June 2006

In this Issue:

New Resources

• Office of Minority Health: A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations
• Families USA: Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices
• Families USA: State Health Beat e-newsletter
• Pediatrics: "The Changing Face of Race: Risk Factors for Neonatal Hyperbilirubinemia" 
• Milbank Quarterly: "Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care"
• UCLA Center for Health Policy Research: “Language Barriers Pose a Risk for California HMO Enrollees”
• GWU School of Public Health and Health Services: The Legality of Collecting and Disclosing Patient Race and Ethnicity Data

Activities in the Field

Policy Updates  
   
     Medicare Part D
     Medicaid

Upcoming Events

New Resources

In response to growing concerns about racial, ethnic, and language disparities in health and health care, along with the need for health care systems to accommodate increasingly diverse patient populations, the Office of Minority Health has developed A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations. This guide is intended to help health care organizations implement effective language access services to meet the needs of their limited-English-proficient patients, as well as to increase patients’ access to health care.

Families USA has released a report that examined the prices charged by Medicare Part D drug plans. The report found that virtually all Part D plans have raised their prices for the majority of the top 20 drugs prescribed to seniors. The report, Big Dollars, Little Sense: Rising Medicare Prescription Drug Prices, also compared the prices that Part D plans charge with the prices secured by the Department of Veterans Affairs (VA). It found that, for each of the drugs studied, the lowest Part D plan price was always higher than the lowest price secured by the VA.

Families USA has also recently launched an e-newsletter called State Health Beat. This e-newsletter highlights new and interesting campaigns and tactics that state health care advocates are working on across the country. To subscribe to this e-newsletter, click here and check the box called “State Health Beat.”

Medical professionals often take into account a patient’s race or ethnic background when diagnosing conditions or determining treatment options. For the condition known as hyperbilirubinemia, an acute and potentially devastating form of neonatal jaundice, hospitals use the race of the newborn's mother to predict risk. Black newborns are at lowest risk for developing the condition. However, a new study, “The Changing Face of Race: Risk Factors for Neonatal Hyperbilirubinemia,” found significant disparities between the race assigned to mothers of newborns by hospital staff and those mothers' self-described race, a discrepancy that could potentially undermine efforts to identify and treat the condition. For more information on this report, which was published in Pediatrics, please click here. 

A new report published in Milbank Quarterly analyzes efforts underway in the United States and the United Kingdom to address racial and ethnic disparities in health care. These efforts range from establishing national public health goals to report cards that are compiled at every level of the health system. To read the report, "Evidence into Policy and Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle Disparities and Inequalities in U.S. and U.K. Health and Health Care," please click here.

Findings from a new study indicate a need for language services for members of both commercial and public program HMOs. Among California’s adult HMO enrollees ages 18 to 64, 3.4 million speak a language other than English at home, and of those, almost 30 percent report not being able to speak English well or not at all. More than 1 million of these HMO members with limited English proficiency (LEP) are at risk of facing problems with obtaining health care services and receiving quality treatment. The new study, “Language Barriers Pose a Risk for California HMO Enrollees,” emphasizes that health plans must continue their efforts to identify the language preferences of all their LEP members and tailor their language services programs to meet the needs of their diverse clientele. To learn more about this study, please click here.

A new policy brief from the Department of Health Policy at George Washington University closely examines whether the collection of patient data by race or ethnicity, as part of a program for quality improvement, violates the law. The brief, The Legality of Collecting and Disclosing Patient Race and Ethnicity Data, affirms that it is legal to collect and report health quality data by patient race and ethnicity. Furthermore, the report calls for government guidelines to further encourage and shape the practice of data collection by race and ethnicity.

[Return to top] 

Activities in the Field

The New Orleans Area Health Disparities Initiative is a project focused on addressing post-Katrina rebuilding efforts and creating safer and healthier communities. As part of this initiative, the Poverty and Race Research Action Council (PRRAC), the Health Policy Institute at the Joint Center for Political and Economic Studies, and the Alliance for Healthy Homes helped to organize a meeting on June 12, 2006, to highlight local responses to health disparities in communities of color. The meeting included New Orleans-based and national racial and environmental justice, legal, and health research and advocacy organizations. The Initiative is related to a larger series of meetings supported in part by the W.K. Kellogg Foundation that brings together public health researchers, community organizers, and advocates in racially divided metropolitan regions to share their efforts to address health disparities.

The focus of the meeting in New Orleans was health justice—fairness in targeting resources and redressing structural racism and economic discrimination faced by low-income communities of color. During the meeting, the participants considered the following objectives:

• Establishing a new framework for understanding and talking about health disparities that is grounded in the geographically specific history of race and class in the New Orleans area;
• Building new partnerships for eliminating health disparities that cut across traditional boundaries of health, science, the environment, jobs, wages, fair housing, and legal services;
• Implementing new community development and environmental training programs for community leaders;
• Securing health coverage for all residents of New Orleans; and
• Saving Charity Hospital and similarly challenged New Orleans health care providers and institutions.

For more information on the New Orleans Area Health Disparities Initiative, please contact Philip Tegeler, Executive Director, Poverty & Race Research Action Council, at ptegeler@prrac.org or by phone at 202-906-8024.

[Return to top]

Policy Updates

Medicare Part D

Since the start of the new Medicare drug program in January—a program hailed by President Bush and his congressional allies as a solution to the unaffordable drug expenses facing many seniors and people with disabilities—there has been considerable debate about how many Medicare beneficiaries actually have gained coverage because of the program and whether the program has been successful in enrolling those most in need. However, one question has been largely ignored in the national discussion about Part D: How have the more than 8 million racial and ethnic minorities in Medicare fared under the new program?

