The Health Care Fairness Act of 1999

By Phyllis Griffin Epps

Legislation now pending in the United States Senate would expand the role of the federal government in supporting the study and elimination of disparities in health status suffered by racial and ethnic minority populations in this country. The Health Care Fairness Act of 1999, or S. 1880, was introduced in the Senate on November 8, 1999. The bill is a comprehensive and appropriately aggressive plan for attack upon one of the most shameful aspects of life and health in America.

The Background

Race and ethnicity are indicators of health status in America. For all its economic wealth, America lags behind most other industrialized countries in health status as measured by longevity, morbidity, and mortality. The poor ranking is explained in large part by the lower health status of America’s minority populations. Infant death rates in African American, Native American, Alaskan Native and Hispanic populations are higher than the national average. African Americans and Hispanic Americans suffer higher incidence and death rates for diabetes, cancer, and cardiovascular disease than their white counterparts. Vietnamese and Hispanic women in the United States have a cervical cancer incidence rate several times higher than white women. The incidence of tuberculosis is five times higher for Asian Americans and Pacific Islanders than for the total population. Stroke is the only leading cause of death for which mortality is higher for Asian American males than for white males. The average life expectancy for African Americans is nearly seven years less than the average life expectancy for white Americans. Minority women and children make up a disproportionately high percentage of AIDS cases reported.

In February 1998, President Clinton announced the goal of eliminating disparities in health status experienced by racial and ethnic minority populations by the year 2010. Through its Initiative to Eliminate Racial and Ethnic Disparities in Health, the U.S. Department of Health and Human Services (HHS) has identified several health areas that reflect disparities known to disproportionately affect multiple racial and ethnic minority groups at all stages: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection and AIDS, and immunizations. The elimination of health disparities is an overarching objective of Healthy People 2010, a national prevention agenda of health management goals and objectives for the next decade.

The Health Care Fairness Act of 1999 is the latest attempt to tailor a legislative approach to correcting disparities in health based on race and ethnicity. The Office for Research on Minority Health was founded in 1990 at the National Institutes of Health to promote research and training related to the disproportionate incidence of disease among members of racial and ethnic minority groups. Last June, Rep. Jesse Jackson, Jr. introduced H.R. 2391, the National Center for Domestic Health Disparities Act of 1999, to expand the powers and budget of the Office of Research on Minority Health. The bill was lauded by leaders in the field of minority health research, but was criticized by Dr. Harold Varmus, Director of the National Institutes of Health, as harmful to current and future efforts to address minority health disparities by the institutes and centers within NIH.

The Legislation

The Health Care Fairness Act of 1999 would elevate the existing NIH Office of Research on Minority Health to center status under a new name: the Center for Research on Minority Health and Health Disparities. The bill equips the new center with four major mechanisms not available to the existing office:

  1. The Director of the Center will participate with other Institute and Center Directors to determine policy and initiatives at NIH.
  2. The Center will act as a catalyst for strategic planning for the entire NIH and the Director will be the primary federal official with responsibility for monitoring all minority health research conducted or supported by NIH.
  3. The Director of the Center has the authority to make peer-reviewed grants in areas of promising research, which are not addressed by the existing centers and institutes at NIH.
  4. A new program of support for research excellence at those academic health centers which have demonstrated a historic commitment to studying and addressing diseases which disproportionately affect Americans in racial and ethnic minorities.
The budget proposed for the Center is $100 million for the upcoming year. The amount exceeds the Office of Research on Minority Health’s current operating budget by $25 million.

The legislation would also expand the responsibilities of agencies other than NIH. Through the Director of the Center, HHS would establish a loan repayment plan as a tool of recruiting qualified minority individuals into biomedical and other fields of research in which minorities are underrepresented. HHS would also establish a grant program to support the development of culturally competent curricula in health care education. The National Academy of Sciences would study HHS’ data collection practices and procedures regarding race and ethnicity and recommend improvements.

Sponsored by Senators Edward Kennedy, Daniel Akaka, Daniel Inouye, Blanche Lincoln, and Paul Wellstone, the Health Care Fairness Act of 1999 was referred to the Committee on Health, Education, Labor, and Pensions. Representatives Charles Norwood, John Lewis, and Jesse Jackson, Jr. will introduce the Health Care Fairness Act in the House. The bill is further supported by Dr. David Satcher, Surgeon General, Dr. Louis Sullivan, President of Morehouse School of Medicine and former Secretary of the Department of Health and Human Services in the Bush Administration, and Dr. Harold Varmus, outgoing Director of the National Institutes of Health.

The Health Care Fairness Act of 1999 would allocate resources in minority health research with greater efficiency than is possible under the current system. The new Center would have the tools to craft a meaningful research agenda and, if necessary, to fund projects in the public and private sector instrumental to the eradication of race-based gaps in health status. The proposed legislation would implement policies designed to focus the attention of the agencies and departments of the federal government. Equally as important, the passage of the Health Care Fairness Act of 1999 would constitute due acknowledgement of the elimination of health disparities linked to race or ethnicity as a national priority. That a nation with such high levels of prosperity and economic development should retain enormous gaps in health status is reason for shame. As with most efforts to erase the painful legacy of the nation’s history of race relations, the problem cannot be solved without the attention of the public sector as well as the private.