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House Subcommittee Hears Testimony on Health Equity and Accountability Act

On June 24, the House Energy and Commerce Subcommittee on Health held a hearing to discuss H.R. 3014, the Health Equity and Accountability Act of 2007. Sponsored by Rep. Hilda Solis (D-CA), the bill would amend the Public Health Service Act (P.L. 87-838) to require the secretary of Health and Human Services to establish the Robert T. Matsui Center for Cultural and Linguistic Competence in Health Care, as well as provide for a variety of grants and programs that seek to mitigate or eliminate socioeconomic health care disparities.

Chair Frank Pallone (D-NJ) stated, “Though we as a nation have made tremendous strides in improving the health of all Americans, there remain significant inequalities with respect to both access to health care and the quality of care provided among different ethnic groups in this country. As numerous reports have been published highlighting these gaps in our health care system, it is clear that action must be taken to address these inequalities.” According to Rep. Pallone, “The Health Equity and Accountability Act targets the underlying causes of the current health disparity crisis, including racial, ethnic, gender, and rural disparities. The bill would strengthen educational institutions and reinforce efforts to ensure culturally sensitive health care, such as overcoming language barriers. It would support programs to address the shortage of health care providers focusing specifically on those that address minority health care providers. Finally, it would establish community-centric initiatives to improve health care services and eliminate health disparities among legal citizens.”

Rep. Solis stated, “Over the past decade, legal immigrant, non-citizens have faced increasing restrictions on access to federally funded health care services, such as the five-year waiting period for programs, such as Medicaid and [the State Children’s Health Insurance Program] SCHIP. H.R. 3014 is necessary to reduce the health inequities that Latinos and other communities of color face… It strengthens educational institutions, bolsters efforts to ensure culturally and linguistically appropriate health care, and removes language and cultural barriers. This legislation also strengthens and coordinates data collection. By investing in prevention efforts and in our health care system, H.R. 3014 will reduce costly emergency room visits and expensive medical errors.”

John Ruffin, director of the National Center on Minority Health and Health Disparities (NCMHD) at the National Institutes of Health, stated, “The Centers for Disease Control and Prevention reports that chronic diseases account for more than 75 percent of the annual $1.4 trillion for medical care costs in the U.S. The existence of health disparities is a complex economic burden that necessitates urgent, direct, and sustainable intervention…The body of research on health disparities emerging from the NCMHD and the other institutes and centers is starting to grow. Collecting, analyzing, interpreting, and translating the data and lessons learned is our commitment going forward. Research translation into culturally, socially, linguistically, and generation-appropriate tools is a high priority. Research is futile and we will have little or no impact in eliminating health disparities, if our findings cannot be translated into a user-friendly language for the community and health care provider.”

Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said, “We cannot ignore the evidence that certain groups persistently suffer worse health and worse health care. Both race and social class, independently and in combination, contribute to health inequalities in the United States. Lower income generally means worse health, and racial and ethnic differences in health status also persist.” She continued, “To be clear: Racial or ethnic disparities do not simply reflect differences in income…The data tells us only about black-white differences in care, not what is happening with the quality of care for Hispanic or Latino Americans, Asian Americans, or Native Americans. The Health Equity and Accountability Act would change that, ensuring the collection of data on both race and ethnicity, as well as on primary language. This regional approach is critical to reducing disparities because, like any quality problem, disparities do not look the same everywhere…Another essential step is increasing the quality and availability of health care language services for patients with limited English proficiency. Poor communication can lead to devastating, even deadly consequences for patients…The Health Equity and Accountability Act will not only support standards for language services, but also provide additional research on the barriers, cost-effectiveness, and best practices for delivering language services.”

