Disparities in health care in the United States continue to exist. Factors associated with health care disparities include race, poverty, and gender. Factors contributing to racial/ethnic health care disparities include socioeconomic factors, lifestyle behaviors, social environment, racial/ethnic discrimination and access to preventive health care services. Among minorities, African Americans endure unacceptable health disparities and are most often not in a position to influence policy and actions that lead to changes that could eliminate disparities.

 
According to the CDC, African Americans remain the least healthy ethnic group in the United States. In looking back at the progress made toward eliminating health disparities in Healthy People 2010, disparities between the African American population and the population with the best rates increased for 34 objectives. Ten of those objectives were for death rates: neonatal and postnatal deaths, adolescent deaths, firearm-related deaths and homicides, diabetes-related deaths, and deaths due to HIV infection, coronary heart disease, stroke and cardiovascular disease among patients with chronic kidney disease. CDC data as recently as 2013 continues to reveal that African Americans often have the highest age-adjusted death rates of any ethnic group. Life expectancy at birth in the United States has increased from 1980-2014 for all, including African Americans. The gap in life expectancy between blacks and whites has decreased from 5.2 years in 1980 to 3.4 years in 2014.

 My remarks on health disparities are presented as background information. The Affordable Care Act, which Congress is working to repeal and replace, has been changing the funding for hospitals, from a
systembasedonthe quantity of patients and procedures to one focused on quality of care. Under the Affordable Care Act, many of the responsibilities that have traditionally been those of public health were incorporated into the “Community Health Plan” of hospitals and the expansion of Medicaid. This change in the basic protocol of healthcare delivery offers a significant opportunity for African Americans and other under-represented minorities to insert themselves into the health care infrastructure.


Not all states have participated in the Medicaid expansion under the Affordable Care Act. This has resulted in negative consequences for access and the health status of minorities and the poor. Some states with higher percentages of African American populations are among the 17 states that have rejected Medicaid expansion. According to the Kaiser Foundation, 40% of eligible African America adults live in states rejecting Medicaid expansion. They are twofold more likely than whites to remain uninsured.

 In addition, a study showed that in states not expanding Medicaid, low-income adults aged 18-64 were more likely to be African American and reside in rural areas, than in states expanding Medicaid. They were also less likely to have a usual source of care and preventive services.

 The changes in
health care
recently approved by the House of Representatives and not passed by the Senate have in common, the major contraction of Medicaid as a funding source for providing health care. There is a consensus that if the ACA is finally repealed and replaced as is being attempted by Congress up to 22 million fewer people will be insured over the next decade. Clearly, as in the past, a disproportional number of the uninsured Americans will be African American and other minorities.