Academic journal article Harvard Journal of Hispanic Policy

Inclusion and Exclusion of Latinos in the Affordable Care Act: Challenges and Opportunities for Achieving Health Equity

Academic journal article Harvard Journal of Hispanic Policy

Inclusion and Exclusion of Latinos in the Affordable Care Act: Challenges and Opportunities for Achieving Health Equity

Article excerpt

WHILE THE PATIENT PROTECTION AND Affordable Care Act (Affordable Care Act) moves the nation closer to achieving universal health coverage, the United States has yet to fully embrace a right to health framework guaranteeing access to health care for all residents. (1,2) As a result, millions of individuals and families will remain on the margins of our health care system. Given disparities in health and health care among communities of color, racial and ethnic minorities are particularly disadvantaged by the absence of a universal health care program. The devolution of federal responsibility for health care and other social welfare programs to state governments, antigovernment rhetoric, and anti-immigrant sentiment have contributed to a "social context of exclusion" that undermines efforts to achieve health equity. (3,4,5) This article explores how this social context has restricted access to health care and its impact on insurance coverage for the Latino population under the Affordable Care Act. I conclude with a discussion of how the right to health framework, which the United States has recognized through its participation in international bodies such as the United Nations, serves as a useful approach to achieving a more inclusive health care system for the Latino and general population in the United States.

LATINO DISPARITIES IN HEALTH AND HEALTH CARE

Health disparities are avoidable differences in health experienced by socially disadvantaged groups. (6,7) These differences are inherently unjust given that these disparities are linked with discrimination or marginalization of members of disadvantaged groups. (8,9) While nonmedical social determinants (e.g., poverty, neighborhood characteristics, racial discrimination, housing, social isolation) are increasingly recognized as underlying drivers of health disparities experienced among racial and ethnic minorities, lack of access to quality health care remains a significant contributor to increased morbidity and mortality among communities of color. (10,11)

Latinos are especially at risk for the ill effects associated with being uninsured and marginalized, including limited access to health care services, poorer-quality medical care, and delays in diagnosis and treatment of chronic conditions. The U.S. Latino population is diverse and some health conditions affect ethnic subgroups differently; however, higher levels of obesity and physical inactivity in addition to excess mortality rates due to diabetes, certain types of cancers (cervical, stomach, and liver), HIV, liver disease, homicide, and work-related injuries have been observed among Latinos compared to the general population. (12,13) Latinos receive fewer health screenings and preventative care such as mammograms, Pap and HIV tests, influenza vaccinations, and prenatal care. (14) Moreover, Latino farmworkers and their children have worse health care outcomes compared to individuals and families not involved in agricultural work. (15) In accessing the quality of care received, Latinos report financial limitations, their race or ethnicity, and accent as factors that have colored their interactions with health care providers. In a national survey of over four thousand Latinos conducted by the Pew Hispanic Center and Robert Wood Johnson Foundation in 2008, among those who received care in the past five years, 23 percent report receiving poor-quality medical treatment; of those, 31 percent attribute their financial limitations while 29 percent perceived their race or ethnicity as the reason for the poor treatment, and another 23 percent reported that their accent or how they spoke English contributed to their poor treatment. (16) Other studies have also shown that Latino Spanish-only speakers report significantly less patient satisfaction than their English-speaking counterparts. (17)

Latinos have the highest uninsurance rate (32 percent), compared to Whites (13 percent), Asian Americans (18 percent), African Americans (21 percent), and Native Americans (27 percent). …

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