If, as the saying goes, politics makes strange bedfellows, crafting health reform has produced some of the more unlikely. LGBT groups, faith-based groups, insurance companies, and the Black Caucus Health Brain Trust are among the diverse interests agreeing on one thing: It's time to end disparities in access to resources, or outcomes, said Daniel Dawes, who coordinates a 250-member coalition (National Working Group on Health Disparities and Health Reform).
Basically there are aspects of each bill that pinpoint how closing gaps based on disparities will benefit people who have been locked out previously. But some of that depends on how these differences are defined. The House (Sec. 2301) broadly includes:
"race, ethnicity, primary language, sex, sexual orientation, gender identity, disability, socioeconomic status, or rural, urban, or other geographic setting, and any other population or subpopulation determined by the Secretary to experience significant gaps in disease, health outcomes, or access to healthcare.""Significant gaps" may be the key phrase here.
Other differences include:
•Data Collection: Data collection will be essential to establishing base line information and monitoring compliance. The Senate's version (Sec. 4302) improves upon the House's (Sec. 242) for data collection and identifying people with disability status as a category.
•Prevention and wellness: This was an early priority of Pres. Obama, and the House bill (Sec. 2301) dedicates half the allocated funding to reduce disparities. The Senate's provision (Sec. 4201), while similar in some ways, does not dedicate resources for reducing health disparities.
•Workforce: Portions of the Child Healthcare Crisis Relief Act (S. 999), introduced by Sen. Jeff Bingaman (D-NM), and Rep. Patrick Kennedy's (D-RI) bill to increase mental health service professionals (HR 1932,) were folded into their respective chambers. In the Senate's bill it is Sec. 5203), in the House, Sec. 2530.
A side-by-side comparison of House (HR 3962) and Senate (HR 3590) versions having to do with disparities can be downloaded in this pdf compiled by Premier Healthcare Alliance Advocacy, an organization representing 2,200 not-for-profit hospitals.
Overall comparison
The Bazelon Center for Mental Health Law has produced a chart comparing major differences in House and Senate bills, along with indications about which is preferable. Given the size and controversy of each bill, this chart may include items that have slipped by. The different provisions for interstate sale of insurance, for example, indicates that the House bill maintains the authority of the state in which the insured resides, whereas the Senate bill waives rights to the state in which the policy is sold. In this instance, Bazelon endorses the House bill. For a detailed comparison of provisions such as medical home, community based services, Medicaid reimbursement, download the chart in pdf form.
