Since President Barack Obama was sworn into office, the nation has been on edge about his campaign promise, change. Health care reform has been high on his agenda, especially with the failing economy the previous administration (George W. Bush) so kindly established. According to the U.S. Census Bureau, an estimated 45 million Americans are uninsured. Twenty percent include African Americans.
Historically, Black health care and coverage have been on the bottom of the totem pole, warranting Blacks to provide care themselves.
Dr. Samuel Shacks, former King Drew physician and medical expert, says African Americans' health care is inadequate and has been since the Civil Rights era of the '60s. Black physicians began to open up their own hospitals and private practices in the late 1800s.
"A majority of Blacks received insurance coverage initially through Black benevolent societies created by freed slaves after the Civil War," Shacks explained. "Activities such as these were pre-modern forms of voluntary private health insurance." He says two major Black insurance companies of the time were Golden State Mutual of Los Angeles and The Spaulding Insurance Company of Atlanta.
Though African Americans made provisions for themselves, Shacks says the government's health care was ultimately inadequate, especially when Black hospitals and insurance companies began to dwindle.
Obama's health care plan, which is actually a health insurance plan, is supposed to close the gap between the un(der)insured Americans and those with decent packages. Nearly 32 million uninsured citizens are supposed to be covered through this new plan.
Since passing on March 23, nationwide, people have been trying to figure out exactly how the law is going to impact them. While the plan will not be in full effect until 2014, experts and health care professionals are attempting to break down the facts. Last Wednesday, MA'AT Club for Community Change held a public forum about Obama's health care bill, bringing to light the possible impact the bill could have on the African American community.
Njideka Obijiaku, main facilitator of the event, says this plan is a step in the right direction, but there are flaws to the bill that should be ironed out later.
"Theoretically, it creates access for a lot of folks," she said. "The bill has a lot of holes and a lot of things that sound good, but when it comes down to tactical implementation, I'm sure there will be amendments, copies will be modified, gaps that were left open will be more amplified. The discussion is certainly not closed."
When looking at the bill as it relates to the African American community, Obijiaku recognizes that there are some disparities in health care compared to mainstream Americans, especially those living in more affluent areas. She says some of the main issues Blacks are currently facing are equity and disparity, sighting the quality of health care in South Los Angeles compared to care in Westwood, for example. She also points to the closing of Martin Luther King Hospital.
"Economic development doesn't sound like it's related to the health care debate, but it is," Obijiaku explained. She says access and quality have historically been the issue for the Black community, but through the president's bill, low-income areas and cities flogged with compromised care will have better access.
Individuals who qualify will receive subsidies of amounts comparable to their income. Businesses will also be mandated to provide health care provisions for their employees.
Small businesses are broken down into two groups: category 1 - those with 49 or fewer employees and category 2 - those with 50 or more.
Category 1 employers will not be held accountable for supplying their employees with insurance. Category 2 employers will be issued a $2,000 fine for not providing insurance for employees. The government will offer tax credit for covering 35 to 50 percent of insurance costs for employers who do provide insurance, however.
Under the new law, everyone will be required to obtain some kind of coverage, but there are a few exceptions. Native Americans, undocumented people, incarcerated people, and individuals with religious objections will not be required to obtain insurance.
What about the ones who can't afford it? Low-income, under employed and unemployed people have opportunities to gain access through government subsidies. Individuals making less than 14,000 a year (households 29,000 a year) will not have to pay no more than 3-4 percent of their incomes for insurance. Individuals making $44,000 a year (households $88,000 a year) will not pay more than 10 percent of their income for insurance. These changes will take effect in 2014.
Obijiaku also explained that Medicaid would be expanded, therefore providing more access for people falling under the low-income bracket.
Individuals making $200,000 a year (households $250,000 a year) will get hit with a tax increase. These changes will take effect in 2011.
There is a fine for individuals who choose to avoid paying for coverage of $95 in 2014, $325 in 2015 and $695 in 2016. According to Obijiaku, the enforcement has not been detailed at this point, but the government will issue hardship waivers.
The bill purportedly will impact seniors in a positive way. Before the bill, many seniors on Medicare fell into a "donut hole," making seniors responsible to pay for medication.
"I think they will be impacted well. Currently, folks on Medicare are spending between $27.50 and $1600 on prescription drugs. You have this very large group of people who had high prescription costs who fell in this donut hole. The biggest piece of the bill eliminates that donut hole," Obijiaku said.
She added that the bill also invests in preventive services, increasing payouts to primary care physicians and eliminates co-pays for government-approved services. However, Medicare Advantage participants will see the funding for the program be cut over the next 10 years. The savings will go back to Medicare.
"I see the benefits and challenges (for African Americans). People will theoretically have increased access to health insurance. However, for communities like ours, where you have major hospitals close down, you are not only putting a lot of strain on outside health facilities, but you are also putting a high strain on community clinics," she said.
The bill offers an influx of resources to community health facilities, but it is unclear how the resources will be used. President Obama is requiring clinics to double their client capacity over the next five years. Obijiaku is concerned because of other factors that currently impact health care quality in neighborhoods of color.
"I think there were things that were not included and not thought totally out; the capacity of our community clinics, the education within our communities and you have the infrastructure that exists in communities of color," she shared. "There is also a question of health education. I think there are some social disparities that weren't taken into account that have major implications on Black health."
Shacks agrees. He believes Black health care should be a civil rights issue at this point, but the Obama administration is failing to adequately address the root of the disparity.
"The recently passed 'health reform bill' did not take specific notice of ethnic disparities," Shack commented. "The solution to better health for all Americans rests with the needed evidence-based answers to the etiology of Black health disparities."
He gives the Obama administration an "F" for failing to address Black health care.
Despite the efforts the bill makes to broaden access, other issue remain for Black health. Obijiaku says insurance reform does not address the needs of the general African American population, however, the bill does have the potential to decrease the gap.
MA'AT Club for Community Change has more information available to the public. E-mail Njideka Obijiaku at firstname.lastname@example.org. Obijiaku has a Masters degree in public health from Drexel University.