonstrably false. The rest of the email’s wild claims can be similarly disproved by referencing the empirical text of H.R. 3200.

Lie #4: Public money would be used to fund abortions

The same inaccurate email referenced above claims that two sections of the House bill would lead to “govt abortions.” House Minority Leader John Boehner [R, OH-8) has made similar claims. He stated in a National Review op-ed that the health care bill “will require [Americans] to subsidize abortion with their hard-earned tax dollars.” These claims, however, are false. There is nothing in the bill that would override the 1976 Hyde Amendment (full text of which is here in .pdf) prohibiting the use of federal funds for abortions.

Again here is the actual text from the bill:

Lie #5: The government will have direct, real-time access to individual bank accounts

This lie has been spread by Rush Limbaugh, Rep. John Shadegg (R-AZ), and others. The false claim, as typified in this KFYI News piece, is that “Section 163 of the bill states that the government would be allowed real-time access to a person’s bank records – including direct access to bank accounts for electronic fund transfers.”

Again here is the actual text from the bill:

What this section refers to, as OpenCongress user kbarnard1367 points out, is not “real-time access to a person’s bank records,” but rather, real-time access for health care providers to information relating to a person’s insurance coverage:
"What’s the first thing you give the doctor? Your health insurance card. What do they do with it? Call the insurance company to see if you still have insurance. So instead of a phone call and a 5 minute wait the nice receptionist swipes your card in her computer and sends a message down the internet and gets a near “Real time” response that says yes this person still has insurance with us. Your pharmacy has been doing this for years.
… in other words, this section of the actual bill does not do what Limbaugh and Rep. Shadegg and others claim. They are demonstrably wrong (see above). It is simply a check on the status of an individual’s insurance coverage, one that already happens today and would be required under any possible system built on individual health insurance.
A few lines down, another section of the bill has been targeted as the part that would supposedly provide the government with private financial information.
One line of the section attempt to standardize electronic administrative transactions, such as electronic fund transfers that occur between insurance companies and health care providers for the purpose of administrative simplification. Another line would enable electronics funds transactions to allow “automated reconciliation” of health care costs. This would basically amount to nothing more than an automatic online bill-pay system for people to pay their premiums every month.
There is no language in H.R. 3200 that would make it legal for the government to have “direct, real-time access to individual bank accounts.” The bill even includes basic requirements that all personal data that is collected under the provisions is used in a matter that meets privacy and security laws, and it restricts “inappropriate” uses, “including use of such data in determinations of eligibility (or continued eligibility) in health plans.”

Reduce disparities by taking marital status out of health care

The demographic groups that get less health care, get sick more and don't get well as much as other Americans are also more likely to be unmarried. Marital status currently acts as a barrier to health care for millions of Americans. Making health insurance more affordable for unmarried people, and taking other measures to increase their access to care, could decrease disparities and increase health equity. Why aren't health care reformers promising equal costs and access to all Americans regardless of marital status?

For more detail on the problem and solutions, please visit and

Language Access and Health Care Reform

Common Sense Advisory just published a report on the topic of the proposed bill and sections that would improve language access, hopefully reducing health and health care disparities for limited English proficient patients. 14 sections of the proposed bill specifically address linguistic and cultural barriers.

A copy of the press release is available here:

And, the full text of the release is pasted below.

Also, a recent blog post, "New York Fans the Flames of Language Access," describes initiatives in New York that show promise to spread to other states, including a recent complaint and settlement requiring major pharmacy chains to print labels in multiple languages and provide telephone interpreting services. That post is available here:

Market Research Report Pinpoints 14 Sections of Proposed U.S. Health Care Reform Legislation That Will Influence the Nation's Provision of Health Care Interpreting and Translation Services

August 20, 2009

BOSTON, Aug. 20 /PRNewswire/ -- With an estimated 50 million people who speak languages other than English at home, the United States health care system serves one of the most linguistically diverse patient populations in the world. A new report from market research firm Common Sense Advisory answers the question, "How will health care reform affect patients with limited English proficiency (LEP)?" The firm's new report, "Health Care Reform and Language Services," pinpoints 14 sections of "America's Affordable Health Choices Act of 2009" that will influence the nation's provision of health care interpreting and translation services.

"Numerous studies show that when patients cannot understand discharge instructions and treatment plans, they return to the hospital, which results in excess costs," comments Nataly Kelly, Common Sense Advisory senior analyst and lead analyst for the study. "By increasing the health care system's capacity to provide language services, the proposed legislation would help prevent wasteful spending on unnecessary procedures while improving societal health."

According to the 32-page report, the bill would make new funds available for language access, including 24 grants of up to US$500,000 for translation and interpreting services. The proposed legislation also addresses cultural and linguistic competence training for doctors, nurses, and other clinical staff. "This training is critical, because no matter how much funding is available for interpreting and translation services, health care workers must understand how to comply with the law and use language services properly," adds Kelly.

"U.S. Health Care Reform and Language Services" continues Common Sense Advisory's ongoing research and insight into the areas of language access, translation, and interpreting services. The report is available to members of Common Sense Advisory's research. More information is available at

About Common Sense Advisory

Common Sense Advisory, Inc. is an independent market research firm specializing in the on- and off-line operations driving business globalization, internationalization, translation, localization, and interpreting services. Its research, consulting, and training help organizations improve the quality of global business. For more information, visit


Melissa Gillespie
+1 760-522-4362