by LYGEIA RICCIARDI
In these first days of the Trump Administration, there is a great deal of uncertainty, but it’s clear that healthcare will remain in the spotlight. Repealing and replacing “Obamacare” is still at the top of the Republican party’s—and President Trump’s—agenda.
Congress and Trump have already taken steps to repeal the Affordable Care Act (ACA), though a replacement for it has yet to be articulated. Trump promises “insurance for everybody” in a form that is “much less expensive and much better,” but has yet to reveal details about how to meet his goals.
While changes in healthcare policy will have ramifications for all Americans, members of underserved populations are likely to be disproportionately impacted because they are statistically less healthy and are also the least likely to have health insurance coverage. Parts of the ACA address Medicaid, which provides health insurance to 70 million people—by definition among the poorest Americans. Nine million whites make up the largest racial group of people who have gained coverage as a direct result of the ACA, but significant numbers of minorities, including 3 million African Americans and 4 million Hispanics, have also gained coverage. The ACA also helps LGBT Americans by forbidding discrimination due to gender or sexual orientation, and by enabling same-sex families to apply for joint healthcare coverage. According to a report issued by the nonpartisan Congressional Budget Office on January 17th, if the ACA were to be rolled back without a replacement, 18 million people would lose health insurance in the first year. There would also be significant restrictions in reproductive health services for women.
Thousands of Americans have been participating in rallies across the country urging Congress not to dismantle the law, and support for it has recently reached record levels according to a poll by NBC News:
Maintaining the ACA was also a consistent theme highlighted in the women’s marches in Washington DC and cities and countries around the world the day after the presidential inauguration.
By contrast, however, many Trump supporters—including some members of underserved and minority groups—believe that Obama and the Democratic party have left them and their needs behind in many domains, including healthcare. From their perspective, a lack of jobs, high crime rates, and other factors resulting from failures in leadership have contributed to economic hardship and growing epidemics of poor health. As Trump said on the campaign trail, “To those African-Americans and Latinos suffering in our country, I say very simply, ‘What in the hell do you have to lose? Vote for Donald Trump. I am going to fix it.’”
If Trump makes good on his promises, including repealing the ACA, some believe Americans would be much better off overall, particularly since the ACA itself is, by some measures, part of the problem. For example healthcare exchanges in Arizona which were set up in response to the ACA left people in most of the state with little or no choice among healthcare insurance providers and steeply rising healthcare premiums.
Digital Health and the Underserved
Against this backdrop of political uncertainty, how should we think about the relevance of digital health for underserved communities? In my opinion, particularly if underserved populations are at risk of losing health insurance coverage and related benefits, whether in the short or long term, it’s more important than ever to leverage digital tools to maximize scarce healthcare resources.
In addition, some of the same digital infrastructure and tools that can improve health are also critical to healing and strengthening democracy—Internet access, mobile phones, data analytics that help us understand and avert or address problems, and participation in virtual communities. It’s important to invite members of diverse (and particularly underrepresented) groups to a broader forum to share their perspectives on healthcare and other topics so we can begin to close the acrimonious rifts that have been tearing the country apart throughout the election process.
Though we don’t know the details of policies under the Trump Administration, Republicans have traditionally favored open market solutions that put greater economic responsibility in the hands of states (as opposed to the federal government) and individuals. In healthcare, this is likely to translate into block grants to states to pay for healthcare services, and greater consumer responsibility for choosing among insurance providers and direct payment for healthcare goods and services. Assuming this general trend, people will need more access to data and support in making sense of it to make informed decisions. This is critically important and challenging given low literacy levels, especially among members of underserved populations—nearly half of Americans have trouble understanding and using health information, a fact which already results in an estimated $230 billion/year in healthcare costs.
Last year I wrote a blog series published by HIMSS on Leveraging Digital Strategies to Address Health Disparities, which covered the following topics based on research and conversations with front line experts:
- Measure What You Want to Manage – on defining disparities, and the role of data and population health
- Navigate the Digital Divide (it’s more complex than you may realize!) – on technology adoption and use by particular population groups
- Design for Your Population’s Needs – on the particular requirements of elderly and disabled populations
- Speak The Right Language on literacy and cultural sensitivity
- Engage the Community on trust and community collaboration
Regardless of the political climate, the topics and approaches explored in that series apply, I believe. I learned from people on the front lines of using digital technologies to address health disparities, and their insights are as valid as ever. Now, a year later, I hope we can constructively explore and learn more together in a more interactive format, even as the political stakes and related emotions run high. Please join the Twitter chat on digital health, health reform, and the underserved on January 31 at 8:30 PM Eastern at #hcldr. Following are the topics we’ll cover:
T1 To what extent do you think an ACA “repeal and replace” is likely to impact underserved populations specifically?
T2 What are the areas of greatest opportunity to use digital health to benefit underserved populations?
T3 How do we best avoid deepening the “digital divide” in healthcare?
T4 What are some real life examples of effective uses of digital health involving underserved populations?
Throughout the year, John Sharp, Senior Manager, Consumer Health IT at the Personal Connected Health Alliance/HIMSS and I have kept our eyes out for news on multiple angles of the topic of digital health and the underserved. Here are a few we’d like to flag for you:
- Right Place, Right Time: Consumer Perspectives (Jan 17, 2017) Report by the Altarum Institute and Oliver Wyman on consumers’ use of healthcare information, with an emphasis on underserved populations
- Fighting the Injustice of Health Disparities: Honoring the Legacies of Dr. Martin Luther King Jr. & Dr. John M. Eisenberg (January 16, 2017) Blog post and citation of a speech posted on the Disruptive Women in Healthcare blog by Robin Strongin
- Using Genetic Technologies to Reduce, Rather Than Widen, Health Disparities ] (August, 2016) Article by Caren E. Smith et al in Health Affairs about genetics, research, and health disparities
- This Group Gives Unused Fitness Trackers Second Lives (August 16, 2016) Article in Boston Magazine by Jamie Ducharrme on Recycle Health, which collects wearables and donates them to research studies focused on underserved populations
- Can a Digital Health Startup Prevent Diabetes in Medicaid Patients? (July 29, 2016) Stat News article by Andrew Joseph on Omada Health and its diabetes research
- Hispanics and Mobile Access to the Internet (July 20, 2016) Research by Anna Brown et al on mobile adoption by Hispanic Americans
- Primary Care Implementation of After-Visit Summaries for Patients with Limited Health Literacy (2016) Paper by Courtney Lyles, PhD et al commissioned by the National Academies of Sciences, Engineering, and Medicine Research on how to improve legibility of after visit summaries for low literacy populations