Implications of health care reform.

All Americans, regardless of race or ethnicity, deserve quality health care services when they need them. When the provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) (now more commonly called the Affordable Care Act [ACA]) are fully implemented by 2014, approximately 32 million Americans who currently do not have health insurance coverage will be covered, and coverage will be more affordable for many millions more. The ACA makes vital improvements to health care access, quality, and services for millions of Americans with health and behavioral health needs. Social workers practice as part of health care teams and are specifically trained to address the psychosocial implications of acute and chronic illnesses. They practice across the continuum of care, including community and public health clinics, hospitals, nursing homes, home health care, primary care, veteran service networks, and hospices. The new law contains key provisions that address critical changes social workers believe are needed to improve the public's health and to start moving toward a system that focuses on keeping people healthy and is affordable for all. HEALTH DISPARITIES An essential component of eradicating health inequities is addressing the social determinants of health. Social determinants include a person's socioeconomic status, neighborhood, employment conditions, access to health care, and personal behaviors. Those social determinants, coupled with the lack of insurance coverage for minority and poor populations, prevent vulnerable individuals from receiving appropriate health care. In addition, stigmatizing practices in health care delivery and a lack of racial and ethnic diversity and cultural competence among health care providers lowers the quality of health services for racial and ethnic minority groups. Even after adjustments for socioeconomic characteristics and other access-related factors are considered, differences in health literacy between groups and the failure to include minority populations in medical research also contribute to a lower quality of health services. A December 2010 report published by the Center for American Progress (CAP), Easing the Burden: Using Health Care Reform to Address Racial and Ethnic Disparities in Health Care for the Chronically Ill (Russell, 2010), stated that chronically ill Americans from racial and ethnic minorities have much to gain from the implementation of the ACA. To make the health care system sustainable into the future, we must recognize that most chronic diseases can be prevented. The CAP report also stated, "The total annual cost of racial and ethnic health disparities, including direct medical costs and indirect costs such as lost productivity, lost wages, absenteeism, family leave, and premature death, is of the order of $415 billion" (p. 2). Improving access to prevention services, in combination with better management and coordination of care, is an investment that pays off with better health outcomes and more productive lives at lower cost. Social workers in communities across the country are actively participating in day-to-day efforts to ensure that vulnerable populations have access to, and receive, quality health care. MENTAL AND BEHAVIORAL HEALTH The new health care law requires health plan benefits to include mandatory mental health, substance use, rehabilitation, prescription drugs, and preventive services. …