Washington, D.C. -  Today, Congresswoman Hilda L. Solis (D-CA), Chair of the Congressional Hispanic Caucus Task Force on Health and the Environment and a Member of the Energy and Commerce Committee's Subcommittee on Health, released the following statement as prepared for delivery, at a hearing in the U.S. House Committee on Ways and Means hearing titled, "Addressing Disparities in Health and Healthcare: Issues for Reform."

Chairman Stark, Ranking Member Camp, and my colleagues, thank you for inviting me to testify about the inequities of our health care system. Chairman Stark, I would especially like to commend you for your leadership in bringing attention to disparities in health communities of color.

I am pleased to be here today with Representatives Christensen and Bordallo. We represent the Congressional Hispanic, Black, and Asian Pacific American Caucuses, known collectively as the TriCaucus.

As the Chair of the Congressional Hispanic Caucus Task Force on Health and the Environment and as a member of the Energy and Commerce Subcommittee on Health, I am working to improve the health of all individuals, particular communities of color. Latinos are the fastest-growing racial/ethnic group in the United States. We make up 14 percent of the population, which is more than 42 million people across the nation, yet we also suffer from the highest uninsured rates in the country. According to data released by the Census Bureau in 2007, 34.1 percent of Latinos (more than 15 million) are uninsured, compared with 20.5 percent of African Americans, 15.5 percent of Asian/Pacific Islanders, and 10.8 percent of non-Hispanic Whites.   

As we move forward toward national health reform, we must not leave behind our most vulnerable and underserved populations. Unfortunately, current programs do leave behind our most vulnerable and underserved populations.

Communities of color often suffer from higher rates of death and disease. The Agency for Healthcare Research and Quality’s 2007 National Healthcare Disparities Report (NHDR) finds that “Overall, disparities in quality and access for minority groups and poor populaitons have not been reduced since the first NHDR.”  According to the 2007 NHDR, Latinos fared worse than non-Hispanic Whites for seven of eight core measurements of health care access and for 23 or 38 core report measures of quality.

The growing diversity of our country means that many patients encounter barriers to receiving optimal health care.  By 2050, it is projected that members of racial or ethnic “minority” groups will together account for almost half of the U.S. population.  Currently, nearly 52 million people, or more than 19 percent of the U.S. population, speak a language other than English at home.  There are also a substantial number of individuals who are not proficient in the English language.  According to the 2006 American Community Survey, almost 11 million U.S. citizens speak English less than very well. 

I have seen firsthand the growing diversity in our nation. In my district in East Los Angeles and the San Gabriel Valley, more than 60 percent of my constituents are Latino, and approximately 20 percent of individuals are of Asian Pacific Islander descent.  Sixty-eight percent of families speak a language other than English at home.

For these communities, culture and language play vital roles in the provider and patient relationship.  Culture can define how health care information received, interpreted, and acted upon by patients. Communication barriers, such as the lack of langauge services, between patients and providers contribute to reduced quality of care, adverse health outcomes, and increased racial and ethnic disparities. Such barriers can lead to lower patient adherence to medications and decreased participation in health care decision making. A study by the Access Project based at Brandeis University, titled “What a Difference an Interpreter Can Make,” indicates that more than 25 percent of limited English proficient individuals who needed but did not get an interpreter reported that they did not understand their medication instructions.  Non-English speaking patients are also less likely to use primary and preventive care and are more likely to seek care in emergency rooms.

Given the existing health inequities of our health care system, I introduced H.R. 3014, the Health Equity and Accountability Act with the support of my TriCaucus colleagues.  I am proud that we now have the support of more than 100 Members of Congress.  In addition, we also have a letter of support from more than 300 organizations. I would ask that this letter be inserted into the record.

This legislation, which we introduced in past years, is based on many of the Institute of Medicine’s recommendations from Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.  This legislation would require federal agencies to improve access for individuals with limited English proficiency and create a Medicare demonstration project examining access to care, costs, and health outcomes for beneficiaries.  Several provisions of H.R.3014 have been referred to this Committee and I as stated in a letter addressed to Chairman Rangel and Ranking Member McCrery on October 23, 2007, I am eager to work with you to enact these provisions.

Improving access to health insurance, including Medicare, is a key part of reducing inequities in health.  However, efforts that only address access to insurance are inadequate, as evidenced by continuing disparities seen within the Medicare population.  The Institute of Medicare found marked disparities among Medicare beneficiaries, even after adjusting for socioeconomic differences.  According to the 2007 National Health Care Disparities Report, among Medicare patients, Latinos and Native Americans are least likely to receive all recommended care for heart failure.  In addition, an April 2008 article published in Health Services Research found that Spanish speakers enrolled in Medicare managed care plans have more difficulties with provider communication and timeliness of care when compared to non-Spanish speakers. 

On August 11, 2000, the President signed Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency."  This Executive Order requires Federal agencies to examine the services they provide, identify any need for services to LEP individuals, and develop and implement a system to provide those services so LEP persons can have meaningful access to them. 

I believe that Medicare, as a leading purchaser of health care, has the opportunity and responsibility to reduce racial and ethnic health disparities.  Consequently, I am pleased that some of H.R. 3014’s provisions were included in H.R. 3162, the Children’s Health and Medicare Protection Act (CHAMP) of 2007.  I and many of my colleagues worked hard to pass the CHAMP Act and to protect provisions related to the reduction of disparities.  Unfortunately, the Senate failed to take up the Medicare provisions.

This past December, before another short-term Medicare physician fix bill was enacted, I urged the inclusion of provisions that would improve low-income Medicare beneficiaries’ access to services.  On June 4, 2008, I also led a letter from the Congressional Hispanic Caucus asking for the inclusion of the same provisions in the Medicare package recently developed by the Senate Finance Committee.  I would like to insert this letter into the record.  

I also strongly support a Medicare demonstration protect to improve communication between providers and limited English proficient seniors, a study on Medicare payments for language services, an Institute of Medicine report on the impact of language services on the health of Limited English Proficient beneficiaries, and a report on Medicare compliance with national standards on Culturally and Linguistically Appropriate Services (CLAS).  

The CLAS standards, some of which are mandates for health organizations that receive federal funding, were developed by the U.S. Department of Health and Human Services' (HHS) Office of Minority Health.  They are intended for adoption by health care organizations and represent a way to improve access to health care for minorities, reduce inequities, and improve quality of care.  I strongly believe that all of the CLAS standards should be adopted by Medicare and other health organizations.  I am pleased that several of these provisions were included in S. 3101, the Medicare Improvements for Patients and Providers Act, which was recently introduced by Senator Baucus.  

In closing, I would like to take the opportunity to note that our health is the product of our social determinants of health, including income, race, education, environment and geography.  Housing, transportation, education, energy, and agricultural policies all impact our health, although most Americans think only of our health care system when we speak about health.  

Our current health care system is not the sole reason why racial and ethnic populations experience higher rates of death and illness.  Given this Committee’s jurisdiction, I kept my remarks limited to changes to our health care system.  However, it is my hope that this Congress and future leaders will consider how seemingly-unrelated policies impact our health, particularly the health of vulnerable communities of color.

Thank you again for inviting me to testify before you today.