Running head: POLICY ACTION PLAN: HEALTH CARE DISPARITIES 1

Policy Action Plan: Health Care Disparities Across Socioeconomic Strata

Jessie Mbah

Delaware Technical Community College

Policy Action Plan: Health Care Disparities 2

Overview of the Problem

Health disparities in the United States are a result of social determinants of health.

People with a low socioeconomic status overall “experience worse health and die earlier than

their better-off counterparts”. Health care disparities include lack of access to health care,

lack of quality care, and poor or nonexistent insurance coverages. Low-income individuals

are affected by both health and health care disparities. Furthermore, socioeconomic status is

intricately linked to race, ethnicity, gender, and many other factors. This has been a prevalent

issue in the American health care system and many policies have attempted to address these

disparities.

Key Stakeholders

At the local level, the stakeholders to be contacted are the hospitals and primary care clinics

in Delaware. I have included these facilities because they can provide key information on the

patients who frequent their facilities such as; who are the majority of patients that have health

coverage based on their racial/ ethnic makeup? Who are the patients that are frequenting

these facilities? What are they going in for? How can healthcare professionals assess the

social determinants of health for these patients? Having this information can help inform who

may not be visiting these facilities. This can also inform why certain individuals are not

visiting these facilities.

 Delaware Hospital for the Chronically Ill: (302) 223-1000

 Bayhealth Hospital, Kent Campus: (302) 674-4700

At the state level, community health centers are key stakeholders. Community health centers

(CHC) are not-for-profit and provide high quality affordable health care to uninsured,

underinsured, and underserved patients. Because these centers serve targeted populations,
Policy Action Plan: Health Care Disparities 3

their participation in ongoing policy discussion on health equity is integral. CHCs provide

primary and preventive care, dental care, and mental health services. Henrietta Westside

Family Healthcare in Dover offers the above services including 24 hour physicians,

reproductive care, health counseling, and many other services. Johnson Medical Center in

Wilmington also provides similar services.

 Westside Family Healthcare

Kent/Sussex County Scheduling line: (302) 678-4622

 Henrietta Johnson Medical Center : (302) 655-6187

At the National Level, a key stakeholder is Medicaid. Contacting Medicaid in particular

would inform how many people have been insured ever since the Affordable Care Act was

implemented. Medicaid is a program that helps offset the cost of health care for eligible low-

income individuals. Discussions on health disparities should include Medicaid because of its

design to improve access to health care for low-income people.

 Medicaid Toll-Free: 877-267-2323

Current and Pending Laws

The Affordable Health Care Act is the most progressive national policy that tackles

health care disparities. The Affordable Care Act has reduced health care disparities within

socioeconomic groups (Griffith et al., 2017). The ACA increased insurance coverage for low-

income individuals and expanded health care insurance eligibility. 

 Health Equity and Accountability Act of 2018 was developed to eliminate health

disparities due to racial and ethnic differences and the intersections with “immigration status,

age, disability, sex, gender, sexual orientation, gender identity and expression, language, and

socio-economic status”. Furthermore, Title IV specifically addresses socioeconomic strata: It

includes the improvement of health care Services—Removes harmful barriers to health

Policy Action Plan: Health Care Disparities 4

insurance coverage while maximizing the positive impact of federal health care investments

in communities of color.

Implementation Strategies

There are many steps to take to lobby for health equity. The most straightforward

ways to lobby would be to contact the local, state, and federal policymakers. By writing

emails to policymakers such as legislative assistants or congress members, I would push for

the importance of going forward with the Health Equity and Accountability Act of 2018. I

would highlight the fact that health disparities are directly affecting the lives of my own

patients in the facility I work at. Writing emails to members of Congress and their staff on the

Subcommittee on Health, Employment, Labor and Pensions to make progress with the bill

because the last action taken for the bill ended with this subcommittee. 

Talking Points

1. Why Addressing Health Disparities is Important

Health and health care disparities are a prevalent issue in the United States that is easy

to dismiss. If not directly affected by lower SES, it may be hard to see why health disparities

impact the nation as a whole. Addressing health disparities would ultimately improve overall

healthcare quality within the nation. Additionally, health disparities have shown to be costly.

It has been reported that disparities “amount to approximately $93 billion in excess medical

care costs and $42 billion in lost productivity per year, as well as economic losses due to

premature deaths” (Orgera & Artiga, 2018). Furthermore, according to the Joint Center for

Economic and Political Studies, the United States could save almost $230 billion in medical

expenditures if health care disparities are addressed. 30.6% of medical care expenditures

were from excess costs in racial and ethnic minority groups from 2003-2006 (Spittel, 2018).
Policy Action Plan: Health Care Disparities 5

2. The Effectiveness of Policies

The Affordable Care Act was implemented in 2011 and since then, the effects of this

law have been generally positive. Under the ACA, health care coverages have increased

significantly. Survey data compiled from 2011-2015 shows insurance coverage gap change

between households with annual income of $25,000 and $75,000 and above. This gap

reduced from 31% to 17% in expansion states and 36% to 28% in non-expansion states.

