Transcript Disparities-Related Opportunities and Challenges from National Health Reform Dennis P. Andrulis, PhD, MPH Senior Research Scientist, Texas Health Institute Associate Professor, University of Texas School.

Disparities-Related
Opportunities and Challenges
from National Health Reform
Dennis P. Andrulis, PhD, MPH
Senior Research Scientist, Texas Health Institute
Associate Professor, University of Texas School of Public Health
Nadia Siddiqui, MPH
Senior Health Policy Analyst, Texas Health Institute
October 6, 2011 | Issue Briefing | Washington, DC
The Safety-Net, Disparities, and
Affordable Care Act
• Working to eliminate health disparities is a central goal of
national health reform--dozens of provisions directly
support this goal.
• Safety-net providers “organize and deliver a significant
level of health care and related services to uninsured,
Medicaid and other vulnerable populations.”
• Racially and ethnically diverse patients make up nearly
two-thirds of those served by safety-net institutions.
• The Affordable Care Act holds much promise but
substantial risk for the safety-net, and, by implication, it
raises questions around who will care for diverse and
vulnerable patients they have traditionally served.
Opportunities & Risks for Safety-Net in Serving Diverse Populations
Opportunities
Risks
Health
Insurance
• 32 million newly insured by 2019
• Increased competition among
• Support for cultural/linguistic requirements providers for formerly uninsured
in outreach & enrollment
•If private sector targets more lucrative
markets, could be left with high cost
patients
Financing
Reforms
• Substantial support for health centers and
other safety net settings
• State grants for underserved areas
• Increases in Medicaid reimbursement for
primary care
• $18 billion reduction in
disproportionate share hospital
program—which finances 22% of
unreimbursed care at public hospitals
Workforce
Support
• Grant preference to institutions training
minority professionals
• Support for workforce diversity and
training in cultural competence
• Increase in scholarships for service in
underserved areas
• Sufficiency of workforce expansion in
relation to growth in insured
• Lack of appropriations—e.g.,
community health workers, cultural
competence curriculum
Delivery &
Payment
Innovation
• Improved care coordination for lowincome
• Medical homes for Medicaid patients
• Payment programs to improve quality and
continuity of care
• Many may lack infrastructure such as IT
• For some, low or negative operating
margins/lack of capital may limit ability
to innovate
Continuing and Growing Challenges
• Populations remaining at or beyond the margins—23
million uninsured—will continue to rely on the safety-net
– 11 million undocumented immigrants
– State/local safety-net financing possibly in jeopardy due to antipathy
toward undocumented and myth that “uninsured problem is solved”
• Timeline
– Financial pressures on safety-net in caring for 52 million uninsured
between now and 2014, given growth in uncompensated care, low profit
margins, and location of many in high-poverty areas
• Federal, State and Local Support
–
–
–
–
Budget cuts at all levels affecting safety net
State antagonism toward health care reform—e.g., lawsuits
Impending Supreme Court decision on insurance mandate
Change in presidential leadership?
Maintaining a Viable Safety-Net to Care for
Racially and Ethnically Diverse Populations
• Continued federal, state, local and philanthropic support
for safety-net providers to assist in transitioning and
continued care to large numbers of uninsured
• Risk adjusting payments for health status—e.g. multiple
chronic conditions, community/social determinants
• Reductions in disproportionate share hospital program
linked to measurable reductions in uncompensated care
• Collaboration of safety-net institutions with other
providers to leverage limited resources/take advantage of
innovation opportunities