Justice, Sacrifice, and Suffering: The Continued Struggle for Health Equity

Written by

Daniel Dawes
Daniel Dawes Daniel E. Dawes, J.D. is a health care attorney and consultant in Washington, DC. During health reform negotiations, he worked closely with the White House and Congress, and founded and chaired the National Working Group on Health Disparities and Health Reform – a group comprising over 250 national organizations and coalitions - to ensure that health reform legislation included health equity provisions to reduce disparities in health status and health care among vulnerable populations.

While the debates continue as to whether or not the Affordable Care Act (ACA) should be implemented, a key component of health reform that is often overlooked includes health equity and the elimination of disparities in health status and healthcare among vulnerable populations.


The ACA includes robust health equity-related provisions, which provide a bridge to health equity that affords marginalized groups — particularly racial and ethnic minorities—increased access to culturally appropriate, quality health care, preventative care, and comparative effectiveness research.

For racial and ethnic minorities who are the most likely to be uninsured, experience higher unemployment rates, and have a lower income—which makes it harder to obtain employer-sponsored health insurance coverage—Medicaid expansion and the creation of health insurance exchanges would provide these communities access to vital health services.

This equates to almost 4 million African Americans gaining coverage by 2016 and almost 6 million Latinos gaining coverage overall. In addition, the ACA provides a unique opportunity to expand the scope of research related to health disparities, increase diversity in clinical trials, and identify, develop and distribute appropriate interventions and solutions to address these disparities. The law also provides new investments to increase the number of culturally competent primary care physicians and other health professionals.

For these reasons, the implementation of the ACA is critical to the realization of health equity throughout our country. The Supreme Court ruling on the ACA, while essentially weakening a key aspect of the ACA’s efforts to expand health insurance coverage to the working poor—Medicaid Expansion – by making the expansion of this program optional for states, nevertheless upheld the ACA and the provisions aimed at addressing health disparities. This certainly is not the last obstacle confronting the health care law and health equity.

Even though there may be upcoming struggles, we are reminded by Dr. Martin Luther King, Jr., “Human progress is neither automatic nor inevitable…. Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.” Health professionals, who are the daily bridge to health care in their community, have the chance to be strong advocates for their patients and the general public. And with the ACA empowering consumers and other health professionals, America will see a time when everyone will be able to have access to life-changing health care, in turn eliminating health disparities in our communities.

Kenneth Pass contributed to this article alongside Daniel Dawes

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