An obnoxious feature of the Affordable Care Act(?)

I went to my hospital today to have my eyes dilated as part of the vision checkup.  After looking at my health insurance card and driver's license, the receptionist said, "As part of the health care reform, we have to ask you for your race."

"Why do you need to know that?" I asked in the most mild, polite tone that I could, since it was not the poor woman's fault.

"You're free to decline to answer," she said, and added that it used to be really hard for her to ask this question.

I said that I was, quite obviously Asian, but apparently that was not precise enough for the requirements of the new health reform act.  It was necessary for some reason to classify me as not just "Asian" but "Chinese."

I have little reason to doubt the receptionist's statement that she had been instructed to collect this information.  I am curious as to what reason the government would have to make health insurers ask such a question . . . .

Comments

[Aaron Worthing]

well, the reality is that ethnicity is occasionally relevant in medicine.

But yeah, it is still obnoxious.

[Moses]

Beyond the matter of access to care, minorities (as a population) receive lower quality of care than whites do all other factors being equal. In Unequal Treatment, the landmark report issued by the Institutes of Medicine in 2003, the study committee concluded that the poorer health outcomes suffered by racial minorities relative to whites was due in part to their "unequal treatment" at the hands of health care providers and within health care systems.

In short, they're trying to measure and fix the problem of racism in medical care. So while Bainbridge (who links you) and implies some subtle "out-to-get-whitey"/"intrusive government" crap...

The fact is, you are at risk to get substandard health care solely because you're Chinese. And racism, while hidden behind the facade of politeness in adults, is pervasive in this country.

[TangoMan]

The fact is, you are at risk to get substandard health care solely because you're Chinese. And racism, while hidden behind the facade of politeness in adults, is pervasive in this country.

Um, no. The study suffered from the same logical flaw that religious creationists like to exploit, which is the god in the gaps hypothesis which here transforms into the racism in the gaps hypothesis. They saw unequal outcomes when sorted through a filter of race, isolated whatever other variables they could identify and then shoved the remainder of the variance into the category of racism.

Accusations of racism are pretty serous and when they're unfounded they're scandalous. The professions of health care, education and social work tend to draw a lot of people who are intent on helping people, fighting injustice and who are ever sensitive to racist behavior. To turn around and accuse these people of being racist simply because their is unexplained variance in medical outcomes when parsed by race is offensive. Those unexplained outcomes are present regardless of the race of the physician. The only morally valid way to throw out the charge that there exist a racist filter in the delivery of healthcare is to measure it directly. Inferring that it exists due to unequal outcomes, while not accounting for the genetic reality of race and the medical consequences which arise from the genetic basis of race grossly misdiagnoses the problem, unjustly tarnishes the reputations of all people in the health care field, misdirects health care resources, engenders unwarranted suspicion in patients, and in short does no damn good at all.

[Craigwhoward]

"racism, while hidden behind the facade of politeness in adults, is pervasive in this country"

Utter nonsense. It may exist but it's certainly not pervasive (see, I can make assertions just like you can). There is much consternation in some circles about the dismal health outcomes of many African-American. This is what has led to the charges of racism in medical care.

Ignored, though, is the lack of attention paid to general health by low-income African-Americans and their poor follow-up to prescribed health procedures. This is evident in state Medicaid programs such as New York's which attempt to move heaven and earth to get them to the doctor's office, even if it means allowing them free rides in ambulances no questions asked.

The reaction is similar to the insistence by some activists a decade or so ago that banks were practicing "redlining" or racism in their supposed failure to grant mortgages in certain neighborhoods. Well, in some neighborhoods, people had terrible credit scores and no income -- that was what led to the dearth of mortgages.

The insistence on blaming the majority for the weaknesses of a minority lead to government idiocies like requiring you to state your race to have your eyes dilated.

[Matthew Lewis]

I don't know the specifics of whether or not this is a new requirement from the ACA, but I would be wary in general of taking providers'/insurers' words for such things. There have already been plenty of instances of businesses blaming the ACA for things they would have done anyway or were unrelated. Having a massive bill nobody understands taking effect gives everyone a convenient scapegoat for basically anything health-related.

[Tung Yin]

It appears to be real:

42 USC 300kk.

Sec. 3101(a)(1)

IN GENERAL.—The Secretary shall ensure that, by not later than 2 years after the date of enactment of this title, any federally conducted or supported health care or public health program, activity or survey (including Current Population Surveys and American Community Surveys conducted by the Bureau of Labor Statistics and the Bureau of the Census) collects and reports, to the extent practicable—

(A) data on race, ethnicity, sex, primary language, and disability status for applicants, recipients, or participants;
(B) data at the smallest geographic level such as State, local, or institutional levels if such data can be aggregated;
(C) sufficient data to generate statistically reliable estimates by racial, ethnic, sex, primary language, and disability status subgroups for applicants, recipients or participants using, if needed, statistical oversamples of these subpopulations; and
(D) any other demographic data as deemed appropriate by the Secretary regarding health disparities.

Sec. 1946.(a)

EVALUATING DATA COLLECTION APPROACHES.—The Secretary shall evaluate approaches for the collection of data under this title and title XXI, to be performed in conjunction with existing quality reporting requirements and programs under this title and title XXI, that allow for the ongoing, accurate, and timely collection and evaluation of data on disparities in health care services and performance on the basis of race, ethnicity, sex, primary language, and disability status. In conducting such evaluation, the Secretary shall consider the following objectives:
(1) Protecting patient privacy.
(2) Minimizing the administrative burdens of data collection and reporting on States, providers, and health plans participating under this title or title XXI.
(3) Improving program data under this title and title XXI on race, ethnicity, sex, primary language, and disability status.