CIVIL RIGHTS PROTECTIONS REINFORCED UNDER THE AFFORDABLE CARE ACT

CIVIL RIGHTS PROTECTIONS REINFORCED UNDER THE AFFORDABLE CARE ACT *

Some of the most important provisions for Latinos in the health reform law don’t have to do with health † insurance. While the coverage expansions in the Affordable Care Act (ACA) are paramount when it comes to improving Hispanics’ health care access, the law also includes a number of other provisions that will reinforce civil rights protections and advance health equity for communities of color.

Just a few generations ago, many parts of the U.S. operated entirely separate hospital systems, rigidly segregated by race. In the 1960s, federal civil rights laws and creation of Medicare were fundamental to hospital integration, as health systems were to integrate as a condition of federal Medicare ‡ reimbursement. The ACA emphasizes and fortifies protection from discrimination in health care settings, both explicitly and through key provisions designed to measure health care improvements and hold systems accountable to diverse patients’ outcomes. See Box 1 for Ana’s story, which illustrates the need for all of these components of the law.

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Protection from discrimination in health care settings. For the first time, the health law explicitly extends federal protections, including Title VI of the Civil Rights Act and other important civil rights laws across the health system. Section 1557 of the ACA prohibits discrimination or exclusion from participation in health programs and activities receiving federal funds or that are administered or established by the federal government. This applies to unequal treatment based on race and national origin (which includes discrimination based on language) as well as other protected classes such as sex and disability status.

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Investments in diversifying the health care workforce. The law makes substantial investments in the workforce through incentives, scholarships, and programming that will increase the number and diversity of health care providers. Programs such as the National Health Service Corps and the Title VII Health Professions program will increase the recruitment and retention of providers from communities of color and meet more of the primary care demands in medically underserved areas. The ACA also establishes programs to advance cultural competence training and recognizes the critical role that community health workers (promotores de salud) play in promoting health and providing culturally and linguistically appropriate care.

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Improvements in health care delivery and prevention. Research has found that in some instances, Hispanics and other people of color receive lower quality care than their non-Hispanic White peers in the same scenario. By measuring quality of health care and health outcomes, health care systems can better identify disparities and measure improvements. The ACA supports innovative strategies to improve health care quality through better coordinated care and communication, focusing on patient experiences. It also encourages innovation and reduced error in health care settings by exploring the payment and reward of providers based on good health outcomes. The law establishes important roadmaps for promoting health and wellness across systems, including the National Quality and Prevention Strategies. In both cases the law requires

The terms “Hispanic” and “Latino” are used interchangeably by the U.S. Census Bureau and throughout this document to refer to persons of Mexican, Puerto Rican, Cuban, Central and South American, Dominican, Spanish, and other Hispanic descent; they may be of any race. Furthermore, unless otherwise noted, estimates in this document do not include the 3.7 million residents of Puerto Rico. † This fact sheet was authored in June 2012 by Kara D. Ryan, Senior Research Analyst with the Health Policy Project in the Office of Research, Advocacy, and Legislation at the National Council of La Raza (NCLR). NCLR is the largest national Hispanic civil rights and advocacy organization in the U.S. ‡ June Eichner and Bruce C. Vladeck, “Medicare As A Catalyst For Reducing Health Disparities,” Health Affairs, 24 No. 2 (March 2005): 365-375.

CIVIL RIGHTS PROTECTIONS REINFORCED UNDER THE AFFORDABLE CARE ACT that the strategies developed must incorporate plans to identify and address the needs of vulnerable populations, including racial and ethnic minorities. 

Accountability through data collection and reporting. It is difficult to improve gaps in health care access and quality when they are hidden. Section 4302 of the health care law requires data to be collected and reported by race, ethnicity, primary language, sex, and disability in all health programs. While this provision still requires funding to be fully implemented, the administration has already released standards for the mandatory categories which currently apply to national population health surveys that are critical in measuring the health of American communities.

Health administrators are also testing the data collection procedures for LGBT populations. This more comprehensive data collection can increase accountability in the health system by allowing researchers, policymakers, and advocates the ability to more rapidly identify and respond to disparities in access, quality, and health outcomes.

Box 1. Disparate Treatment at the Doctor’s Office The ACA reinforces civil rights protections for Latinos and other underserved communities, protections that are still essential despite decades of progress toward equity. In fact, health care providers may treat Latinos and other communities of color differently without making a conscious decision to do so. All of the provisions profiled above—nondiscrimination provision, workforce investments, quality improvement, and data collection—can play a role in promoting equal treatment for Hispanics in health care settings.

Take one Oregon mother, Ana, who spoke up when she felt her physician had profiled her insurance status based on her ethnicity. She explains, “I went to my private doctor to take my son—he had hurt himself in a sport—and she was a different doctor, she did not know us. She wrote on the paper ‘no insurance’ and she sent us to get X-rays. Back when my son was a baby, we didn’t have insurance but [this time] she never checked. I think she looked at my face, saw that I was Mexican, and assumed that I did not have insurance. I felt very bad—I asked the department, ‘Do you want my insurance card? Because [the doctor] wrote that I don’t have insurance, and I do.’ They said ‘Yes, of course, so sorry,’ and I even spoke to the people in the clinic about the experience. Even the doctor came back to talk to me and she said, ‘I don’t know why I even wrote that.’ I told her, ‘You did and I just want you to know that you can’t do things like that, you just can’t make those decisions just like that.’

Although Ana’s son received the care he needed, the physician’s assumption about the family’s insurance status could potentially have played a role in the treatment and follow-up instructions for his injury. Investments in a more culturally competent workforce, together with antidiscrimination protections, are important steps to reduce bias—explicit and implicit—at the doctor’s office.