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Minorities face hurdles in getting health care

Published: Wednesday, June 27 2012 11:50 p.m. MDT

In this March 22, 2010 photo, Jose Perez, 22, receives dialysis treatment at a clinic in New York.  Perez, an undocumented immigrant, suffers from renal failure and receives dialysis treatment three times a week.  (AP Photo/Seth Wenig) (Seth Wenig, ASSOCIATED PRESS) In this March 22, 2010 photo, Jose Perez, 22, receives dialysis treatment at a clinic in New York. Perez, an undocumented immigrant, suffers from renal failure and receives dialysis treatment three times a week. (AP Photo/Seth Wenig) (Seth Wenig, ASSOCIATED PRESS)

Editor's note: This report is part 5 of "Coming to our Census," a series of reports that takes a careful look at the issues posed by the changing demographics of Utah and the nation.

Related coverage

Part 1: The changing face of Utah - Are we ready to embrace the future?
Part 2: Poll results: Utahns welcome diversity but perceptions don't always match reality
Part 3: Some solutions in place to close education gap, but is Utah willing to pay for them?
Part 4: Latino students face barriers to higher education
Part 6: Immigrants, refugees can choose which aspects of culture to assimilate

Editorial: 'Coming to our Census' series takes needed, critical look at issues posed by Utah's changing demographics

Lists: Poll responses: Benefits of a more diverse population in Utah; Poll results about Census data: Perceptions don't always match reality

KSL coverage: 'Coming to our Census'

SALT LAKE CITY — Three-year-old Sinai is draped across her mother's lap, chocolate eyes dull and downcast, long eyelashes fluttering. For two days, her aunt explains as she reaches over to stroke the little Latina's black hair, she has been turning down food and complaining of throat pain.

"I worry when the kids are sick," Rita Mosqueda says. Since her sister and her five children moved into her West Valley City split-level six months ago, the 40-year-old immigrant mother of three and her husband have been paying the bills for both families. A day-care worker and a landscaper, neither have health benefits.

Ethnic minorities are far more likely to be uninsured than the American population as a whole. While just 13.9 percent of Caucasians don't have insurance coverage, the same is true for 33 percent of Hispanics, 22 percent of blacks and 18 percent of Asians. Perhaps as a result, despite notable progress in the overall health of the nation, there are continuing disparities in the burden of illness and death experienced by minorities. Black and Hispanic children are almost three times as likely to be in poor or only fair health as white children. Not only are minority populations more likely to develop chronic diseases, they are also more likely to get sicker and die from them.

This year, for the first time in history, the number of minority babies born in the United States outnumbered the number of white babies, according to the U.S. Census Bureau. As the demographics of the nation shift, health care experts say the need to address minority health issues is becoming more and more urgent. Excess rates of preventable diseases among minorities are expected to cost taxpayers approximately $337 billion over the next decade, according to research from the Urban Institute. Left unchecked, these annual costs will more than double by 2050.

"I strongly believe that the future of our health care system depends on its ability to grapple with the confluence of demographics and health care disparities," said Sinsi Hernandez-Cancio, director of health equity for FamiliesUSA, a Washington, D.C.-based nonprofit dedicated to promoting high-quality, affordable health care.

Access to health care

For now, Mosqueda quiets her worry for Sinai by sending her teenage daughter to the drug store to get advice from the pharmacist. She'd go herself, but her English is not good and she worries about her ability to correctly interpret important medical directions. She prays the syrup the teenager brings home will do the trick. If not, well, "I try not to worry about that," she says, with the help of an interpreter. Mosqueda can't pay for medical care.

Disparities in minority health can be attributed in large part to socioeconomic factors, Hernandez-Cancio said. Poverty is strongly correlated with poor health and, in the United States, minority poverty rates are more than double white poverty rates. Minorities are more likely to work low-wage, more physical jobs and less likely to have health insurance.

"If you don't have insurance it is pretty much game over for you," she said. "A lot of the minority jobs don't offer health insurance and when you don't have insurance it's really hard to get the care that you need."

Even if minorities can overcome the insurance hurdle, though, studies show they may not get quality care.

Language is often an issue.

"Not having the ability to communicate with your health care provider in your primary language has been shown to cause more medical errors and worse health care outcomes," Hernandez-Cancio said.

Researchers, controlling for access-related factors such as insurance status and income, have also found evidence that racial stereotyping and biases may contribute to unequal treatment in health care settings. For example, in a 2011 study of 220 medical interns, Harvard researchers found most physicians tended to harbor biases against black patients. When randomly assigned a black patient with chest pain or a white patient with chest pain, interns tended to give minorities less care. Similarly, Columbia University recently found minorities with obstructive pulmonary disease were less likely to receive transplants and more likely to die than whites.

Judi Hilman, executive director of Utah Health Policy Project, got up close and personal with racial and cultural bias in 2004 when Primary Children's Medical Center physicians refused to place an eligible Hispanic toddler on the heart transplant waiting list. When she and now-Senator Luz Robles, D-Salt Lake, tried to intervene on the 2-year-old's behalf, she said they were told in no uncertain terms that the girl was turned away because her parents, who were immigrants, were illiterate.

