Last month marked the third anniversary of the Patient Protection and Affordable Care Act, a landmark effort to make health insurance coverage more affordable and accessible. Among the many provisions guiding health reform, the Affordable Care Act includes requirements to ensure the health care system provides adequate coverage for individuals in need of services for mental and substance use disorders. According to a report from the HHS Assistant Secretary for Planning and Evaluation (ASPE), the Affordable Care Act provides one of the largest expansions of mental health and substance use disorder coverage in a generation.

Starting January 2014, an estimated 27 million uninsured individuals will have access to health insurance, and 25 percent of uninsured adults have a mental health condition or substance use disorder or both. The Affordable Care Act presents critical opportunities to improve access to care for these individuals. Building on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the Affordable Care Act ensures that mental health and substance use services for newly covered individuals are provided at parity with medical and surgical benefits. The law also requires all new small group and individual market plans to cover 10 Essential Health Benefit categories, including mental health and substance use disorder services.

Improvements to the health care system will not only benefit individuals with behavioral health conditions, but also other groups who experience health disparities. Racial and ethnic minority populations are disproportionately uninsured, face systemic barriers to health care services, and often receive lower quality care and experience worse health outcomes. A concerted effort is needed to ensure that individuals from diverse racial and ethnic populations in need of mental health or substance use services are able to benefit from the expansion of coverage offered by the Affordable Care Act.

As the open enrollment period for the Health Insurance Marketplace approaches, targeted approaches for outreach and enrollment of diverse populations will be critical to reaching these vulnerable groups. The Office of Behavioral Health Equity at SAMHSA has partnered with four national associations (National Asian American Pacific Islander Mental Health Association, National Council on Urban Indian Health, National Latino Behavioral Health Association, and National Leadership Council on African American Behavioral Health) to identify and support the implementation of culturally appropriate outreach and enrollment practices, with the goal of increasing health insurance coverage among diverse populations.

Improved coordinated care and the integration of primary and behavioral health care, supported by Affordable Care Act provisions, will also benefit minority populations in need of mental health or substance use services. Individuals from racial and ethnic minority groups are more likely to seek services from primary care providers; therefore, integrated care models can increase access to behavioral health services. Coordinated care also offers the potential to provide improved services for prevention and early intervention. SAMHSA funds the Primary and Behavioral Health Care Integration program, to provide support to communities to coordinate and integrate primary care services into publicly funded, community-based behavioral health settings, resulting in improved access to primary care services; improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease; increased availability of integrated, holistic care for physical and behavioral disorders; and better overall health status of clients.

Through these provisions and an emphasis on reducing health disparities, the Affordable Care Act presents critical opportunities for making access to health care more affordable for diverse populations. Now as the federal government partners with communities, we can work together to ensure these opportunities become a reality.

April marks National Minority Health Month. It's an important time to shine the spotlight on health disparities in our country as well as to call attention to some exciting programs the President's Council on Fitness, Sports, and Nutrition is working on to make sure individuals and communities have the best possible access to sports activities and healthy foods.

Many Americans may not know that communities of color experience higher rates of certain health conditions like obesity, diabetes and heart disease than the rest of the population—this is called a health disparity.* As an Asian-American, this is something that is close to my heart since minorities often face health disparities due to language and cultural barriers.

When I was growing up I was fortunate to have access to safe parks and recreation centers that allowed me to be involved in a variety of sports and daily physical activity. Through my parents I also learned the importance of healthy eating. Fresh, healthy foods were always available. Sadly, many children today do not have these opportunities.

At the President's Council, we are fortunate to work closely with First Lady Michelle Obama's Let's Move! initiative to reverse the childhood obesity epidemic sweeping across our nation. Through programs such as Let's Move! Cities, Towns and Counties; Chefs Move to Schools ; Let's Move Faith and Communities ; and Let's Move Salad Bars 2 Schools, our nation is tackling the childhood obesity epidemic head on by identifying gaps and disparities, working to find solutions and providing resources that are easily accessible to everyone.

