Short Paper 9: The ACA and Health Disparities

Prepared by: Deborah A. Reid and Doreena Wong*
Introduction
This Short Paper examines provisions of the Patient Protection and Affordable Care Act (ACA) that address health disparitiesfor particular communities and identifies areas where further development is needed to address disparities.1
Our discussion focuses on some of those provisions addressing data collection, prevention of chronic illnesses, workforce development, and quality improvements. As the paper will note, although these provisions offer a blueprint for improving the health status of underserved people; unfortunately, the ACA does not guarantee that funding will be available to ensure adequate implementation.
Background
The goals to obtain improved life expectancy and overall health have remained out of reach for many communities of color, particularly for low-income communities. Quality of health care is often affected by factors such as an individual?s economic status, race, and gender.2 According to a National Vital Statistics Report, ethnic minority groups continue to have noticeably shorter life expectancies than whites, due to factors such as disproportionate burdens of disease and lack of access to health care.3
The ACA recognized the need to eliminate health disparities. In the health care workforce title, the ACA defines a population as a ?health disparity population? if there is a
significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population . . . includ[ing] populations for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to or satisfaction with such services as compared to the general population.4
 
Discussion
The ACA provides several initiatives geared towards addressing health disparities for underserved populationsthrough general areas of data collection, prevention, workforce development, and quality improvement strategies. It should be noted that some of the ACA?s new grant programs that impact health disparities are authorized but funds have not yet been actually provided. Many of these provisions include statutory language to authorize funding in the amount of ?such sums as necessary for FY 2010 ? FY 2014? (?such sums as necessary? hereinafter referred to as ?SSAN?).5 Funding for new discretionary funding programs must be provided by congressional appropriators, who may decline to fund new activities and programs. Accordingly, although these provisions were included in the ACA, some may not become funded, except if actually included in the appropriations process.
The ACA also amended and authorized new funding for existing discretionary grants through the Public Health Service Act.6 In addition, other ACA prevention programs have mandatory funding through the ACA?s Prevention and Public Health Fund.7
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