Focusing on section 503 of H.R. 3014, which addresses optional coverage of legal immigrants under the Medicaid program and SCHIP, James Edwards, adjunct fellow at the Hudson Institute, expressed concerns regarding the “unacceptably vague and, therefore, dangerously abuse-prone” language regarding the bill’s “entitlement eligibility to ‘undocumented residents who are lawfully residing in the United States.’” Characterizing H.R. 3014 as “wide-reaching legislation and perhaps overly ambitious,” Mr. Edwards asserted that “This bill falls at the intersection of welfare, health care, and immigration policy. Any one of these is difficult to craft prudently and responsibly, so as to minimize adverse effects. Attempting to delve into all three policy areas at once could well prove risky.”

Dr. Sally Satel, resident scholar at the American Enterprise Institute, discussed “the determinants of health status,” stating that “efforts to improve the health of
minorities will be most successful when they target the factors associated with socioeconomic disadvantage that predispose individuals to poor health and suboptimal care. Such disadvantage is not limited to racial or ethnic groups.” Dr. Satel continued, “The key to making those interventions work is the ability to engage patients in their care. The initiatives described in H.R. 3014 are targeted at facilitating such engagement through improved patient-clinician communication. Patients who are more engaged in treatment, particularly those with chronic diseases, are more likely to take action in managing their conditions. The end-point measure of true success will be improvement in patient health. This health-promotion approach transcends race and applies to all individuals of lower socioeconomic status…the mere grind of being poor, the overwhelming personal and family and occupational problems, the social disruption and instability, and the lack of safety nets, pushes self-care into the background. The importance of watching one’s diet, exercising, checking blood glucose, quitting smoking or drinking, is surpassed by more pressing daily realities.”

Dr. Mohammad N. Akhter, executive director of the National Medical Association, stated, “disparities exist, and unless we commit to reducing or eliminating them they will persist, indefinitely.” Stating that the NMA is endorsing H.R. 3014 as a “[piece] of legislation seeking to improve the health status of minority communities and vulnerable populations,” Dr. Akhter added that “All our efforts are futile if we do not have an efficient way to measure progress.”

Janet Murguía, president and CEO of the National Council of La Raza, stated that “The Health Equity and Accountability Act (H.R. 3014) addresses many of the underlying barriers that limit access to care for Latinos and other racial and ethnic minorities by considerably improving the health care infrastructure. NCLR believes that Americans will be best served by passing this legislation in its entirety. The provisions of this bill are particularly important to improving the health care system for Latino families because they: restore access to critical programs for some lawfully residing immigrant children and pregnant women; encourage effective communication in health care settings; increase accountability in health care; and support community approaches to health care delivery.” She concluded, “H.R. 3014 provides policymakers with a road map for closing gaps in health care. It opens several points of entrance to the health care system for Latinos and immigrants and encourages measures for culturally and linguistically appropriate services. H.R. 3014 also provides financial resources for proven community-based programs to conduct health promotion activities, particularly in communities with low health literacy, and to expand and enhance outreach and enrollment efforts that open health insurance channels for Latinos and other Americans.”

Deeana Jang, policy director at the Asian and Pacific Islander American Health Forum, expressed the organization’s full support for H.R. 3014, citing “six important strategies included in H.R. 3014 that address disparities in coverage, access, and quality: standardizing the collection, analysis, and reporting of data on race, ethnicity, and primary language in an accurate and appropriate manner; ensuring that effective communication takes place between provider and patient through the provision of competent language assistance; removing barriers to enrollment in public health programs based on citizenship status; promoting a diverse and culturally competent health care workforce; increasing investment in community-based health promotion programs; and improving accountability and evaluation.”

Several members, including subcommittee Ranking Member Nathan Deal (R-GA) and Rep. Joe Barton (R-TX), expressed concern about an emphasis on race eclipsing the study of income’s effects on health disparities. Rep. Barton stated, “Data certainly show that some diseases seem to follow racial lines, but they also show that it’s how rich or poor you are that makes the much greater difference in health outcomes.” Dr. Lavizzo-Mourey disagreed, stating that “Even after controlling for income and education levels, disparities continue to exist.” Ms. Jang added, “Asian American and Pacific Islander communities are not homogenous, but lack of data on specific minority sub-groups mask the disparities that exist.”

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