On Wednesday March 11th, the Senate and Assembly Health Committees held a Joint Hearing on Health Disparities in California. Co-chaired by Senator Ed Hernandez (D-West Covina) and Assemblymember Rob Bonta (D-Oakland), the hearing featured panel presentations by advocates and researchers discussing the status of California’s communities of color and recommendations for addressing persistent health disparities. In addition, staff from the Department of Health Care Services (DHCS), Office of Health Equity, Covered California, Safety Net Institute, and Partnership Health Plan discussed initiatives to improve data collection and analysis to better align health care services to address health disparities.
Defining Disparities in California
CPEHN’s Executive Director Sarah de Guia framed the discussion by emphasizing the need to incorporate an equity lens into our post-ACA health care delivery system. She noted that the key to reducing health disparities is to ensure standardized data collection and analysis of demographic data for disparities reduction initiatives and incorporating primary prevention into our delivery system to address the root causes of disparities.
B. Darcel Lee, President and CEO of the California Black Health Network (CBHN) spoke about disparities in health outcomes for African-Americans in California, particularly in infant mortality rates which are three times higher than any other single racial or ethnic group, an issue that is of primary importance to CBHN. Latino Coalition for a Healthy California Executive Director, Xavier Morales, gave an impassioned speech about diabetes in the Latino community, noting “this is an epidemic that is a primary concern for our organization.” Diabetes impacts 55% of Latinos in California, and 1 in 2 children of color are now expected to grow up with diabetes according to the latest statistics.
Jonathan Tran of the Southeast Asia Resource Action Center presented on the importance of disaggregated data for Asian and Pacific Islander (API) communities, where disparities are often masked due to the large “Asian” category. Using Covered California data, Tran showed how uninsured rates between Koreans and Latinos are actually similar, compared to the overall Asian category. Ayako Miyashita from the Williams Institute also discussed the importance of the standard collection of data as an essential first step towards better meeting the health needs of the lesbian, gay, bisexual, and transgender communities.
Both Assemblymember Bonta (D-Oakland) and Assemblymember Chiu (D-San Francisco) discussed bills they introduced this legislative session on data collection. AB 176 (Bonta) would require the Department of Education and the California Department of Public Health to collect disaggregated data on API populations and AB 959 (Chiu) would require the state to begin collecting demographic data on sexual orientation and gender identity.
Senator Bill Monning (D-Santa Cruz) asked panelists to discuss strategies for combatting efforts from the soda industry that target children and communities of color. Senator Monning has introduced SB 203 which would require a safety warning label on sugar sweetened beverages. Xavier Morales touched upon the importance of prevention including efforts to strengthen neighborhood safety to promote physical activity and the need to identify revenues to help address the wave of children and adults impacted by pre-diabetes.
Assemblymember Sebastian Ridley-Thomas (D-Culver City) stressed the importance of ensuring workforce pathways aimed at increasing diversity in the health professions to combat health disparities, particularly in low-income areas and communities of color. Senator Monning noted that the proposed state budget includes increased funding for the Song-Brown loan repayment program, which creates incentives to work in underserved areas.
Beyond the Triple Aim
Health Policy consultant Ignatius Bau spoke about opportunities under the ACA for better communication and exchange of patient demographic data between hospitals and providers through Health Information Exchanges and Electronic Health Records. He noted that data on race, ethnicity, language, sexual orientation, and gender identity “needs to be exchangeable through cloud-based solutions rather than requiring the different systems at the physician practice, health plan level, and hospital level to try and communicate with each other.” This was echoed by Howard Berliner from the New School who agreed that sociodemographic data should be collected in order to understand the intersectionality between cost, quality, and health disparities. He stated that without this data, safety-net hospitals in poorer communities are often penalized for higher readmission rates because Medicare does not take into account chronic conditions faced in poor communities.
Bau also urged that demographic data is standardized and included as a mandatory requirement of an All Payer Claims Database. Senator Hernandez recently introduced SB 26 which would create such a database in California. He also stressed that California needs to go above and beyond the “triple aims” of population health, cost, and quality to ensure that equity is a central part of the conversation.
Disparities in the Era of Data
Sarah Brooks from the Department of Health Care Services (DHCS) and Peter Lee from Covered California presented on their agencies’ efforts to reduce disparities. Brooks acknowledged that addressing disparities is a key goal of DHCS. She said the agency is working with national and state groups, including CPEHN, to address disparities. DHCS is optimistic about the new disparities-related initiatives in the 1115 Medi-Cal waiver renewal proposal which is part of the state’s efforts to secure $15-20 billion from the federal government. Brooks also touched on DHCS’ plans to require the stratification of quality measures by race, ethnicity, primary language, and geographic region. Additionally, advocates learned that DHCS has started stratifying grievance and appeals data to determine whether certain groups are getting appropriate care. Plans that are found in default must come into compliance or be fined.
Lee also said that addressing disparities was central to Covered California’s mission. He pointed to the improvement in Latino enrollment from the first open enrollment period to the second as an example of how his organization is working to achieve its goals. He acknowledged that Covered California is continuing to learn the best outreach strategies to improve enrollment. He also pointed to the importance of health literacy, as many of the Covered California enrollees have never had insurance before. He noted that Covered California will be working with diverse consumer groups to improve patient experience.
Jahmal Miller from the Office of Health Equity (OHE) echoed the comments of advocates on the need for better data on health disparities. OHE is working to ensure that data is more standardized and available on disparities. Miller shared an example of OHE’s mapping project which shows the nexus between areas that have higher concentrations of communities of color and poorer air quality, demonstrating the notion that your zip code determines your health.
The forum provided a great opportunity for advocates and legislators to discuss some of the most pressing health issues impacting communities of color and how state agencies can work to reduce health disparities. While there is a lot of work to be done, CPEHN was pleased to see the legislature and state agencies taking a proactive approach to reduce health disparities. We hope to see more policy proposals to address health disparities and foster health equity throughout California.