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Connecticut and Other States Seek “Best Practices” to Implement Health Care Reform


As the deadline to fully implement the Affordable Care Act nears, health care professionals gathered in Hartford on Monday to unpack mountains of data wrapped in regulations attached to the first major overhaul of the U.S. healthcare system since 1965.

This Act, also known as “Obamacare,” became a reality when President Barack Obama signed it into law on March 23, 2010. If implemented thoroughly, the Act would expand healthcare access and increase health coverage, key components to mitigate health disparities, experts say.

Enrollment for the program is set to begin Oct. 1, 2013. Medical coverage is to begin Jan. 1, 2014.

Some contend this Act could significantly address health disparities.

healthbeatlogo“I think it could have a major impact of health disparities because proportionally to the population, individuals who are more likely to be affected by the Affordable Care Act are people of color,” said Dennis P. Andrulis, a senior research scientist at the Texas Health Institute. Andrulis was one of about 200 public health researchers, policy makers, practitioners and other stakeholders who attended the Institute of Medicine’s daylong conference entitled, Achieving Health Equity via the Affordable Care Act: Promises, Provisions, and Making Reform a Reality for Diverse Patients, at the Mark Twain House on April 22.

Of the 6.8 million newly eligible Medicaid recipients, about 45 percent would be people of color, a figure that mirrors the demographics in the country. Consequently, more than 60 provisions in the ACA are related to race, ethnicity, language and cultural competency to reduce disparities in urban and rural America, Andrulis said.

The work to see this ACT implemented, which will cost $5.1 billion, includes community outreach. It also includes materials to be developed for people with limited English proficiencies, low medical literacy and low reading skills. And already resistance, manifested at various levels, has begun.

In Texas, Andrulis said, discussions are centered on how to navigate the penalties for opting out.  Already, 14 states have opted out. And 12 states are undecided. Since it was signed into law, the U.S. House Republicans voted 39 times to repeal Obamacare. In the coming months, health advocates expect there will be persistent attempts by conservatives to dilute the potential of the law. Of course, Andrulis said, it’s in the Obama administration’s best interest to ensure effective implementation of this act.

To implement this sweeping act, it will be necessary to engage communities at the grassroots level, said U.S. Rep. John Larson (D-1st), who with Gov. Dannel Malloy and Lt. Nancy Wyman gave opening remarks at the daylong conference.

Connecticut is one of several states that have already opted in and have begun to expand Medicaid. Malloy said that the legislature has just started deliberating over this “monumental task” of expanding access by setting up health care marketplace to sell insurance to about 242,000 uninsured people in Connecticut.

Part of delivering services to traditionally underserved population also includes diversify the workforce that serves them. Groups such as Access Health CT have also begun that process, according to Access CEO Kevin J. Counihan.

It’s uncertain, however, how much progress has been made toward implementing networks to engage health consumers in Connecticut. But officials said they are working to ensure health equity, a term bandied about by stakeholders.

And what exactly is health equity?

According to Medical Director of Community Benefit at Kaiser Permanente Winston F. Wong, health equity is the proposition that people in the United States should achieve optimum health without barriers related to their social status, such as income, race, ethnicity, immigration, sexual orientation and other social factors.

Such has been the case for decades, said Wong.

“If you look at the mortality among African American men, their risk ratio is 1.8 times that of their white male counterpart,” he said. “And that pattern has been there for more than 50 years. So we haven’t actually made much progress, particularly around African American males.”

Wong added that with the growing Asian and Latino populations, there is also a reflection of continued disparities, such as diabetes among Hispanics. According to a recent report, up to 50 percent of Hispanics will develop diabetes in the next generation.

So between now and October, there is an emphasis on reaching these population with new information that would help mitigate acute health disparities.

Ignatius Bau, a health researcher, and other health advocates said officials at the top must have meaningful engagement with communities of color, to not just tack their logos on websites as “nice partners” but to also provide significant financial support to have impact. Additionally, there needs to be robust efforts to inform these communities in a timely manner, not close to major deadlines.

Bau also suggested that to truly address the existing health disparities among patient centered health homes and clinics, state officials and other high-level stakeholders should consider the following recommendations:

  • Educate and engage diverse and vulnerable patients, families, caregivers about medical homes
  • —Sponsors/payers for medical home initiatives can highlight opportunities for disparities reduction/health equity, including additional requirements and payments
  • —Monitor standards specific to health equity for compliance and improvement
  • Develop and disseminate technical assistance to medical home practices  on achieving health equity
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