Most recently, the First Lady launched Let's Move! Active Schools to increase physical activity opportunities for America's youth throughout the school day. Make sure your school is signed up today! The President's Council serves as the federal government lead for Let's Move! Active Schools – so please send us any ideas about what more we can do in your community.

The time is now to eliminate health disparities and work toward a healthier nation. We all have a role to play in creating an environment where physical activity and nutritious food options are available to all Americans. I am confident that we will get there!

*For information about the U.S. Department of Health and Human Services' Action Plan to Reduce Racial and Ethnic Health Disparities, visit: http://minorityhealth.hhs.gov/actnow/.

Gathered in the parking lot of my hometown church, family and friends were "catching up" with each other before leaving the annual "Homecoming" service and dinner. While in the parking lot, I overheard a conversation between two cousins. One was sharing that she had attended two funerals the day before, and her husband had been ill for several months. Caring for her husband, maintaining a full-time job outside the home and responding to the needs of her adult children and grandchildren had taken their toll on her physically and emotionally. She also commented that she was experiencing back pain but decided it was only arthritis. In this cultural context, arthritis is a minor, recurring and mostly annoying pain that is associated with aging. She had recently celebrated her 51st birthday. Her cousin asked if she had gone to see the doctor about the pain in her back, and she replied, "No, I just didn't want to hear any more bad news."

Back in Atlanta, I attended a high school basketball game and sat beside the uncle of one of the girls on the dance team that would perform at half time. He knew I worked at CDC and was curious about my work at the agency. I described our focus on eliminating health disparities, and this ultimately led to a conversation about a health issue he was having. He told me that for several months, he had been seeing blood in his stools. He was very concerned, and wondered if it might just be hemorrhoids. I asked if he had gone to see a doctor about this, and he said, "No, I just don't want to hear any bad news."

While conducting research several years ago with black men with type 2 diabetes, I was referred to a man who was experiencing multiple symptoms of diabetes but declined to be tested. I asked why he didn't want to know if he had diabetes, and his response was "it's not a good time to know." "Why isn't it a good time?" I asked, and he said, "I'm taking care of my elderly parents, the economy isn't good and it's just not a good time to know." I told him that if he in fact had diabetes, it was better to know and take action to control it. He didn't say anything, but got into his car and drove off. I don't know if or when he was ever tested for type 2 diabetes.

As a medical anthropologist, I am always interested in these types of arguably anecdotal statements made in unsuspecting community contexts to help explain why despite the progress our nation has made over the past 50 years, racial and ethnic minorities still lag behind the general population on many health fronts. We know that communities of color are less likely to get the preventive care they need to stay healthy, are more likely to suffer from serious illnesses, such as diabetes, heart disease and colon cancer, and are less likely to have access to quality health care.

But now, preventive services, consumer protection and other reforms under the Affordable Care Act are giving millions of Americans of all ages, races and ethnicities more value for their health care dollars and contributing to the slowest growth in health care costs in 50 years.

The Affordable Care Act is already making prevention more affordable and accessible for all Americans by requiring health plans to cover many preventive services for free. For example, new health plans must offer no-cost coverage for services that will prevent and control these diseases, like:

• Screening for obesity, and counseling from your doctor and other health professionals to promote sustained weight loss, including dietary counseling from your doctor.
• Blood pressure screening, and counseling on the use of daily aspirin to reduce the risk of a stroke.
• Tests to screen for high cholesterol and diabetes to reduce the chances of developing heart disease.

So how do we work together to ensure that more people actually use and benefit from these services? Achieving the goals of the Affordable Care Act is a shared responsibility between health care and public health practitioners, policymakers, employers and the community. A full discussion of strategies that can bridge the availability of services with persons needing those services is beyond the scope of this blog; however, there are places to begin, such as:

• Mobilizing state and local health departments, community-based organizations, voluntary health organizations and other community resources to implement what has been learned through research and practice about patient activation and patient and family engagement to increase utilization of health services among people who have not previously had access and must now learn how to navigate the health care system;
• Engaging Community Health Workers and Patient Navigators;
• Ensuring a diverse and culturally competent workforce;
• Creating prevention messages that encourage the use of preventive services in ways that leave people feeling empowered by the decision to take advantage of these services rather than "not wanting to hear any more bad news;"
• Acknowledging and addressing the social determinants of health, and the disruptions that come when there is a diagnosis of a life-threatening disease (e.g., new demands on one's time, attention, and finances; new uncertainties about the future; yet another thing to manage) among people whose lives are already stressed and vulnerable;
• "Reaching in" to communities of color and collectively working to change the community conversation to one that promotes wellness and believes we can prevent disease.

