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Health and Race: Reforming Care in Communities of Color

The Patient Protection and Affordable Care Act will give minorities far greater access to medical services.

The federal healthcare reform law will present enormous opportunities for communities of color, which have long suffered from higher rates of chronic illness and far less access to care. But residents will need to educate themselves about the changes to come and accept a healthy dose of individual responsibility for the measure to be successful.

That was the message from a panel of experts that gathered this week at Rutgers Newark campus for a forum hosted by the New Jersey Public Policy Research Institute (NJPPRI), the New Jersey Medical School, and the University of Medicine and Dentistry of New Jersey’s college in Newark. The session, "Prescription for Healthcare Reform: Implications for Communities of Color,” was designed to start a conversation with the community about the new law. Organizers also provided a list of resources to help the audience, which included a mix of community leaders, healthcare providers and policy experts, learn more.

To take full advantage of the benefits the law will bring, residents will need to spread the word in their communities about how the law works and to come together to voice their needs and concerns to policymakers and elected officials, the panelists said.

But that's only part of the picture. In order to reduce the chronic illnesses that are prevalent in these communities, residents must make basic lifestyle changes, asserted Dr. Robert L. Johnson, the dean of NJMS.

"Your primary care provider cannot change your weight, or change your blood pressure, or go out and exercise for you," he said, eliciting a few knowing sighs from the audience.

No Miracle Cures

While America is known for its ability to perform medical miracles, far too many residents must go without basic, preventative healthcare, explained Johnson. The problem is exacerbated in black and Latino neighborhoods, where doctors are hard to find and the impact of chronic diseases – like obesity, diabetes and asthma – is all too common.

The healthcare reform law, signed by President Obama in March of 2010, may well provide some relief. The primary goal is to get 32 million more Americans enrolled in health insurance plans. Experts predict the reform could benefit roughly 600,000 of the 1.3 million New Jersey residents who now lack coverage. Ray Castro, with the liberal think tank New Jersey Policy Perspective, noted that more than half of these uninsured residents are minorities.

To meet this goal, the law – technically the Patient Protection and Affordable Care Act – will greatly expand access to Medicaid, allowing millions of working people who now earn too much to qualify to enroll in the subsidized program, which is funded by the state and federal government. It will also provide tax-credit subsidies to individuals with higher income levels, and some small businesses, to help them purchase insurance on their own through exchanges, or state-run marketplaces for private plans that meet a certain standard. Some elements of the law have already taken effect, but the bulk of these provisions will start in 2014.

But Laurie Ehlbeck, state director for the National Federation of Independent Businesses, said her members are concerned the reform will actually drive up costs for individuals and business owners when the mandate takes effect. The law requires everyone to have health insurance and imposes a $95 fine for uninsured individuals, in 2014; businesses, depending on size, would pay between $750 and $3,000 per uninsured worker.

“It’s not that [employers] don’t want to offer insurance, it’s not that they’re being cheap. It is just so expensive,” Ehlbeck said.

But providing insurance isn’t a cure-all, the panelists agreed. There is already a serious lack of primary care physicians -- especially in urban areas – and the aspects of the law designed to help train more doctors, nurses and other caregivers "will not add up to enough' to meet the new demand, Dr. Johnson said. In Massachusetts, which has implemented a state reform similar to the federal measure, doctors are working seven days a week and still can’t fit in all the new patients, explained Assemblyman Herb Conaway (D-Camden), who is also a medical doctor.

Accountable Care

The law also encourages healthcare providers to form Accountable Care Organizations and Patient-Centered Medical Homes, two models that are designed to improve coordination, provide more appropriate patient treatment and keep down costs. Another element calls for creating an integrated system of electronic medical records, which could be accessed by multiple doctors and viewed by patients. Johnson said it is important that minorities push to ensure their communities are fully included in these aspects of the reform, encouraging them to organize and work with local and state leaders to make certain their neighborhoods get funding and demonstration projects.

But panelists stressed that regardless of the government’s efforts to help people access appropriate and affordable care, preferably near their homes, individuals will have to step up if they want to improve their own health and the wellbeing of their communities. Johnson said that 75 percent of the $2.7 trillion spent on healthcare each year goes to treat chronic illness -- often things that people can help themselves to avoid.

Assemblyman Conaway warned that, given this backlog of untreated conditions, healthcare spending will surely rise at first when millions of people obtain insurance coverage and flood their doctors’ offices seeking treatment when the law takes effect in 2014. But over time, as patterns shift and fewer patients end up in emergency rooms -- where care is far more expensive -- costs will start to stabilize.

"But to truly bend this cost curve, individuals will have to make changes," Conaway added. Communities will need to come together to advocate for safe playgrounds and parks, where kids can play actively without fear, and for neighborhood supermarkets that sell a wider variety of healthy foods, he said, and patients must follow their doctors orders to stop smoking, take their medicine as directed, and start exercising more.

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