The Affordable Care Act and Minority Health: Part IV (Workforce Diversity)
As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This fourth post of a five-part series describes the current initiatives to diversify the health care workforce with greater minority participation.
Racial and ethnic minorities are underrepresented in the American health care workforce, something that has changed little in the past 20 years. Why does that matter? According to the U.S. Health Resources and Services Administration (HRSA), it matters because [underrepresented] minority health professionals, particularly physicians, disproportionately serve minority and other medically underserved populations, and because minority patients tend to receive better interpersonal care from practitioners of their own race or ethnicity, particularly in primary care and mental health settings.
The data reveal severe underrepresentation among certain minority groups in the health care workforce. Although non-Hispanic Blacks make up 12.2% of the population, they account for 6.3% of active physicians, 5.8% of registered nurses (RNs), and 4.2% of physician assistants (PAs). Hispanics make up 16.3% of the population, yet they account for 5.5% of physicians, 3.9% of RNs, and 4.7% of PAs. In contrast, non-Hispanic Whites and Asians make up 68.4% of the population, 86.5% of physicians, 83.2% of RNs, and 90.8% of PAs.
The Affordable Care Act recognized the importance of workforce issues when it created the National Health Care Workforce Commission, which has yet to meet because Congress has not authorized its funding. Beyond this commission, the ACA also established or updated a number of other programs that may have an impact on the racial and ethnic composition of the health care workforce. These include:
- A $4 billion investment between 2010-2015 into the existing National Health Service Corps (NHSC), which offers scholarships and loan repayments to health professionals who work in poor or rural areas. About one third of professionals who currently receive NHSC support are racial and ethnic minorities.
- Expanded loan repayments and scholarship funding for disadvantaged students, many of who are members of underrepresented minority groups. The ACA reauthorized the Health Careers Opportunity Program (HCOP), which received funding of $60 million over five years; the Scholarships for Disadvantaged Students program, which received $47 million a year; and Nursing Workforce Diversity Program, which received $16 million a year. HCOP was not reauthorized in 2015.
- Reauthorization of Title VII Centers of Excellence (COE), which received $23 million in 2010-2015. This has funded 19 awards to historically Black Colleges and Universities (HBCUs), Hispanic COEs, Native American COEs, and “other” health professions schools that meet the program requirements. Grants support programs that enhance the academic performance of underrepresented minority students, support minority faculty development, and facilitate research on minority health issues.
- Creation of the Health Profession Opportunity Grants (HPOG) program, which received $67 million over five years. HPOG provides education and training in allied health professions to recipients of Temporary Assistance for Needy Families (TANF) or other low-income people. Over five years, 32 organizations (included five Indian Tribal entities) received grants.
- Grants to support the Community Health Workforce (community health workers), who work in “medically underserved communities, particularly racial and ethnic minority populations.” As mentioned yesterday, this provision has not received funding from Congress.
Although the ACA recognized the importance of increased diversity in the health care workforce, the impact of its programs will limited by reductions in the funding originally authorized, the time-limited scope of the legislation, and the long pipeline needed to change the racial/ethnic distribution of health care professionals. Programs that can “feed” the pipeline at early educational levels (such as PennLDI’s SUMR program) will be needed to make a substantial impact on diversity. Ironically, HCOP, a program that funded initiatives at K-12, baccalaureate, and post-baccalaureate levels, was discontinued because the federal budget “is prioritizing investing in programs that have a more immediate impact on the production of health professionals by supporting students who have committed to and are in training as health care professionals.” Nevertheless, the inclusion of diversity programs and goals the ACA is an encouraging direction. As racial and ethnic minorities become an even larger portion of the population in the near future, these programs will need to be implemented earlier and longer in the educational process.