Breaking the Cycle of “Unequal Treatment” with Health Care Reform: Acknowledging and Addressing the Continuation of Racial Bias

Since the Civil War access to health care in the United States has been racially unequal. This racially unequal access to health care remains even after the passage of Title VI of the Civil Rights Act of 1964 (“Title VI”) and the election of an African-American President. Both of these events held the promise of equality, yet the promise has never been fulfilled. Now, many hail the passage of the Patient Protection and Affordable Health Care Act (“ACA”) as the biggest governmental step in equalizing access to health care because it has the potential to increase minority access to health insurance. However, access to health insurance means little when physicians continue to exhibit conscious and/or unconscious racial prejudice keeping them from adequately treating African-Americans (interpersonal racial bias); health care entities close and relocate leaving minority neighborhoods without medical facilities (institutional racial bias); and the health care system is based on ability to pay, not need, leaving those with poor health and no money, usually minorities, without access to health care (structural racial bias). Thus, in order to equalize access to health care, the government must acknowledge that racial bias (interpersonal, institutional, and structural) is the central cause of racial disparities in the United States, and implement institutional and structural changes to address racial bias in health care, such as integrating quality improvement programs and civil rights enforcement. Then, and only then, will the cycle of unequal treatment be broken