May 2006

In this Issue:

New Resources

• National Health Policy Training Alliance for Communities of Color: Agenda and speaker presentations from its health journalism training
• The Children’s Defense Fund: Improving Children’s Health: Understanding Children’s Health Disparities and Promising Approaches to Address Them
• The Congressional Black Caucus Health Braintrust: Virtual town hall meeting webcast on Medicare Part D

Activities in the Field

Policy Updates  
   
     Medicare Part D
     Medicaid

Reflections From the Field

Upcoming Events

New Resources

If you missed the recent health policy journalism training conducted by the National Health Policy Training Alliance for Communities of Color, you can view the full agenda and speaker presentations online. [Click here]

The Children’s Defense Fund has released Improving Children’s Health: Understanding Children’s Health Disparities and Promising Approaches to Address Them. This report begins with an overview of health disparities, focusing on the stark racial and ethnic differences in health that exist among children and how differences in health coverage and income affect those disparities. A number of community- and state-based programs are profiled as examples of promising approaches to addressing these disparities. To request a copy of this report, please e-mail cdfhealth@childrensdefense.org.

The Congressional Black Caucus held its annual Spring Health Braintrust on April 26 and 27. In addition to a full-day discussion of health disparities and how to reframe the minority health debate, the Braintrust also hosted a virtual town hall meeting on Medicare Part D. To view the webcast of the meeting, click here.

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Activities in the Field

Health Care for All (HCFA), a Boston-based advocacy organization dedicated to expanding high-quality, affordable health care to all people in Massachusetts, has taken a leading role in efforts to reduce racial and ethnic health disparities. Recently, the Boston Public Health Commission awarded Health Care for All a one-year planning grant to examine the role of private insurers in reducing racial and ethnic health disparities.

In the first phase of the project, HCFA completed formative research and key interviews with Boston-focused health insurance companies and one national insurer. Project participants included Aetna, Tufts Health Plan, Harvard Pilgrim Health Care, Blue Cross Blue Shield of Massachusetts, and Neighborhood Health Plan.

HCFA began the second phase of the project on April 21, 2006. During this phase, HCFA is convening a working group of insurers and disparities reduction advocates to:

• develop ongoing collaborative relationships that inform insurance company efforts to address disparities among their membership, and 
• identify potential programmatic or policy solutions that can be pursued by insurers in the future.

At the first working group meeting, HCFA presented the initial findings from the project’s first phase and facilitated a discussion of areas that will be pursued in the future.

The working group will reconvene in June to focus on key interest areas and potential action steps around advocate and insurer identified issues, including:

• Collecting racial and ethnic data,
• Internal organizational and provider training, 
• Ancillary programming, 
• Collaborative work with communities of color,
• Covered benefits, and Plan marketing.

For more information about this project and any of Health Care for All’s disparities efforts, please contact cwatson@hcfama.org.

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Policy Updates

Medicare Part D

The May 15 enrollment deadline for Medicare Part D has passed, leaving up to 4 million seniors who did not enroll in the program without prescription drug coverage for the rest of the year. Many of the eligible beneficiaries who did not enroll will now face a substantial lifetime penalty if they choose to sign up later. The penalty (which is calculated by raising an individual’s monthly premium by 1 percent for each month the person delays enrolling in a plan after the deadline) could make prescription drug coverage unaffordable for many of those who missed the May 15 deadline.

Evidence has emerged suggesting that racial and ethnic minorities have been disproportionately left behind by Part D. While the prescription drug benefit has extended drug coverage to many seniors who previously lacked access to affordable drugs, more than 2 million eligible racial and ethnic minorities were not enrolled in a plan with prescription drug coverage as of May 7, barely a week before the enrollment deadline.

What’s more, although the new program offers significant subsidies to low-income seniors to help make prescription drugs more affordable, only about one out of four seniors who are eligible for these subsidies (also called “Extra Help”) are actually receiving them. This is a particular problem for minorities, since they make up a disproportionate share of the low-income population. However, without specific enrollment data on race and ethnicity, it is impossible to accurately gauge the impact the program has had on communities of color. It is unquestionable, however, that the program has not reached its full potential to reduce racial and ethnic disparities among the Medicare population.

For more on Medicare Part D and its role in low-income populations, read Families USA’s recent report, The Medicare Drug Program Fails to Reach Low-Income Seniors. You can find the latest information from Families USA on Medicare and the prescription drug benefit by going to www.familiesusa.org/issues/medicare.

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Medicaid

Two states, Kentucky and West Virginia, have recently made changes to their state Medicaid benefit packages that will affect many of the low-income children and parents enrolled in the program. They are the first states to have benefit package changes approved by the federal government since the passage of the Deficit Reduction Act of 2005 (DRA), which made it easier for states to “tailor” Medicaid benefit packages to specific populations.

The new packages will offer different sets of benefits for different groups of individuals. This is a dramatic departure from Medicaid’s traditional structure, which ensured that all beneficiaries had access to the same medical services and benefits (with few exceptions). Under the new state plans, many parents and children in Kentucky and West Virginia who are enrolled in Medicaid could face higher costs and reduced services. Depending on the specific plan they enroll in and their particular circumstances, some beneficiaries might have more restricted access to prescription drugs and necessary medical services than other beneficiaries in the same state.

