Disparities in Health Coverage

In our second guest blog from Dr. Carter-Pokras's Health Disparities Course, Zoé Bendixen, a second-year Masters of Applied Anthropology student in the Department of Anthropology, examines the issue in the context of health insurance coverage.

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As with many health issues, disparities exist in health coverage among different races and ethnic groups. Even before job losses began accelerating and the resulting losses in health coverage many people are now experiencing, the issue of the uninsured and underinsured was a pressing issue.

Health care reform is drawing serious attention across the nation and in Congress, and recently Cover the Uninsured Week and National Public Health Week focused on the growing number of uninsured. On April 2, the American Public Health Association (APHA) released its Agenda for Health Reform, calling for administration and Congressional leaders to:

• Support population-based services that improve health, and
• Reform health care coverage and delivery.

Disparties in health coverage exist both across the US and here at home in Maryland. According to the Current Population Survey’s Annual Social and Economic Supplement, the percent of uninsured in 2008 was 12.1% for Whites, 20.4% for Blacks, and 33.5% for Hispanics. As for Maryland, 11% of non-Hispanic whites, 19% of non-Hispanic Blacks, 39% of Hispanics and 15% of Asian/Other, non-Hispanics did not have health insurance.

Why do these numbers matter? Does health insurance coverage matter when it comes to health? A report by the Urban Institute says it does, reporting that:

• Uninsured people receive less medical care and less timely care
• Uninsured people have worse health outcomes
• Lack of insurance is a fiscal burden for uninsured and people and their families

Examples of newly passed legislation to extend coverage to the uninsured in the state of Maryland that are awaiting the Governor’s signature include:

• Several consumer protections in the individual health insurance market, including: expanded health insurance coverage for those with pre-existing health conditions; protection of coverage for health conditions present when policies are purchased; and regulation parity for out-of-state health insurance companies under Maryland law (HBs 32, 39, & 235, Maryland Insurance Administration reform package)
• Improved prosthetic coverage on insurance policies for Maryland’s amputees (HB 579/SB 341, Prosthetic Parity Act)
• Expanded Medicaid coverage to former foster children transitioning to adulthood (House Bill 580)
• Extended domestic partner benefits to the families of state employees (Budget Appropriation)

While the issue of ethnic and racial disparities in health exists on many different levels and must therefore be addressed at many different levels, health coverage appears to be a contributing factor.

School of Public Health faculty, staff and students are therefore involved in health care reform discussions at many levels. With the current political climate attuned towards health care reform, it is timely to make sure that racial and ethnic disparities in health coverage are included in this debate and subsequent implementation.