On January 27, the Senate Health, Education, Labor, and Pensions Committee held a hearing, “Access to Prevention and Public Health for High Risk Populations,” addressing common barriers to health care, including geographic isolation, un- and underinsurance, the elderly, and physical challenges.
Sen. Tom Harkin (D-IA) said, “Last month, Sen. [Edward] Kennedy [D-MA] asked me to chair the Prevention and Public Health Working Group. I’m convinced that [improving public health] has got to be the central focus of any reform legislation because we’ll never get costs under control unless we place a major emphasis on disease prevention while strengthening America’s health system.” He continued, “We’re in the early weeks of America’s great debate about health care reform. I’ve laid down a public marker of my own, saying that if we pass a bill that provides health insurance but does nothing to improve public health infrastructure, then we have failed the American people. I’ll lay down a second marker at this hearing: if we fail to seize this opportunity to improve public health services for vulnerable, at-risk populations, then that, too, would be a terrible failure.”
Ranking Member Mike Enzi (R-WY) said, “We need to move our system from sick care to health care and that means focusing on prevention, not intervention. It’s common sense an ounce of prevention is worth a pound of cure. Any earnest effort to expand access to health insurance, reduce health care costs, and improve quality of care must include targeted provisions to prevent and manage chronic diseases, and must ensure that patients in all areas of the country have access to these services.” He continued, “Chronic diseases are among the most common, most costly, and most deadly illnesses that patients face but they are also often the most preventable and most treatable. By helping patients across the country, particularly in underserved populations, prevent and manage these deadly diseases, we can save lives and money.”
Lisa I. Iezzoni, a professor at Harvard Medical School and associate director of the Institute for Health Policy, outlined some of the difficulties people with disabilities face in accessing health care. Dr. Iezzoni noted that women with physical challenges are more likely to be victims of domestic violence, but cautioned against relying on Department of Justice statistics, as many women do not disclose abuse out of fear of losing their primary caregiver. Discriminatory attitudes remain a major barrier to women seeking care: “Women of child-bearing age with major difficulties walking are 70 percent less likely than other women to be asked about contraception during routine physician office visits…Stigmatizing attitudes could contribute to these findings…Physicians may not discuss contraception with disabled women under another erroneous belief that they are not sexually active and at risk of unintended pregnancy.”
“Plentiful anecdotal reports suggest that basic equipment required for routine health and screening services is frequently physically inaccessible…Women with major difficulties walking are 40 percent less likely than other women to get Pap smears…Some women with major mobility problems report never having had a Pap smear because they cannot get onto the fixed-height examination table in their physicians’ office. Women with major difficulties walking are 30 percent less likely than other women to get mammograms.” Dr. Iezzoni also noted that communication difficulties may be exacerbated by financial pressure. The Americans with Disabilities Act prohibits health care providers from charging deaf or hard of hearing patients for interpreter services, but fees for such services, or fees associated with renovating an office to accommodate physically challenges patients, often exceed reimbursement.
Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation; Dr. David M. Stevens, director of the Quality Center and associate medical director at the National Association of Community Health Centers; Michael Meit, principal research scientist at the University of Chicago and deputy director of the Walsh Center for Rural Health Analysis; Dr. Joseph F. Hagan, Jr., a professor of pediatrics at the University of Vermont; and Dr. Robert Butler, M.D., president and CEO of the International Longevity Center, also testified.