1. Universal and Equal: Ensuring Equity in State Health Care Reform Brian D. Smedley, Ph.D. The Opportunity Agenda www.opportunityagenda.org

2. State Health Care Reform Nearly two dozen states looking at meaningful health care reform, addressing coverage, cost, quality Nearly two dozen states looking at meaningful health care reform, addressing coverage, cost, quality Using a combination of approaches Using a combination of approaches Health care reform legislation is a key opportunity to address inequality in health care Health care reform legislation is a key opportunity to address inequality in health care Coverage expansions are necessary but not sufficient to promote healthcare equity Coverage expansions are necessary but not sufficient to promote healthcare equity

3. State Health Care Equity Benchmarks – Resources: IOM Unequal Treatment report, 2002 IOM Unequal Treatment report, 2002 Commonwealth Fund reports - Commonwealth Fund reports - Beal et al., Closing the Divide: How Medical Homes Promote Equity … Beal et al., Closing the Divide: How Medical Homes Promote Equity … McDonough et al., A State Policy Agenda to Eliminate Racial and Ethnic Health Disparities McDonough et al., A State Policy Agenda to Eliminate Racial and Ethnic Health Disparities Perot and Youdelman, Racial, Ethnic, and Primary Language Data Collection … Perot and Youdelman, Racial, Ethnic, and Primary Language Data Collection … Siegel et al., Enhancing Public Hospitals Reporting of Data … Siegel et al., Enhancing Public Hospitals Reporting of Data … D.B. Smith, Eliminating Disparities in Treatment D.B. Smith, Eliminating Disparities in Treatment

4. Ensuring Full Access to Health Care – States Should: Promote medical homes Promote medical homes Improve and streamline enrollment in public insurance programs, and consistently evaluate outreach efforts Improve and streamline enrollment in public insurance programs, and consistently evaluate outreach efforts Promote diversity among health professionals and cultural and linguistic competence in health systems Promote diversity among health professionals and cultural and linguistic competence in health systems

5. Promoting Equitable Health Care Quality – States Should: Require all public and private health systems to collect data on racial/ethnic, language, and income-based disparities in health care access and quality Require all public and private health systems to collect data on racial/ethnic, language, and income-based disparities in health care access and quality Monitor and publicly report health care access, quality disparities Monitor and publicly report health care access, quality disparities Ensure that disparities are a key goal of quality improvement and pay-for-performance efforts Ensure that disparities are a key goal of quality improvement and pay-for-performance efforts

6. Patient Education and Empowerment – States Should: Develop culturally-appropriate patient education and health literacy programs Develop culturally-appropriate patient education and health literacy programs Train, reimburse, and promote the use of community health workers Train, reimburse, and promote the use of community health workers Strengthening the Health Care Infrastructure – States Should: Strengthen safety net institutions and reduce financial vulnerability of those serving low-income communities Strengthen safety net institutions and reduce financial vulnerability of those serving low-income communities Create incentives for health professionals to practice in underserved communities Create incentives for health professionals to practice in underserved communities

7. Strengthening State Program and Policy Infrastructure – States Should: Strengthen Certificate of Need assessment Strengthen Certificate of Need assessment Establish or strengthen state offices of minority health Establish or strengthen state offices of minority health Addressing Social and Community Determinants of Health Inequality: Improve coordination of relevant state agencies that should address determinants (e.g., education, housing, employment) Improve coordination of relevant state agencies that should address determinants (e.g., education, housing, employment) Create incentives for better food resources in underserved communities (e.g., major grocery chains, farmers markets) Create incentives for better food resources in underserved communities (e.g., major grocery chains, farmers markets)

8. A View from Five States Analyzed legislation in five states (MA, WA, CA, IL, & PA) States are addressing the benchmarks in various ways: Access to health care Creating mechanisms to promote diversity among health are professionals (MA, IL, PA)Creating mechanisms to promote diversity among health are professionals (MA, IL, PA) Improving & streamlining enrollment procedures (MA and IL)Improving & streamlining enrollment procedures (MA and IL) Evaluating outreach & enrollment procedures (MA, WA, CA, IL, PA)Evaluating outreach & enrollment procedures (MA, WA, CA, IL, PA) Quality of care Collecting data on race, ethnicity, and primary language (MA, WA, CA, IL, PA) and publicly reporting info (MA, CA)Collecting data on race, ethnicity, and primary language (MA, WA, CA, IL, PA) and publicly reporting info (MA, CA)

9. A View from Five States (cont.) Patient empowerment Conducting a community health worker study to determine effectiveness in reducing racial and ethnic health disparities (MA)Conducting a community health worker study to determine effectiveness in reducing racial and ethnic health disparities (MA) Health care infrastructure Supporting safety net institutions such as community health centers (MA, WA, IL)Supporting safety net institutions such as community health centers (MA, WA, IL) Providing incentives for health care professional to practice in underserved areas (IL)Providing incentives for health care professional to practice in underserved areas (IL)

10. A View from Five States (cont.) Policy infrastructure Utilizing community health planning to better align resources and need (WA, IL)Utilizing community health planning to better align resources and need (WA, IL) Creating a Health Disparities Council charged with making recommendations on workforce diversity issues, monitoring disease rates (MA)Creating a Health Disparities Council charged with making recommendations on workforce diversity issues, monitoring disease rates (MA) Social and community determinants of health Coordinating relevant state agencies to address social and behavioral determinants (WA)Coordinating relevant state agencies to address social and behavioral determinants (WA)

11. Opportunities for Policymakers and Advocates Make universal health care a core goal and cover everyone Make universal health care a core goal and cover everyone Assess how state policies to expand coverage affect currently underserved groups Assess how state policies to expand coverage affect currently underserved groups Actively follow the implementation of new health care expansion laws Actively follow the implementation of new health care expansion laws Link disparities as a core goal of the health care reform wave Link disparities as a core goal of the health care reform wave