Health disparities in the United States are, unfortunately, nothing new. We’ve written before about the wide disparities in health by gender, race, and socioeconomic status. For example, Black women are four times more likely to die from complications related to pregnancy and childbirth than White women are. Women use more health services than men and pay more for the medical care, and — because they earn less money than men — are less able to afford the care as well.
The Affordable Care Act (ACA) was developed, in part, to address some of these health disparities, by ensuring that millions more Americans have health insurance coverage and by changing discriminatory policies that charged women more for health coverage or that didn’t cover essential health services including birth control and maternity care.
A new study published in the June 2017 issue of Health Affairs offers startling statistics on the degree of health disparities between Americans of different socioeconomic status. Compared to the wealthiest third of Americans, people in the poorest third are far more likely to have health problems and far less likely to have access to health care or to receive high quality care. Other high-income countries have wide disparities in one or two of these areas, but the United States stands out as the only high-income country with large disparities by all three measures. The other countries with similarly “large or moderate” gaps in all three include Russia and Bulgaria.
The study is a timely reminder to lawmakers who are pushing to repeal the ACA. The research was done prior to the implementation of the ACA in 2012. Any potential policy changes that would leave more vulnerable Americans without access to care (including low-income people, people of color, and women) won’t help to reduce the stark health disparities in the U.S.
Among the lowest-income Americans studied, more than 38% rated themselves as being “in fair or poor health,” compared to 21% of the middle-income respondents and 12% of the highest-income respondents. This disparity in perceived health is the third largest of all countries studied, surpassed only by Chile and Portugal.
When it comes to health care access, lower-income Americans don’t fare much better. In most countries, people at the bottom of the income ladder are significantly more likely than those at the top to forego needed medical treatment because they can’t afford it. But the U.S. is at the top of the list, second only to the Philippines.
Poor people in the United States, like those in Bulgaria and Chile, are also less confident than high-income individuals that they’ll receive the best treatment available if they become seriously ill.
The majority of Americans (67%), according to the study, believe that “many” Americans do not have access to the health care they need.
And yet, in large part, Americans don’t seem to have an ethical issue with this wide-ranging health disparity, note the authors:
Americans exhibited less moral concern about income-based differences in the quality of health care that people have access to, compared to respondents in the majority of the other countries in our sample.
It’s important that we address these measures of disparity. But even addressing all of them won’t “solve” the disparity crisis in this country. As Rachel wrote on the OBOS blog in 2014, after the implementation of the ACA:
It’s also important to note that a reduction in health insurance disparities is not necessarily a reduction in health disparities themselves. Even with access to health care, people of color still see gaps in health outcomes, many of which will necessitate larger social, economic and political shifts to solve. And simply having access to insurance does not guarantee the quality of the health care you receive.
The maternal death disparity in this country is not only one of income inequity. While poor women are at greater risk of dying than women who have higher incomes, the disparity between black and white women is consistent at all income levels.
Coming to consensus about how best to reduce the widespread disparities in health and health care will be difficult. The researchers note that in the United States, current national discussions about health care are sharply drawn along party lines: Ninety-one percent of Democrats and but only 42% of Republicans believe that the government has a role to play in creating a more equitable system of health care. This is vastly different than European countries, where researchers found more consensus about the unfairness of income disparities in health care access.
The authors warn that reversing the policies of the ACA would “risk taking a step backward in an area where the United States is in sore need of improvement, and in a political environment where solutions with broad support are increasingly hard to find.”