By Charles Hallman
Two-thirds of Americans who will be newly eligible for health coverage in 2014 are people of color. Who will ensure that these diverse communities will be fully enrolled in new Affordable Care Act provisions and that its implementation will be sensitive to cultural differences?
To that end, members of the Black, Asian, Latino and disabled communities have developed a “Racial Equity Framework” recently introduced by the Greenlining Institute, a California-based racial and economic justice organization established in 1993. “Filling in the Gaps: A Racial Equity Framework for Successful Implementation of the Affordable Care Act” (2012) was co-authored by Greenlining Health Fellow Alexis Dennis, Health Policy Director Carla Saporta, and Research Fellow Chanelle Pearson.
“Recognizing the diversity of experiences of all people, including people of color, is critical to creating effective policy,” states the report, which also
includes “Guiding Principles” and “Guiding Questions” to help implement new policies and to “ensure equitable and positive impact of policies in all communities.”
The report’s recommendations include:
• getting input from diverse stakeholders throughout the implementation process.
• collaboration with community-based organizations, institutions and individuals.
• building a diverse healthcare workforce.
• improving language access and cultural competency.
• creating a system where all citizens can easily access information about health .insurance, enrollment and health care needs.
The Racial Equity Framework is specifically designed for policymakers and advocates, said Dennis in a recent phone interview with the MSR. “A law [such as the Affordable Care Act] can be passed, but you have to have people who say how this law is going to work. The Racial Equity Framework is helping people who are in these positions of power,” she pointed out.
“Oftentimes the people making the decisions about how to implement for us are not people who look like us,” noted Dennis, whose health advocacy work primarily centers on educating communities of color across California about the ACA. “Our experience as Black people is different than the experiences oftentimes of the people making these decisions. Black people, Latino people and Asian people sometimes may have different barriers, like different socio-economic status for example, that makes it more difficult to access these things.”
The Racial Equity Framework is more than a checklist, Dennis said. “You can’t discuss the document, answer all of the questions, and have the result that you are looking for. It’s more about expanding the way that we think, and thinking in a way that is consistent in order to achieve equitable results.
“I’m a young, heterosexual African American female… I also faced discrimination because I am a woman, young, and I am an ethnic minority. Together these experiences helped me shape my view of the world…and helped me understand the experiences of others,” said Dennis. “That always is in the forefront of my mind in the work that I do.
“Applying the Racial Equity Framework in my work at Greenlining helps me to think more consciously about the challenges that the communities I may not identify with might face,” said Dennis. “As a result, I have improved my ability to analyze social problems in creating meaningful, equitable solutions for more communities.”
“There is a huge risk that large populations might be missed,” Saporta said during a June 13 health equity and enrollment teleconference with Dennis and other health experts. She added “It is very critical that no community is left out when enrolling in health coverage. Any advocate or policymaker can really apply this framework in their decision making.”
Outreach efforts must be targeted effectively to ensure communities of color are fully informed, noted Saporta. “Too often we over-generalize the needs of the community or the way in which we reach the community. We need to think of our communities and the differences within. Not all Latinos are Mexicans, and not all Black people are African Americans.”
When the MSR asked if the framework can be effectively applied in light of state budget cuts, Saporta said, “Budget cuts that are not providing a great amount of resources toward this outreach, education and enrollment obviously will be detrimental to the future success of the exchange.” There also must be adequate funding at the state level to assist those persons of color in accessing information or enrolling in health coverage online if needed, she said
The framework will not only help tailor outreach efforts to the specific populations who are most likely to be eligible for health coverage, but also help decision makers “to think more broadly and make policies that actually work in the long run,” said Dennis.
Charles Hallman welcomes reader responses to email@example.com.