Such attempts to restructure Medicaid almost always have the effect of disproportionately hurting racial and ethnic minorities. In Kentucky, for example, 23 percent of all non-elderly African Americans are enrolled in Medicaid. In comparison, only about 1 out of 7 whites in the state are enrolled.

Families USA will be monitoring the implementation of these changes in the coming months. To learn more about the DRA and what changes you should be on the lookout for in your state, read our Medicaid Alert series and view our Medicaid Waiver Tool Box.

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Reflections from the Field

Out of Many, One: Closing Racial and Ethnic Health Gaps through Unified Action
Ruth T. Perot
Executive Director and Chief Executive Officer, Summit Health Institute for Research and Education, Inc. (SHIRE)

“Out of Many, One” resonated deeply as a fundamental truth as I moved among the throngs gathering at the mall. The phrase had been used to headline a newspaper article on immigrants and their supporters who gathered to protest punitive legislation in early April.1 It was equally appropriate as a theme for the protestors who gathered a few weeks later to seek justice for those suffering in Darfur. I was present on both occasions and experienced once again the potential power of “oneness.” It is that same “oneness” that ended de jure segregation in the United States and apartheid in South Africa. It is the power that can transform our country’s “sick care” non-system into a culturally appropriate, integrated and holistic network of services, reflecting a national consensus that the optimal health and well-being of all U.S. residents is the nation’s highest priority.

“Out of Many, One” resonated further because Summit Health Institute for Research and Education, Inc. (SHIRE) has served as co-founder and secretariat for an organization with the same name—Out of Many, One (OMO)—a national, multicultural advocacy coalition. Since 2000, we have charted and pursued a shared course of action to attain health parity for the five communities of color categorized as minorities by the Office of Management and Budget. Although our goals and strategies have been modified over time to address changing circumstances, OMO’s vision remains intact and continues to inspire and energize:

We believe that the attainment of the highest level of health and quality of life is a basic human and civil right. We embrace a vision of healthy communities that respect diverse cultural and spiritual values and empower all people—individuals and families—in a loving, holistic, healing and compassionate manner. We are committed to develop diverse leadership to build healthy  environments and a prosperous, just and humane society . . .

This vision has served to unite organizations representing Native Hawaiians and other Pacific Islanders, Hispanics/Latinos, American Indians and Alaska Natives, African Americans, and Asian Americans. OMO’s vision also calls us to action as we address current issues. For example, we continue to advocate for collecting racial, ethnic, and primary language data to determine whether communities of color are benefiting from public and private health services and initiatives. We are focusing attention on worsening disparities among certain populations and subpopulations (e.g., Latinos/Hispanics) and the possible over-representation of people of color among the millions of eligible persons who have not yet enrolled in Medicare Part D. 

OMO has also sought to prevent the dilution or diversion of resources from efforts targeting racial and ethnic disparities in favor of other disparity categories, such as gender, disability, geography, and socio-economic status. All disparities are important, but we are wary of proposals that would result in “robbing Peter to pay Paul.” These suggestions frequently represent unfunded mandates that would stretch limited resources targeted for racial/ethnic disparities to cover additional groups.

We believe further that focusing on quality improvement approaches for everyone as a means to reduce racial and ethnic disparities may run the risk of leaving in place persistent gaps in health outcomes (e.g., coronary angiography, glucose and cholesterol control). An additional risk, once again, is stretching funds devoted to closing gaps between minorities and the total population to cover a much broader group.

Powerful forces are beginning to gather to thwart our advocacy efforts as we move inexorably toward a future where the word “minority” has less and less meaning. Challenges to the very concept of health disparities are emerging. Recently, a team of researchers posited that non-minorities actually face greater quality risks. Further, pitting one group against another has worked in the past to halt many movements for social change. It is therefore more important than ever to create and maintain a sense of “oneness,” informed by strategic thinking and planning. SHIRE and OMO have joined forces to create a resource document, Building Coalitions among Communities of Color/A Multicultural Approach, that provides specific strategies and action steps.

We applaud the Minority Health Initiatives program of Families USA and other national, state, and community-based advocacy groups for supporting and partnering with coalitions and organizations representing communities of color. Pooling our power and maximizing our influence to achieve social justice is an important mandate. But acting collectively as people committed to one another’s well-being is also a prerequisite if we are to transform health care in this country, ultimately serving everyone “in a loving, holistic, healing, and compassionate manner.”

For references cited in this piece, or for more information on SHIRE, please e-mail shire@shireinc.org.

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Upcoming Events

• Health Care for All is hosting a Health Disparities Policy Conference on June 13, 2006. This conference, which will take place in Shrewsbury, Massachusetts, will examine the latest local, state, and national disparities data and determine how to use it for policy change. To learn more about the conference, click here.
• The University of Texas M. D. Anderson Cancer Center is hosting the 4th annual Disparities in Health in America: Working Toward Social Justice summer workshop. The workshop will take place from June 24-30, 2006, in Houston, Texas.
• 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 Alliance on Mental Illness is hosting a summit in Washington, DC called Eliminating Disparities: Multicultural Strategic Summit. This event, which will take place from June 28-July 2, 2006, will focus on disparities in the mental health field and will bring together leaders from around the country.
  
  

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