"They were convinced the family would not be able to handle the home care instructions to the letter," Hilman said. "We thought they would bring together support for the family — case managers, interpreters, whatever they needed to make it happen — but they just didn't."

When the girl died, Hilman said the family was taken by surprise. Because of the language barrier, they never quite understood the gravity of the situation.

"Things are definitely getting better," she said. "Still, we worry that when there are decisions of life and death and the level of care that is required is very complicated, decisions are being made inappropriately."

Improving health

As Mosqueda waits for her daughter to return from the pharmacy, she explains her health care plan.

"The best thing to do is to not get sick," she says.

If the family is healthy, she won't have to worry about paying medical bills.

It's a goal easier stated than accomplished, but with the help of Communities United, a Salt Lake City nonprofit dedicated to improving health outcomes among minorities, Mosqueda says she is learning the steps to take to ward off illness. On her fridge, Mosqueda has posted a diagram of a plate sectioned off to represent how many vegetables, grains and meats she should feed her family each day. Before taking a free nutrition class from the nonprofit, Mosqueda says she cooked "food that had a lot of grease." Now she's deep frying less and making salads more. Communities United also taught her about the importance of getting regular mammograms and helped her find a doctor who would perform the exam pro bono. She is grateful, she says, because her tests came back irregular.

Mosqueda learned of Communities United from a neighbor who works as a health promoter. Community leaders who promote preventative health among neighbors and friends play an important role in helping to close the health care gap, Hernandez-Cancio said. Like "the mom that everyone goes to for advice," these health promoters already have the trust of the community. They have proven effective in helping friends and neighbors cross cultures, overcome financial barriers and navigate the health care system.

"Community health centers are incredibly important because they address some of the issues of providing," Hernandez-Cancio said. "They are taking the lead in providing programs and do prevention work and they go the extra mile, for example, providing a van to drive a patient to services."

Communities United also helps people like Mosqueda secure translating services.

Federal regulations require health care organizations to provide translators for those who struggle with English. But, according to a 2010 study from the Palo Alto Medical Foundation Research Institute, only 13 percent of U.S. hospitals meet the government language standards. Most hospitals provide language assistance in a timely manner to those who speak the most commonly requested language, but few provide services for those who speak less common languages. A majority of hospitals rely on untrained family members to translate and provided important paperwork only in English.

It is important to understand the specific needs of each ethnic group, so those needs can be met most effectively by providers, said Marylin Lynk, a researcher at Maryland's Adventist Health who is studying the provision of culturally and linguistically appropriate care at hospitals and other medical facilities.

"Having the physicians and nurses understand what some of the cultural nuances are or even what the health beliefs and practices are of different populations can help with increasing quality of care," she said.

Insurance for the poor

Perhaps the most sweeping solution to minority health care woes on the horizon is President Barack Obama's Affordable Care Act, said Lisa Clemans-Cope, a senior research associate and health economist at the Urban Institute.

"If the ACA is upheld by the Supreme Court, we have a historically unprecedented opportunity to address these long-standing differentials," she said.

The law expands Medicaid eligibility by establishing a national floor and providing coverage for low-income adults without dependent children, Clemans-Cope said. The gains for minorities will be huge, according to her research. She estimates blacks, Hispanics and Asians will all see an 8 to 12 percent increase in insurance coverage.

The ACA also sets aside $11 billion to invest in expanding and creating community health centers.

"ACA is a big step in the direction in improving access to health care for everybody," she said. "Differences in minority coverage rates and health care access will be reduced and you would expect that to be followed by improvements in health status. All of these elements add up to a really big expansion of coverage that was not going to happen without the new law."

But, she said, the law does not address the health care needs of the nation's undocumented immigrants and their U.S.-citizen children. Nationwide, 21 percent of all uninsured children live in mixed-immigration status families, according to the Urban Institute.

"If you really want to maximize enrollment you have to address mixed-immigration status families," she said. "Some families are eligible but are not enrolled and are not accessing the resources available to them. They live in fear that the immigration status of one member could be adversely affected if another member participates in a public program."

When it comes to insurance, Mosqueda isn't getting her hopes up, yet. But, she says, watching as Sinai whimpers in a feverish sweat, it would be nice not to worry.

"She is so sick," she says. "I can't really do anything about it."

Editor's note: This report is part 5 of "Coming to our Census," a series of reports that takes a careful look at the issues posed by the changing demographics of Utah and the nation.

Related coverage

Part 1: The changing face of Utah - Are we ready to embrace the future?
Part 2: Poll results: Utahns welcome diversity but perceptions don't always match reality
Part 3: Some solutions in place to close education gap, but is Utah willing to pay for them?
Part 4: Latino students face barriers to higher education
Part 6: Immigrants, refugees can choose which aspects of culture to assimilate

Editorial: 'Coming to our Census' series takes needed, critical look at issues posed by Utah's changing demographics

Lists: Poll responses: Benefits of a more diverse population in Utah; Poll results about Census data: Perceptions don't always match reality

KSL coverage: 'Coming to our Census'

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