WHITE PAPER -- Health Policy: A Vehicle for Improved Health and Economic Outcomes for Urban America

Monday, January 6, 2014
“Of all the forms of inequity, injustice in health care is the most shocking and inhumane.”
— Dr. Martin Luther King, Jr.
For over 100 years, the National Urban League (NUL) has been committed to the mission of
economic empowerment in African American and other underserved communities – a mission that
is inextricably linked to the reduction of racial health disparities in America. Since 2004, NUL has
provided health care services to over six million individuals. Urban League affiliates offer a broad
range of health programs, including health screenings, assistance accessing insurance and social
safety net programs, basic health and wellness training, as well as chronic disease prevention and
management education. Through our signature program, “Project Wellness”, NUL has partnered
with the Morehouse School of Medicine and trained over 500 community health workers across the
nation. These community health workers are identifying and training trusted leaders within their
communities and empowering them with health and wellness tools that they can pass on to their
friends, families, neighbors, and other community leaders. Through this empowerment model, we
are creating a lasting cultural change in underserved communities that will improve health
outcomes and lead to better quality of life.
In 2012, the National Urban League Washington Bureau (NULWB) released a report, “State of
Urban Health: Eliminating Disparities to Save Lives and Cut Costs”, which presents a sobering look
at the economic impact of health disparities in America. In addition, each year we publish several
essays focused on health equity issues in our signature publication, “The State of Black America”.
This year, through the launch of the Urban Solutions Council, NULWB joined forces with private
sector health industry partners, Centene and Amgen, to identify and explore areas of policy
alignment that will help promote economic growth and employment in urban communities, while
also helping to eliminate health disparities. Through the work of the Urban Solutions Council, we
have identified a number of policy solutions that will improve health and quality of life in urban
America, create jobs, and enhance the economic recovery.
What’s at Stake for the National Urban League and Our Partners?
The Affordable Care Act represents a historic opportunity to reduce the number of uninsured
through an expansion of Medicaid and through new health insurance exchange marketplaces that
increase access to affordable coverage. Beginning in 2014, in states that implement the ACA’s
Medicaid expansion, adults with incomes up to 138% of poverty ($26,951 for a family of three in
2013) will now be eligible for Medicaid. In addition, individuals will be able to purchase coverage
through new health insurance marketplaces, and qualified individuals are eligible for subsidies to
help pay for coverage offered through these marketplaces.
African Americans and Latinos stand to gain the most from effective implementation of the
Affordable Care Act because they are more likely to experience poorer health outcomes and are less
likely to have health insurance coverage when compared to whites. According to the 2013 State of
Black America report, African Americans have higher rates of death compared to any other racial or
ethnic group for most major cancers, including stomach, lung, prostate, and colon cancers1. Latinos
are more likely than whites to die from diabetes, liver disease and HIV2. Both African Americansand Latinos are more likely than whites to be diagnosed with obesity and diabetes and other
chronic conditions3. Despite these troubling statistics, African Americans and Latinos are also least
likely to have access to health insurance. While 48 million individuals nationwide lack insurance
coverage, 29 percent of Latinos and 19 percent of African Americans are uninsured compared with
11 percent of whites.
In addition to taking a physical toll on families in underserved communities, health disparities also
impose a significant burden on the U.S. economy because people in poorer health incur greater
health care costs and miss more time (and earnings) from work. According to The State of Urban
Health report, in 2009, health disparities cost the U.S. economy $82.2 billion --$60 billion in direct
health care spending and $22 billion in lost productivity5. These costs represent health care
expenditures and time away from work that could have been avoided if health outcomes for
racial/ethnic groups with poorer health were the same as racial/ethnic groups with better health
outcomes (i.e., if disparities were eliminated). African Americans bore a disproportionate share of
that cost with $55 billion, followed by Hispanics with $22 billion6. Private insurance plans paid
38.4 percent of these increased health care costs from health disparities, but the second highest
cost burden, 27.7 percent, goes to individuals and families through out-of-pocket payments, much
of which is due to inadequate insurance coverage7. If we do nothing, the cost of disparities is
projected to grow to $363.1 billion by 20508.
Given these trends, there is much at stake in effective implementation of the Affordable Care Act for
the National Urban League and its partners:
1. The number of uninsured African Americans will decrease and disparities in access to care
and health outcomes for African Americans will be significantly reduced.
2. Poor, uninsured African Americans across the country will have coverage if all 50 states
expand Medicaid.
3. Increased costs due to lost productivity and health care spending will go down due to
reductions in health disparities.
4. Demand for health workforce and technology jobs will increase due to increased access to

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