By Orlando Sola, Amelia MacIntyre, Bryce Spitze, and Ankeeta Mehta
Minority populations historically have faced significant obstacles in accessing health care. Over the past six years, health care reform has dominated the attention of American politicians, yet Latino communities continue to struggle to receive the resources necessary to address their medical needs. Data from the CDC shows that the U.S. Latino population is disproportionately affected by obesity, HIV/AIDS, preventable hospitalization, and teen pregnancy. To ensure that the interest of Latino and other marginalized populations are met within current health care reform, underserved populations require leaders whose expertise extends beyond clinical acumen.
Future generations of physicians will have to become familiar with political and community advocacy skills as well as clinical expertise. By introducing medical students and residents to health policy early in their education, we can create skilled leaders in Latino health care who are prepared to advocate for equality and ensure successful implementation of legislative gains.
Latinos face special barriers to accessing health care, largely attributed to lower socioeconomic status as well as cultural and language obstacles. The Pew Hispanic Center found that over half of nonelderly Latinos are employed in agriculture, service or construction industries, where employment-based health insurance often is not available. Studies by the Kaiser Foundation noted that Latinos are one of the fastest-growing minority groups in the United States, but continue to suffer from one of the highest uninsured rates among racial/ethnic minorities: Nearly one in three Latinos lack coverage.
Why have Latino communities had difficulties in addressing inequalities in health care? Part of the blame can be linked to the lack of educational resources related to health policy for minority medical students. Institutions and individuals in academic medicine can help by developing the necessary educational infrastructure to benefit under-represented minority communities.
The Patient Protection and Affordable Care Act (ACA) includes several reforms that are meant to improve access to health care for indigent populations. These include expanding the eligibility requirements for Medicaid and providing subsidies for individuals to access private insurance on state and federal health exchanges. However, recent rulings on the ACA by the Supreme Court have provided state governments the ability to decline a federally-funded Medicaid expansion and to forego creating a state health insurance exchange.
These expansions are critical for Latino populations, as over half (57 percent) of uninsured Latinos would qualify for Medicaid under the expanded eligibility requirements. On February 11, the Department of Health and Human Services reported that eight in ten Latinos in the United States would qualify for Medicaid or subsidies if all states fully implemented the ACA; many of the states that have declined Medicaid expansions contain large Latino populations. In Texas and Florida alone, Latinos comprise more than 20 percent of the statewide population.
Some states have passed legislation that will inhibit the ability of Latino communities to access health care. Laws recently passed in Texas restrict health care navigators’ ability to assist individuals who have difficulty understanding and completing applications for coverage through Medicaid or health care exchanges. The debate on health care reform has now moved from a federal stage to one within state governments across the country. By participating in these conversations, local and regional medical leaders can have a significant impact in developing vital community resources and advocating on both regional and national platforms for greater reform implementation.
New programs and initiatives recognize the need for specialized teaching and training in order to prepare future doctors to serve Latino communities. Medical Spanish is a recent addition to curricula at several U.S. medical schools. In 2007, the University of California system launched Programs In Medical Education (PRIME), an innovative training program that focuses on developing health care providers well-versed in Latino culture and health care provision. Yet the need still exists for greater learning opportunities for medical students and residents interested in health policy and galvanized by the disparities they see in underserved communities.
The Latino Medical Student Association (LMSA) has a rich history as a student-led, grassroots organization. In 2014, LMSA will provide additional training, mentoring and networking initiatives in Latino health policy in the first-ever LMSA Student Policy Section at the National Hispanic Medical Association Annual Conference in Washington, DC. Medical students interested in policy will be invited to attend workshops on current issues in Latino health care, participating in a dialogue with legislators, and help to develop policy ideas within LMSA. Students will also be able to network with current leaders in the Latino community and develop structured mentoring relationships facilitated by residents and senior physicians.
By providing mentoring and networking opportunities as well as scholastic resources, medical schools can set the stage for the maturation of physicians who are comfortable navigating political, clinical, academic, and community-based obstacles to best serve the unique needs of their Latino patients.
Orlando Sola is the current Senior Policy Chair for the Latino Medical Student Association, where he has worked on developing a student driven policy platform. He has a public health degree in Health Policy, and will begin his Family Medicine residency next year. He can be reached at OSOLA2104@GMAIL.COM.
Amelia MacIntyre is the West Region Vice President of Policy for the Latino Medical Student Association. She currently trains in a federally qualified community health center where nearly 90 percent of the patient population is Spanish-speaking only. Prior to medical school, she worked in the Washington, DC, area on health policy initiatives that advocate for underserved populations.