Tuesday, May 18, 2021


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Excerpted From: Sabrina Wilks, Healthcare for All: Why Minorities Continue to Fall, 43 Thurgood Marshall Law Review Online 2 (2019)  (Student Comment) (107 Footnotes) (Full Document)

In 2010, the enactment of the Patient Protection and Affordable Care Act (PPACA) or the Affordable Care Act (ACA) signed into law by Congress marked major change. The PPACA is an expansion of Medicaid and provides added care and coverages for eligible individuals. The goal of the healthcare reform is to ensure that every person living in the United States would have accessible and affordable healthcare. Healthcare coverage is an expensive necessity that most families, especially those with low income, are unable to afford. While this system is positive for society as whole, and while the focus is often on the expense of the program, there is often little attention given to the quality of healthcare that many receive. A legal reform in healthcare that should be beneficial to all cannot fulfill its intended purpose because the law is not applicable to everyone. Moreover, the quality of care offered is inconsistent across the nation. Quality care goes beyond the physical locations of providers; it involves the mental and emotional care that patients should receive. Some patients receive better care than others. Studies show that race plays a major part in the quality of care that patients receive, and minorities most often than not are the recipients of poor quality care. Unless there are significant changes that address the disparities in healthcare, minorities will remain in a disadvantageous position. [. . .]

The Patient Protection and Affordable Care Act is composed of several parts and subparts. A few areas that it focuses on include the improvement of the coverage that prevents lifetime or annual limitations. Specifically,

A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish: (1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or (2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary.

Another benefit of the act is the coverage of preventive health services. "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for" any of the following. If there are evidence-based items or services that have in effect a rating of ‘A' or ‘B' in the current recommendations of the United States Preventive Services Task Force, then those items or services should be covered.

An important coverage is immunizations that are recommended practices of the Centers for Disease Control. Evidence-informed prevent care and screenings for infants, children and adolescents; as well as preventive care and screenings for women; and recommendations regarding breast cancer screening, mammography and prevention all fall within coverage of preventive health services.

The Patient Protection and Affordable Care Act also states that individuals should not suffer discrimination based on their salaries:

The plan sponsor of a group health plan (other than a self-insured plan) may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee or otherwise establish eligibility rules that have the effect of discriminating in favor of higher wage employees.

Most importantly, the quality of care offered needs monitoring by law. The statute provides:

"Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures."

These reimbursement structures would "improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives." They would also "implement activities to prevent hospital re-admissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional." In addition, they would also "implement wellness and health promotion activities."

[The essay is divided into the following sections: (1 Challenges to the Affordable Care Act That Allows Interstate Disparity (2) Disparity That Leads to Poor Quality Care for the Elderly, the Ethnic, and the Poor (3) The Fiduciary Role of Physicians (4) Minorities Receive Worse Care than Whites (5) What Resolutions Do We Have?]

[. . .]

While all proposed resolutions are plausible and could affect some change, we still need to address the root of the problem. Racism rears its ugly head in every side of our daily lives. People with discriminatory dispositions need to change from within, especially those within the medical profession. Otherwise, the giant sore festering under each band aid will continue to ooze inequality, inefficiency, and disparity in our healthcare system.


Vernellia R. Randall
Founder and Editor
Professor Emerita of Law
The University of Dayton School of Law