In its 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care (“the Committee”) noted that “even when insured, [racial and ethnic minorities] may face additional barriers to care due to other socioeconomic factors, such as high co-payments, geographic factors (e.g., the relative scarcity of healthcare providers and healthcare facilities in minority communities), and insufficient transportation.” The Committee characterized “access-related factors” as “likely the most significant barriers to equitable care,” and opined that they “must be addressed as an important first step toward eliminating healthcare disparities.” To this end, the Committee issued “Recommendation 5–7: Structure payment systems to ensure an adequate supply of services to minority patients, and limit provider incentives that may promote disparities.”
In Pennsylvania, Medicaid is a critical source of health insurance for people of color, far more so than for white persons. Currently, 38.7% of black or African American Pennsylvanians and 32.4% of Hispanics rely on Medicaid to pay their medical bills, compared to only 12% of white non-Hispanics. With the advent of national health care reform, Medicaid promises to take on an expanded role in opening doors to the health care system for people of color, by extending coverage to many who previously lacked insurance. But while Medicaid facilitates access to health care for those who might otherwise do without, some Medicaid policies fail to address and may even foster racial and ethnic disparities among its recipients. I first consider the impact on blacks or African Americans of some of Pennsylvania’s major decisions regarding payment for long-term care services for the elderly over the past three decades. I next examine some recent changes to Pennsylvania’s Medicaid program, and whom they impacted. Finally, I recommend that a racial impact statement accompany proposed policy decisions by the Medicaid agency and its major contractors.