Unfortunately, it is impossible to assess the impact of Part D on minority communities, because there is a dearth of data available that include enrollment by race and ethnicity. This is a major shortcoming because, in many ways, racial and ethnic minorities had the most at stake under the new drug progeam. Compared to whites, Medicare beneficiaries from communities of color are much more likely to depend entirely on public programs to cover their health care costs. The poorest and most vulnerable Medicare beneficiaries—those who qualify for both Medicaid and Medicare, known as dual eligibles—are disproportionately from racial and ethnic minority groups. And while most white Medicare beneficiaries have private supplemental coverage (either through employer-based plans, Medicare Advantage, or so-called “Medigap” plans) to fill the holes in coverage left by traditional Medicare, more than half of all minorities rely either entirely on Medicare or on Medicare and Medicaid together. Because racial and ethnic minorities in Medicare were more than twice as likely as whites to lack supplemental health insurance (and thus private drug coverage) prior to Part D, the drug program had enormous potential to improve access to affordable prescription drugs for communities of color.

To complicate matters, the data on minority enrollment in Part D that have been released so far have been extremely misleading. For example, according to a June 9 article in USA Today, federal officials have reported that 70 to 75 percent of eligible African Americans, Asians and Pacific Islanders, and Latinos joined or were automatically enrolled in Part D. Many of those included in this count, however, often had more comprehensive and affordable drug coverage through Medicaid before Part D began. Others are continuing their coverage with former employers.

Because of these gaps in data collection, it is unclear how many racial and ethnic minorities actually have benefited from the program by receiving drug coverage for the first time or by being enrolled in the Low Income Subsidy. It is also unclear what the federal agencies responsible for administering the program are doing to target low-income minority communities and to ensure that the Medicare beneficiaries who stand to benefit the most from the program are enrolling at the highest possible rate.

These are important issues that CMS and the Social Security Administration should address in future reports on the program. In order for Part D to reach its maximum potential, Medicare officials must ensure that the program is reaching those who need it the most. 

[Return to top]

Medicaid

On Friday, June 9, with just three weeks until the law goes into effect (and after most people had gone home for the weekend), the Centers for Medicare & Medicaid Services (CMS) issued guidance to states on implementing the new citizenship documentation requirement for Medicaid. This new law requires that the 51 million U.S. citizens currently enrolled in Medicaid provide documentation of their citizenship status and their identity starting on July 1. Furthermore, after July 1, new applicants will no longer be able to enroll in Medicaid until they have successfully proven their citizenship status and identity.

Undoubtedly, certain groups will be disproportionately hurt as a result of this requirement, including elderly African Americans who may have never been issued a birth certificate, those who live in rural areas, people with disabilities, and those who have been forced to leave their homes as a result of emergencies or natural disasters. Moreover, the new requirement has caused widespread confusion among many Latino and Asian and Pacific Islander citizens and immigrants.

The Administration had almost five months before the July 1 implementation date to help states prepare for this transition and to publish guidance for state Medicaid directors. Instead, CMS officials waited until June 9 to issue guidance to states struggling to figure out how to document the citizenship status of all of their Medicaid enrollees. What’s more, the guidance issued by CMS requires that states verify citizenship following a strict protocol that discriminates against many of those who do not have either a passport, birth certificate, or government-issued photo identification.

This is an unnecessary requirement that will hurt the most vulnerable Americans in Medicaid. In particular, some elderly African Americans who were born outside of hospitals might find themselves unable to prove their citizenship. Others, such as individuals with Alzheimer’s disease or other cognitive disabilities, might not even understand the new requirement or be able to obtain photo identification to prove their identity. The guidance issued by CMS does not provide exceptions for many of these individuals, and the result of the requirement will be that many Americans will be denied health care services.

In Congress, both Senator Akaka (D-HI) and Congresswoman Christensen (D-VI) have introduced legislation to repeal the requirement, but in the meantime, advocates can help mitigate the harm caused by the requirement once it is implemented. It is important for advocates to ask their states how they plan to implement the documentation requirement so that the burden does not fall on applicants and beneficiaries. Advocates can also play an important role in informing others about the requirement and making clear that this provision does not affect Medicaid eligibility for legal immigrants.

[Return to top] 

Upcoming Events

• The University of North Carolina School of Public Health Minority Health Project and the Morgan-Hopkins Center for Health Disparities Solutions are hosting the 12th Annual Summer Public Health Research Institute and Video Conference on Minority Health. The conference will be broadcast from UNC-CH on Monday, June 26, 2006, and from Morgan State University on Wednesday, June 28, 2006. For broadcast information, please visit: www.minority.unc.edu/institute/2006/.
• The National Association for the Advancement of Colored People is hosting their 97th annual NAACP Convention in Washington, DC. This convention will take place July 15-20, 2006, and will include a health symposium and luncheon immediately prior to the opening of the Health Fair and two health workshops on Monday July 17, and Wednesday July 19. For more information, please visit: http://www.naacp.org/events/convention/convention_index.html.
• The National Association of Black Journalists is hosting their 31st Annual Convention and Career Fair in Indianapolis, Indiana from August 16-20, 2006. The National Health Policy Training Alliance for Communities of Color is hosting a breakfast panel on health policy and health disparities that will take place on the morning of August 18, 2006. For information on the convention, please visit: http://www.nabj.org/conventions/2006/index.html. 
  
  

 [Return to top]