Health Care Disparities At Core of VT. Senator's Vote

New America Media, News report, Khalil Abdullah, 

Though an Independent, Vermont Sen. Bernard Sanders extracted a $10 billion expansion of community health centers from his legislative peers in exchange for his support for the Senate’s version of the health care bill last week. The senator was one of the last holdouts the Democrats needed to secure a 60-vote majority necessary to move the legislation forward.

Though several television network commentators and pundits attempted to excoriate Sanders by asking whether he had “sold” his vote to benefit his state’s residents, the volume and harsh tone of their questioning began to dissipate as the veteran lawmaker described what the funding will actually accomplish – and that the expansion benefits other states far more than Vermont and, that, more importantly, it will begin to address the issue of disparity.

Should health care legislation be enacted as conceived, Sanders pointed out during the debate, over 30 million Americans will become insured, with about 15 million more people to be covered by Medicaid. “Where are they going to access the health care they need?” Sanders asked.

“One out of every six rural Americans” and “one in four low-income people of color” is currently being served by the country’s network of community health centers, according to Sanders. These centers serve as primary care facilities, thus providing a consistent treatment alternative to last minute emergency room visits, which drive up health care costs. One report from the Community Health Foundation (RCHN) states that, “In 2009 health centers serve 19 million patients. This generates health system savings of $24 billion in 2009 because of the substantially lower overall cost of care by health centers when compared with non-users.”

Vermont is one of the leaders in establishing a network of community health centers, and would only gain two more from the $10 billion infusion. At issue, however, is approximately one-third of the U.S. population, the “96 million residents of medically underserved urban and rural communities because of their heightened need for primary health care and the role of health insurance reform on expanding primary care capacity,” according to RCHN.

Dr. Lesley Russell, a visiting fellow at the Center for American Progress, and author of a recently released report, “Equal Health Care for All,” points out that “about half the U.S. population will be made up of those who are now minorities by 2042, which means that their health status increasingly defines that of the nation.”

Russell’s report, which includes a comparative analysis of the Senate and House versions of the health care bill, draws on the 2003 landmark Institute of Medicine (IOM) study titled “Unequal treatment: Confronting Racial and Ethnic Disparities in Health Care” to make the case for urgent health care reform. The IOM report asserted that “racial and ethnic minorities tend to receive lower quality health care than non-minorities even when controlled for access-related factors such as insurance status and income.” 

In her report, Russell acknowledged that “relatively little progress has been made toward the goal of eliminating racial and ethnic disparities.” The list includes disparities in cardiovascular disease, diabetes, HIV/AIDS, immunizations, hepatitis, STDs, and tuberculosis. For example, “The mortality rate for African Americans,” Russell wrote, “is approximately 1.6 times higher than for white people – a ratio that is identical to the black-white mortality ratio in 1950.”

U.S. Virgin Islands Rep. Donna Christensen, chair, Health Braintrust of the Congressional Black Caucus, explained that “lack of insurance accounts for maybe 20 percent of the health disparities we see.” She cited the critical role of other factors, such as the dearth of a linguistically and culturally competent workforce, and lack of access to primary care facilities like those championed by Sanders.

In June, the CBC, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus, (collectively, the Tri-Caucus), introduced The Health Equity and Accountability Act of 2009 (HR 3090). Rep. Christensen said sponsors sought input from the business sector, as well as dialogue with the Senate through Illinois Sen. Roland Burris, former Sen. Obama’s replacement. With support from the Progressive Caucus, of which Sen. Sanders was a founding member when he served in the House, the Tri-Caucus has worked to secure key provisions of HR 3090 in the health care bill.

Christensen also credited Maryland Sen. Benjamin Cardin for introducing an amendment to the health care legislation “that would strengthen the Office of Minority Health” within the Department of Health and Human Services, “and elevate the Center of Minority Health and Disparity Research at NIH [National Institutes of Health] to an institute.” 

The result could yield increased financing for studies on how to eliminate disparities, better data collection initiatives, and more gravitas within the health care policy universe. While the media has focused the American public on the costs of health care legislation, scant media energy has been used to educate the public about the cost of health disparities, estimated at close to $413 billion a year, according to the Joint Center for Political and Economic Studies.

Though critics have assailed Sanders’ $10 billion gambit, which also funds medical workforce development, the House version of the health care bill already includes a $14 billion allocation for the expansion of community health centers. Thus, there is optimism among advocates that the conference committee between the two chambers may yield more than $10 billion in the final version.

Sanders’ willingness to support the health care bill, even without a public insurance option, clearly dovetails with an essential IOM finding. Though health care policy experts like Christensen agree that the causes of disparities are complex, “the IOM report found that insurance status is the most critical factor in addressing health disparities.”

And, in Sanders’ view, building community health centers will provide medical access to those “who, when they get sick, can’t find a doctor.”