Intuitively, with an increase in insurance coverage for low income individuals, there should

also be an increase in health care access. Glied et al (2017) found that people who received

Medicaid post-implementation report an increase on having a “usual place of care” (47.1% to

86.5%). Because of the ACA’s positive impact on health care in the United States, laws that

address social equity should be passed. The Health Equity and Accountability Bill is a very

timely example of policies being developed to reduce health disparities.

3. Social Determinants of Health

The social determinants of health (SDOH) are an incredibly important part in

addressing health disparities. SDOH is “often defined as the circumstances in which people

are born, grow up, live, work, and age” (DHSS, 2013). These aspects are in turn determined

by economics, politics, and social policies which affect health disparities. Because of this,

structural changes have to be made in order to reduce these observed disparities. Differences

in health are present in communities with unstable housing. “Substandard education, and

unsafe communities” are all influences on low income individuals’ health outcomes. It is not

possible to isolate the issue of health disparities because of how deeply entrenched it is in

many aspects. Adopting a Health in All Policies approach would incorporate the intersections

of different government branches to combat health disparities. Policies should be developed

Policy Action Plan: Health Care Disparities 6

so as to not be unintentionally harmful to health. For example, economic policies can have

very significant impacts on healthcare and health outcomes.

4. Improving Healthcare Access and Quality

To address health and health care disparities, we must address the systemic barriers

low SES individuals experience regarding healthcare. This includes insurance coverage,

access to healthcare and the general delivery of healthcare. For example, pregnant women

and women up to one year postpartum still die though 60% of these deaths have been found

to be preventable (CDC Data and Statistics).

Socioeconomic status has a noticeable effect on pregnancy-related deaths. Women

who live in poverty are more likely to experience these deaths. The most recent US Census

Data conducted in 2016, shows that Native American and Black minority groups have the

highest poverty rates (27.6 and 26.2 respectively) compared to White counterparts (12.4%)

(Petersen, 2016). It is imperative to examine the factors that affect poor communities as they

relate to health of pregnant women. Many factors contribute to these complications at varying

levels of prevention. Regarding access to health care, poor communities experience unstable

housing, lack of adequate transportation to health care facilities and the facilities themselves

are lacking in high quality care. A first step could involve healthcare facilities partnering with

rideshare services such as Lyft and Uber to provide transportation services for those who may

need it rather than ambulatory services for non-emergencies.

Goals
Policy Action Plan: Health Care Disparities 7

My goal is to meet with my state Congress person: Lisa Blunt Rochester to discuss

ways to improve the health of minority communities. In the next 90 days, I plan to volunteer

with organizations such as the Cancer Society and the American Heart association to provide

health education to minority groups. The types of education would include information on

advantages of screenings for colorectal cancers and smoking cessation. I would also educate

on the importance of exercise and healthy eating habits for optimum health. While health care

disparities are a result of larger structural barriers in the health care system, boosting patient

dignity and helping them ‘own’ their health complications would improve overall health

outcomes.

Conclusion

In conclusion, my goal is to create awareness in minority communities about health

care resources that are available to them, and also ensure that people on the low

socioeconomic strata are making use of these resources. The ultimate goal is to see improved

health outcomes in terms of decreased morbidity and mortality for this population.
Policy Action Plan: Health Care Disparities 8

References

Bureau of Health Equity. (n.d.). Retrieved from

https://dhss.delaware.gov/dhss/dph/mh/healthequity.html

Data &Statistics - Reproductive Health | CDC. (2019, January 16). Retrieved from

https://www.cdc.gov/reproductivehealth/data_stats/index.htm

Glied, S. A. (2017, May 8). Effect of the Affordable Care Act on Health Care Access:

Commonwealth Fund. Retrieved from

https://www.commonwealthfund.org/publications/issue-briefs/2017/may/effect-

affordable-care-act-health-care-access

Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act Reduced Socioeconomic

Disparities In Health Care Access. Health Affairs, 36(8), 1503–1510. doi: 10.1377/

GovTrack.us. (2020). H.R. 5942 — 115th Congress: Health Equity and Accountability Act of

2018. Retrieved from https://www.govtrack.us/congress/bills/115/hr5942

Mason, D. J., Gardner, D. B., Outlaw, F. H., & OGrady, E. T. (2016). Policy & politics in

nursing and health care. St. Louis, MO: Elsevier

Orgera, K., & Artiga, S. (2018, August 8). Disparities in Health and Health Care: Five Key

Questions and Answers. Retrieved from https://www.kff.org/disparities-policy/issue-

brief/disparities-in-health-and-health-care-five-key-questions-and-answers/

Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related

Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep 2019;68:762–

765. DOI: http://dx.doi.org/10.15585/mmwr.mm6835a3external icon.

Spittel, M. (2018, April 26). Health disparities are costly for (U.S.) all – Office of Behavioral

and Social Sciences Research. Retrieved from https://obssr.od.nih.gov/health-

disparities-are-costly-for-u-s-all-think-about-it-in-april-and-beyond/
Policy Action Plan: Health Care Disparities 9