Closing the Equity Gap in Health Care for Black Americans
As Americans focus on troubling racial divisions in the country’s criminal justice system, we should not forget that those divisions exist in other areas of our national experience. One is health care.
The U.S. health care system does not perform well for black Americans. On average they experience worse access to care, lower quality of care, and poorer health outcomes than the nation as a whole.
As a result, blacks are substantially more likely than whites to die early from health conditions considered at least partially treatable or preventable with timely and appropriate medical care. In 2012–13, the rate of death before age 75 from conditions such as hypertension, certain cancers, the flu, and diabetes was twice as high among black Americans as among white Americans. Among blacks, there were 155 premature deaths from health conditions per 100,000 people, compared with only 77 such deaths per 100,000 people among whites.
This striking inequity in preventable deaths stems in large part from persistent disparities in access to affordable health care. Black Americans remain more likely to be uninsured than whites, which may lead to problems accessing and affording care. In 2014, nearly one of four black adults ages 18 and older (24%) reported not having a usual source of care—defined as having a personal doctor(s) or health care provider(s)—compared with fewer than one of five whites (18%). Black adults were also more likely than their white counterparts to face cost-related barriers to care. Nearly one of five black adults (19%) reported there was a time in the past year when they could not see a health care provider when needed because of cost, compared to one of nine whites (11%).
Current changes in the health care landscape offer unprecedented opportunities to close the equity gap for black Americans. The Affordable Care Act’s coverage expansions in particular hold tremendous potential to reduce health disparities. However, the decision of some states not to expand Medicaid disproportionately impacts blacks, leaving millions in danger of remaining uninsured. Uninsured blacks with incomes that would make them eligible for Medicaid under the law are more likely to live in the 19 states that have not yet chosen to expand their Medicaid programs, putting the country at risk for deepening inequities for the most vulnerable Americans.
Even blacks with coverage face obstacles to high-quality care. Not only do we need programs to connect newly insured African Americans with care, but we also need to improve what happens once black Americans enter the health care system. Recent shifts in the way we pay for and deliver health care are creating opportunities for higher-quality, more comprehensive, culturally appropriate care that better meets the needs of minority and other vulnerable populations. Yet, health care facilities that treat large shares of minority patients may face greater challenges in providing high-quality care than those that do not. Therefore, it will be critical to ensure that these providers have adequate financial and technical support in order to be able to improve the quality of care and offer services that address the physical, behavioral health, and social needs contributing to poor health outcomes among black Americans.
Health care is only one of many factors enabling Americans to live long, healthy, and productive lives. By themselves, health services cannot overcome the deep-seated discrimination and pervasive socioeconomic deficits that contribute to poor health outcomes among African Americans. But a more equitable health care system is certainly part of the solution to overcoming the many historic burdens that African Americans still bear in the United States, and to assuring them a quality of life comparable to other Americans.