The "Golden Rules" for Eliminating Disparities: Title VI, Medicare, and the Implementation of the Affordable Care Act.

Abstract

Addressing health care disparities rarely focuses on how the "gold" (meaning the federal dollars flowing into the nation's health system) has, at different times, both widened and narrowed health care disparities. This paper describes (1) the early attempts to use the power of the federal purse to address disparities that led to the enactment of Title VI of the 1964 Civil Rights Act; (2) how Title VI, as applied in the implementation of Medicare, reduced disparities; and (3) the lessons that this story offers for similar opportunities in the implementation of the Affordable Care Act (ACA). Reducing disparities with the implementation of the ACA will require (1) rekindling the spirit of the grass roots movement that captured the Title VI enforcement process with the implementation of Medicare; (2) exposing adversaries through data disclosure and taking advantage of the "invisible army" that supports these goals; (3) using the power of both the economic and ethical versions of the Golden Rule; and (4) creating the political insulation and urgency necessary to reduce health care disparities.