Civil Rights In A Changing Health Care System

PROLOGUE: At the height of the health care reform debate following President Clinton's election in 1992, the Congressional Black Caucus Health Braintrust Forum predicted that the preeminence of managed competition could cause health care reform to become “the civil rights battle of the 1990s.” Nearly four years later that prediction has not come true—at least not overtly. However, civil rights advocates continue to express concern that the disenfranchised—the poor and ethnic minorities—could be left behind as the U.S. health care system undergoes a major transformation to managed care. Sara Rosenbaum and colleagues write in this paper, “The reemergence of discrimination … might be particularly likely if health system changes foster the types of fear and resistance that historically have triggered discriminatory conduct (and laws).” ABSTRACT: Title VI of the 1964 Civil Rights Act prohibits discriminatory conduct by recipients of federal financial assistance. The law has been used in the past to challenge discrimination in health care. The evolution of the health care system from fee-for-service to managed care holds much promise for minority persons, who historically have faced serious, extensively documented barriers to health care access. However, managed care providers, like their fee-for-service counterparts, may perpetuate past discriminatory practices in new ways. Understanding new forms of discrimination is important at this stage of the development of managed care, when program design and policy action can most effectively prevent the occurrence of such practices.