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    Meeting the next ACA deadline

    Healthcare policymakers are preparing for the next deadline required by the Affordable Care Act (ACA), which stipulates federal health programs must collect and report racial, ethnic and language data.

    The reform law requires ongoing and new federal programs to collect and report this data to help the U.S. Health and Human Services secretary to identify and reduce disparities.

    The Institute of Medicine (IOM) has examined the case for eliminating racial and ethnic health and health care disparities in the last few years. IOM identified lack of insurance as a significant driver of health care disparities because, more than any other barrier, it negatively affects the quality of care received by minority populations.

    Moreover, the Agency for Healthcare Research and Quality (AHRQ) has documented that racial and ethnic minorities receive poorer quality of care and face more barriers when it comes to chronic disease management and preventive care.

    In April of 2011, the HHS published a report titled "HHS Action Plan to Reduce Racial and Ethnic Health Disparities – A Nation Free of Disparities in Health and Health Care." The report provides states strategies on how to eliminate disparities.

    A 2010 report, "Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations," outlines significant opportunities to reduce disparities, which include:

    • Data collection and reporting;
    • insurance coverage;
    • cultural competence;
    • access to health care;
    • quality improvement; and
    • research.

    On Oct. 31, 2011, HHS released its final health survey standards aimed at more consistently identifying and eliminating differences in care based on race, ethnicity, sex, primary language and disability, as required by ACA.

    HHS officials said at the time that making data standards and processes consistent will help identify significant health disparities that often exist between and within ethnic groups.

    For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 deaths per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). The HHS points out that these data lines would have remained unexamined had only the umbrella terms of "Hispanic" or "Latino" been used. By adding different ethnic origins as explicit categories on all HHS-sponsored health surveys, the government hopes to better capture and track the health differences and thus target interventions more appropriately.

    Combined Sections I and II of the final standards concern race and ethnicity. The existing government-wide standard from the Office of Management and Budget (OMB) was used as a starting point, with more specific reporting options designed so that the new options roll-up into the broader existing OMB standard, according to HHS.

    For instance, the standard "Hispanic or Latino" was expanded to include Mexican, Mexican American, Chicano, Puerto Rican, Cuban, or Another Hispanic, Latino, or Spanish origin, the term "Asian" now includes the categories Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or other Asian, and "Native Hawaiian or Other Pacific Islander" now also includes Guamanian or Chamorro and Samoan.

    Survey respondents are able to mark all categories that apply to themselves and their households.