HHS Secretary Says Medical Home Can Help Combat Health Disparities

The ability to access a medical home represents one way to reduce health disparities between minority and nonminority patients, according to HHS Secretary Kathleen Sebelius, who testified before the House Appropriations Subcommittee on Labor, HHS, and Education here on June 2.

Minorities are more likely to be uninsured or underinsured compared with their nonminority counterparts, according to Sebelius. However, "having an opportunity for a health home and an ongoing treatment protocol for every American is a step in the right direction" in reducing health disparities, she said.

Sebelius told the subcommittee that workforce issues, including the number of minority physicians, directly affect such disparities because a health care professional's level of cultural proficiency can determine whether a patient feels comfortable seeking care. Sebelius, who testified to the subcommittee about the administration's 2010 fiscal year budget proposal for HHS, said the budget "invests $354 million to combat health disparities (and) improve the health of racial and ethnic minorities and disadvantaged populations."

"The budget recognizes that if we want to ensure that millions of Americans get quality and affordable care, we need to increase the number of health care providers in this country," said Sebelius.

Sebelius also alluded to a report (56-page PDF: About PDFs) released by the White House Council of Economic Advisers on June 2 that outlines how health care reform can strengthen the nation's economy. "The report found that if we continue on the path we are on today, by the year 2040, 72 million Americans will be uninsured, and health care costs will account for more than 34 percent of our gross domestic product," she said.

Without health care reform, Sebelius added, the federal deficit will continue to grow, and more Americans will see their wages eaten away by health care costs. "This is a problem we can avoid if we act now," she said.

At the conclusion of Sebelius' report, Rep. Todd Tiahrt, R-Kan., the senior Republican on the subcommittee, challenged her regarding his concerns about comparative effectiveness research, which is part of the administration's health care reform plan.

"Government will fund research to decide which medicine or medical treatment works best for most people," said Tiahrt. "Then and only then will they pay for that one option. In other words, comparative effectiveness is just another way to say 'rationed health care.'"

Sebelius responded that she spent a lot of time and energy as a Kansas insurance commissioner fighting health care rationing by private insurers who were making treatment choices and overruling the medical decisions of physicians.

"I share your goal that in transforming the health system we don't get to a system of rationed care -- that medical providers should make medical decisions, not government bureaucrats, not insurance companies, not others," she said.

Sebelius and Tiahrt also sparred over the inclusion of a public plan option in any comprehensive health care reform legislation. The Obama administration and most congressional Democrats support a public plan option to give patients more options and to promote competition among private plans. Most congressional Republicans oppose a public plan option, saying it will drive private plans out of the market and lead to a single-payer national health care system.

Tiahrt said making a public plan available would encourage employers to push their employees into such a plan, leading to increased cost-shifting and higher costs for taxpayers.

"I would suggest that the biggest cost shift is going on right now -- the uninsured who come through the doors of that hospital in Wichita, in Topeka and Kansas City," said Sebelius. "Those costs are shifted onto private employers who are desperately trying to keep their employer coverage."

She said a system of preventive and wellness care "reduces the kind of cost shift we have right now, which falls most often on small business owners and small insurance (companies)."

"I think having a fair payment system, shared responsibility, and making sure all Americans have access to more affordable but more effective health care treatment on the front end prevents the kind of cost-shifting that you have just described," said Sebelius.