[Congressional Record Volume 146, Number 119 (Friday, September 29, 2000)]
[Extensions of Remarks]
[Pages E1635-E1636]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     END HEALTH DISPARITIES IN MEDICARE BASED ON RACE AND ETHNICITY

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Friday, September 29, 2000

  Mr. STARK. Mr. Speaker, there is a large body of literature that 
shows people of color disproportionately lack access to health care, 
vital treatments, and preventive screening measures. Several of us on 
Ways and Means have called for a hearing to discuss differences in 
medical care due to race and ethnicity. Although ensuring a fair and 
equitable quality health care system for all Americans is extremely 
important, Congress has failed to address existing disparities.
  Our country is becoming increasingly diverse. Currently, people of 
color represent an estimated 18% of our nation's residents, and will 
comprise more than 25% in 2050. In a state such as California, 
``minority'' populations have already become the majority.
  Among those of Medicare age, racial and ethnic minorities currently 
represent 16% of the population; however, by 2050, that percentage will 
increase to 36% at the same time that the number of elderly is expected 
to increase by 250%.
  The growing populations of minorities, however, have not been able to 
eliminate the vestiges of racism--conscious and unconscious--that still 
remains in our society and in our institutions. The health care system 
is no exception. A Century Foundation Report entitled, ``Vulnerable 
Populations and Medicare Services'' by Marian Gornick contributes more 
strong evidence that disparities continue to exist even when 
individuals have similar health insurance coverage.
  For example, Medicare covers influenza vaccines for beneficiaries on 
an annual basis at no cost. Coverage and financial costs are not 
barriers, but African Americans are only half as likely to receive flu 
shots even though influenza, a forerunner to pneumonia, is responsible 
for excess hospitalizations among elderly with heart and pulmonary 
disease.
  Among those Medicare beneficiaries with coronary artery disease, 
African Americans are less than half as likely to receive coronary 
artery bypass graft or percutaneous transluminal coronary angioplasty, 
two common procedures for treating the disease.
  The following statistics illustrate numerous additional examples of 
the disparities that persist in medical care and treatment. In order to 
truly be an inclusive society, we must continue to attack conscious and 
unconscious racism in all its forms and work towards an equitable and 
just health care system. I hope everyone in Congress can join in 
continuing our efforts in this area.

                     Examples of Health Disparities

          [From Vulnerable Populations and Medicare Services]

                         (By Marian E. Gornick)

       African Americans have 20% less physician visits, and 23% 
     less specialist visits, despite greater rates of certain 
     chronic diseases, limitations in activities of daily living, 
     and reporting of health as fair or poor. But, they receive 
     38% more hospital inpatient visits and 40% more emergency 
     room visits.
       African Americans have 11% less ophthalmology visits even 
     though the prevalence of eye disease is greater.

[[Page E1636]]

       African Americans are half as likely to receive flu shots 
     even though the vaccines prevent influenza, a forerunner to 
     pneumonia responsible for excess hospitalizations among 
     elderly with heart and pulmonary disease. There is no cost-
     sharing for this service so financial barriers are not a 
     cause.
       African American women are 21% less likely to receive a 
     mammography even though they are more likely to have later-
     stage breast cancer at diagnosis and lower survival rates.
       The rate of sigmoidoscopies and colonoscopies among African 
     Americans is 39% and 12% less although the rate of late-stage 
     colon cancer and death rate of colon cancer is greater.
       A sonography was performed at a 24% lower rate among 
     African Americans than whites, possibly contributing to their 
     higher rate of strokes.
       African Americans are more than half as likely to not 
     receive a coronary artery bypass graft or percutaneous 
     transluminal coronary angioplasty, common elective procedures 
     for treating coronary artery disease.
       Thromboendarterectomy, a procedure to treat blocked carotid 
     arteries, was performed at a rate 67% lower among African 
     Americans than whites.
       African Americans are 28% less likely to receive cataract 
     removal/lens insertion to improve vision, but they are 56% 
     more likely to have more severe vision problems that require 
     treatment.
       African Americans are more than 3 times as likely to 
     receive amputations, partly due to diabetes being 1.7 times 
     more prevalent, but also partly due to poor outcomes.
       Arteriovenostomy procedures are more than 4 times as 
     frequent for African Americans, reflecting the greater 
     prevalence of end stage renal disease.
       African Americans are 2.5 times more likely to receive 
     excisional debridement, a procedure for infection and skin 
     breakdown, outcomes associated with quality of care.

     

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