How will you implement and benefit from provisions in the Affordable Care Act to achieve healthier communities?

References:
Lasser, K.E.,Murillo, J., Lisboa S., et.al. Colorectal Cancer Screening among Ethnically Diverse, Low-Income Patients. Arch Intern Med. 2011; 171(10):906-912.
Carman, K.L., Dardess, P., Maurer, M., et.al. Patient and Family Engagement: A framework for understanding the elements and developing interventions and policies. Health Aff February 2013, vol 32(2):223-231.
Hibbard, J.H., Greene, J., Becker, E.R., et.al. Racial/ethnic disparities and consumer activation in health. Health Aff September 2008, vol 27(5):1442-1453.
Hibbard, J.H., Greene, J. What the evidence shows about patient activation: Better outcomes and care experiences; Fewer data on costs. Health Aff February 2013, vol 32(2):207-214.
Cooper, L.A., Powe, N.R. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. The Commonwealth Fund. July 2004.
Cleland, J.G.F., Ekman, I. Enlisting the help of the largest health care workforce – Patients. JAMA, September 22/29, 2010, vol 304(12):1383-1384.

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Too many Americans are not able to achieve their full health potential as disparities in health care persist. Racial and ethnic minorities and other underserved populations face higher rates of disease, fewer treatment options and reduced access to care. They are also less likely to have health insurance than the population as a whole.

An inclusive health and human services system treats people equitably and creates conditions in which all people can achieve optimal health. This is a fundamental gauge of an advanced, educated and economically strong society. However, until we realize that vision, our nation as a whole will continue to suffer. Now is the time to advance health equity.

We're at a crossroads in our history. The Affordable Care Act provides one of the most important levers by which we can advance that vision. The law places a new focus on wellness and prevention and improves access to primary care – a paradigm shift for our current "sick care" delivery system. The cornerstone of the law, improving access to quality health care, will reduce health disparities by bringing down health care costs, investing in the health care of communities, and giving individuals and families more control over their own care.

Everyone should have access to high quality health care. Not all Americans have equal access to health care. For underserved, vulnerable populations, barriers to obtaining health care services continue. The Affordable Care Act makes preventive care, such as regular check-ups, cancer screenings and immunizations available at no cost to those who are eligible. The law also makes new investments in community health teams to manage chronic disease. Because minority communities experience higher rates of illness and death for chronic diseases, this commitment is essential to reducing health disparities. Additionally, the law increases funding for community health centers, which serve an estimated one in four low-income minorities. The new resources will enable health centers to double the number of patients they serve. Combined with investments made by the American Recovery and Reinvestment Act, it will also support 16,000 new primary care providers.

Everyone should receive health care that is respectful of their cultural beliefs and practices, and communication in a language that they understand. Nearly 61 million people speak a language other than English at home. Language barriers impact the ability of individuals to access health care and human services. Individuals with limited ability to read, speak, write or understand English are less likely to have a regular source of primary care. Today, 68 percent of medically underserved communities across the nation are in rural areas. Through our Advancing Effective Communication in Critical Access Hospitals Initiative, my office is working with critical access hospitals nationwide to ensure they provide comprehensive language services to individuals that speak little to no English in rural and isolated areas. Language assistance services are essential to meaningful access to quality health care. If providers and patients do not understand each other clearly, serious consequences can arise. By tailoring services to a patient's culture and primary language, health care providers can bring about positive health outcomes for diverse populations. Moreover, the law expands initiatives to increase racial and ethnic diversity in the health care professions and strengthens cultural competency training for all health care providers.

