CHART 1 Federal Health Reform: Whats in it for Me? Cara V. James, Ph.D. Director of Race, Ethnicity and Health Care Kaiser Family Foundation January 28, 2010

CHART 2 NOTES: Data do not include residents of Puerto Rico, American Samoa, Guam, the U.S. Virgin Islands, or the Northern Mariana Islands. Totals may not add to 100% due to rounding. All racial groups and individuals reporting two or more races are non-Hispanic. DATA: Table 3: Annual Estimates of the Population by Sex, Race and Hispanic Origin for the United States: April 1, 2000 to July 1, 2008 (NC- EST ). Population Division, U.S. Census Bureau. (13.2 million) (2.3 million) (0.4 million) (46.9 million) Total U.S. Population = million (4.5 million) (37.2 million) (199.5 million) Distribution of U.S. Population by Race/Ethnicity, 2008

CHART 3 Nonelderly Health Coverage by Race/Ethnicity, 2008 DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses

CHART 4 Health Reform Goals 1.Expand health coverage 2.Reduce health care costs 3.Improve health care quality 4.Expand health care workforce Where is the reduction or the elimination of health disparities? Where is health equity?

CHART 5 Disparities-Specific Provisions of the House Bill Largely focused on the provision of language appropriate services Requests CMS conduct a study on the availability and utilization of language services, and the potential to provide finance incentives to encourage their use. Requests a demonstration project to promote reimbursement for CLAS services. Asks IOM to produce a report on the impact of language access services on health and health care of LEP individuals Reauthorizes the Indian Health Care Improvement Act for the first time since 2001.

CHART 6 Disparities-Specific Provisions of the Senate Bill Focuses largely on data collection and reporting as a means to reduce racial and ethnic disparities. Requires the collection of data on race, ethnicity, language, geographic location, socioeconomic status (including income and education) and disability Wants the Secretary to develop curricula for cultural competency for individuals with disabilities Provides loan repayment and the development and implementation of strategies to recruit individuals from underrepresented minority populations, disadvantaged backgrounds and rural backgrounds Also reauthorizes the Indian Health Care Improvement Act.

CHART 7 Other Provisions Likely to Impact Communities of Color Medicaid Expansions Individual and Employer Mandate Premium Credits and Cost-Sharing Subsidies Workforce Provisions Funding for federally qualified health centers Prevention

CHART 8 Medicaid Expansions

CHART 9 Distribution of Nonelderly Uninsured by Race/Ethnicity, 2008 Total Nonelderly Uninsured Population = 45.7 million DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses

CHART 10 Distribution of Nonelderly Uninsured Below 133% FPL by Race/Ethnicity, 2008 Total Nonelderly Uninsured Below 133% FPL = 46.4 million DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses

CHART 11 Current and Projected Medicaid Coverage Rates by Race/Ethnicity DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses White Two or More Races Black Hispanic American Indian/Alaska Native Asian NHOPI

CHART 12 Individual and Employer Mandate

CHART 13 Individual and Employer Mandate Changes to individual market: –Ban gender rating –Ban exclusion of pre-existing conditions –Ban variations in premiums based on health status –Identify maternity care as an essential benefit to be covered by all plans in the exchange. Premium credits and cost-sharing subsidies will be helpful to many women purchasing coverage in the exchange

CHART 14 Percent of Nonelderly with Private Coverage by Race/Ethnicity, 2008 NOTE: Estimate for AI/An and NHOPI unreliable due to sample size. DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses N/A

CHART 15 Premium Credits and Cost-Sharing Subsidies

CHART 16 Poverty Status of Nonelderly by Race/Ethnicity, 2008 DATA: 2009 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses million 44.7 million 33.3 million 1.7 million 11.7 million 0.7 million4.3 million

CHART 17 Other Provisions

CHART 18 Workforce Provisions –Training programs, loan repayment programs, and cultural competency efforts Funding for federally qualified health centers –Increase in funding by $33 billion over next 5 years Prevention Efforts –National strategy for prevention, grants for reducing chronic disease, coverage of preventive services in Medicare, and incentives for wellness programs Other Provisions

CHART 19 State Responsibility and Flexibility

CHART 20 Proportion of Nonelderly Who Self-Identify as a Person of Color, by State

CHART 21 Concluding Thoughts Many provisions of the bills will impact everyone. The elimination of racial and ethnic health disparities is not a major focus of the bills, but the final bill will likely have a big impact on communities of color. The disparities-specific provisions of the proposed bills will likely have a limited impact on racial and ethnic disparities. Coverage expansions and disparities-specific provisions are a first step in the reduction of health disparities.

CHART 22 Thank You! Contact Information Cara James, Ph.D. Kaiser Family Foundation