Combating disparities under health care reform: A state public health department's experience

The full implementation of the Affordable Care Act (ACA) is likely to have an impact on racial and ethinic health disparities and the goal of health equity. It is possible to gain an understanding of this potential affect by examining the experience of implementing health care reform in Massachusetts beginning in 2007. As the Commissioner of Public Health in Massachusetts during the years from 2007 to 2012 I was charged with looking for concrete indications of the impact. Some were relatively easy to find. Access to health care services improved for all racial and ethnic groups as a result of health care reform. The overall percentage of uninsured dropped from 7% to 2% while the percentage of uninsured Black and Latino residents dropped from 8% and 10% to 4% and 7% respectively. Health indicators or surrogate markers for health also improved in a number of areas including vaccination again the flu, smoking rates and colonoscopy and other cancer screenings. In addition, those with chronic diseases such as asthma and diabetes were more likely to receive the recommended prevention and symptom control services after health care reform. While access to care and health outcomes improved for all groups in numerous instances, the gap between whites and other populations often did not close and in some instances (such as among Latinos) may have widened. This suggests that specialized attention to reducing disparities in needed even as health care reform improves access. I will offer a few positive examples of such efforts.