Perspective: Title VI, Healthcare Reform, and the Need for a State Antidiscrimination Law

Abstract

"It might be that civil rights laws often go unenforced; it might be that current inequities spring from past prejudice and long standing economic differences that are not entirely reachable by law; or it might be that the law sometimes fails to reflect, and consequently fails to correct, the barriers faced by people of color." - Derrick Bell(1) Equal access to quality health care is a crucial issue that the United States (US) is facing.(2) For too long, we have denied too many Americans equal access to quality health care based on race, ethnicity, and gender.(3) Many factors contribute to disparities: cultural incompetence of health care providers, socioeconomic inequities, disparate impact of racially neutral practices and policies, inadequacy of civil rights laws and enforcement, and multiple forms of discrimination. These disparities exist in health status, access to health care services, participation in health research, and receipt of health care financing.(4) This disparity in health care is doubly significant given the devastating racial disparity in health status that exists. The combination of racial disparity in health status, institutional racism in health care, inadequate legal protection, and the failure of health care reform to adequately address racial discrimination in health care points to a need for a major civil rights law for health care. Several federal laws address access to health care: Title XVIII (Medicare),(5) Title XIX (Medicaid)(6) of the Social Security Act, Title IX,(7) and the Hill Burton Act.(8) The only federal laws related to eliminating racial discrimination in health care delivery are Title VI of the Civil Rights Act(9) and 1557 of the Patient Protection and Affordable Care Act (hereinafter, "Affordable Care Act."(10) Racial inequality in health care persists in the United States despite laws against racial discrimination, in significant part because of the inadequacy of Title VI, and the Affordable Care Act has done little to correct the problem.(11)