Everyone has a right to protection from insurance discrimination. In the past, insurance companies could search for an error, or other technical mistake, on a customer's application and use this error to deny payment for services when he or she got sick, and refuse to sell coverage or renew policies because of an individual's pre-existing conditions. The law bans such practices, so people who have been sick can't be excluded from coverage or charged higher premiums. Women will no longer have to pay higher premiums because of their gender. Additionally, new funding will be available to collect information on how women and racial and ethnic minorities experience the health care system, leading to improvements that will benefit these groups.

Lastly, everyone has the right to the security of knowing their health information is safe and sound. As the agency within the U.S. Department of Health and Human Services that ensures that the privacy practices of several million heath care providers, plans, and clearinghouses adhere to Federal health information and privacy laws, my office, the Office for Civil Rights, works tirelessly to enforce the laws which safeguard the privacy and security of health information. This fall, when enrollment in the Health Insurance Marketplace begins, millions of people will be able to purchase affordable health insurance and gain access to a new health care delivery system centered on coordination and continuity of care –many for the first time. This influx of individuals into the health care system will not only improve access to care, but will allow consumers to take charge of their health and manage their care in concert with their providers. For instance, much like obtaining a copy of one's credit report, individuals have rights over their health information, including the right to get a copy of their medical record, make sure it's correct and know who has seen it. Studies have shown that consumers pay more attention to and become more engaged in their health care when they have access to their own medical information. We will work to make certain that health insurers, health care and human service providers understand and adhere to the health information privacy and patient safety confidentiality laws that they must follow. Additionally, we will continue our outreach efforts to inform consumers about their privacy rights. Increased access, equity of care and patient confidence are major drivers in reducing disparities.

Learn more about patients' rights and how the Affordable Health Care Act puts consumers back in charge of their health care, visit http://www.healthcare.gov/law/features/rights/.

To learn more about the Office for Civil Rights and our work to help protect individuals from discrimination and ensure the privacy of health information, visit us at: http://www.hhs.gov/ocr/.

Leon Rodriguez is the Director of the Office for Civil Rights of the U.S. Department of Health and Human Services.

The prevalence of chronic diseases and conditions is still significantly higher among racial and ethnic minorities; in 2013, minorities continue to live sicker and die younger. Many of us in the research community work each day to find answers to why these disparities persist. Compounding a number of social, environmental and economic challenges, public health historically has not done a good job of including members of minority groups in important research, or advancing knowledge that provides the possible clinical reasons for health disparities.

A key provision of the Affordable Care Act, Section 4302, was designed to strengthen federal data collection and establish standards for collecting and reporting data on race, ethnicity, sex, primary language and disability status. It aims to help researchers, policy makers, health providers and advocates identify, monitor and address health disparities to improve treatment and quality of life.

In my role at FDA and in my previous work as a physician, I have always been committed to addressing health disparities as a dimension of improving the entire health care system. ACA 4302 is an important provision that can have a positive impact on research design and help advance our understanding of health care disparities.

Our mission at FDA is to protect and promote the public's health, serving as both a consumer protection agency and a regulatory agency. We are responsible for ensuring that medical products – drugs, biologics and devices – are safe and effective for their intended use. This includes providing guidance to manufacturers and the review of clinical trial data to ensure that the population included in clinical studies for an investigational product adequately represents the patients likely to be prescribed the product by health care providers. It is critical that careful attention is given to demographic subgroups and health disparities so that the information gathered and analyzed is representative of patients likely to use the product and can be available to inform prescribing decisions if differences are found.

Additionally, FDA provides guidance to product sponsors on diverse representation in research so that any important differences are identified, which may impact safe and effective use. FDA has provided such guidance – Collection of Race and Ethnicity Data in Clinical Trials [PDF | 67KB] – to help medical product sponsors understand and implement current recommendations.

Today, we have an incredible opportunity to move closer to our goal of eliminating racial and ethnic health disparities. What we in the research community must also do is think differently about how we approach inclusion to ensure that racial and ethnic minorities are adequately represented in research at all levels.

To learn more about Minority Health Month and the Affordable Care Act, visit http://minorityhealth.hhs.gov and http://www.healthcare.gov, and join in the conversation @MinorityHealth and @HealthCareGov.