“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.”
– Dr. Martin Luther King, Jr.

This is the first in a blog series highlighting the impact of structural racism in our health system.

Despite national and local efforts to address disparities, people of color continue to experience poorer health than their white counterparts, including higher rates of infant mortality, lower life expectancy and increased prevalence of chronic diseases. Health disparities among racial and ethnic groups are persistent and drive up the cost of care for everyone. The root causes of these disparities are the result of systemic racism within our health system and society. These causes are complex and interrelated and include social and economic determinants (such as income level, education, and living conditions in homes and neighborhoods). In recognition of National Minority Health Month, we felt it was important to unpack the systemic racism embedded in the final rule on market stability the Trump administration recently released.

Although we still have far to go in eliminating health disparities, the Affordable Care Act is a step in the right direction on health equity.

Thanks to the Affordable Care Act, people of color, especially Blacks and Latinos, have had major coverage gains over the past few years. Approximately 12.2 million people—32 percent of those are people of color—are currently enrolled in the marketplace. The uninsured rate for Latinos dropped from 36 percent pre-ACA to 29 percent in the first quarter of 2016. Similarly, the uninsured rates for Blacks dropped from 21 percent in 2013 to 13 percent in 2016. Expanding health insurance coverage is certainly a necessary condition for advancing health equity. However, it is not a sufficient one on its own. People of color face many barriers when accessing quality health care. According to the 2015 National Healthcare Disparities report, compared to their white counterparts, people of color experience significant disparities in both access to care and in the quality of care they received. Summarizing a range of access and quality measures, the report found that Blacks and Latinos had worse access to care on 14 of the 20 access measures than Whites. Blacks, Latinos and American Indians and Alaska Natives received worse care than Whites for about 40 percent of quality measures.

In contrast, in its first health care regulatory action, the Trump administration puts in place policies that disproportionately affect communities of color.

In an attempt to reduce the above disparities, the Affordable Care Act requires Marketplace health plans to include within health insurance plan networks at least 30 percent of essential community providers (ECPs), such as community health centers, family planning clinics, safety-net hospitals, Ryan-White AIDS providers and Indian Health Services Centers, that serve predominately low-income, medically-underserved individuals. These providers have been the primary source of care for populations with the greatest health needs. For women, particularly low-income women and women of color, clinic-based providers, family planning clinics and health centers, are important sources of reproductive and sexual health care. Many ECPs are also on the forefront of providing culturally and linguistically competent services and have worked hard to win the trust of their diverse patient base.

ACA statute and resulting regulations, while not as robust as we would like, are aimed at more equitable access to care for individuals and families who live in low-income and underserved communities, who are disproportionately people of color. Unfortunately, in the final rule on market stability, the Trump administration weakened ECP inclusion standards. For 2018, health plans will only need to include 20 percent (or even less) of ECPs within their network rather than 30 percent. A rollback on standards of essential community provider (ECP) disproportionately affect communities of color. This rule change will restrict access to health services, increase travel times to care facilities and reduce access to culturally and linguistically appropriate health care providers. At its core, the final rule reinforces systemic racism by perpetuating structural barriers to better health for people of color.

As we defend the ACA on all fronts, we must be vigilant in responding to and highlighting changes to rules and regulations that perpetuate structural racism.

The change in the ECP standards is just one example of harmful regulatory changes that rollback our efforts to promote health equity. Community Catalyst, alongside national, state and local partners, is working to protect the ACA from repeal but even during that fight, we must work together to amplify when and how ACA health equity provisions are reversed and/or diminished.

Thanks to thoughtful contributions from various teams at Community Catalyst, including the Private Insurance Team, The Children’s Health Team, The Substance Use Disorders Team and the Health Equity Executive Team.