HALF A CENTURY AFTER the 1964 passage of the Civil Rights Act, racial discrimination endures in many areas of American life, including healthcare. A new paper in Health Affairs, co-authored by Amitabh Chandra, the Malcolm Wiener Professor of Social Policy at Harvard Kennedy School (HKS), considers the problem of inadequate or inferior health care for minority patients (especially African Americans) and offers several recommendations for improving the situation in the U.S.

The authors begin by acknowledging that “minority health care in the United States remains separate and unequal,” and that “de facto segregation still survives.” They examine this reality in light of data related to hospital visits and other medical treatment of minority patients. They consider geographical and other factors which play a role in segregated health care, but argue that the gap in quality of service can and should be closed. While the 2010 passage of the Affordable Care Act attempted to address some of these issues, the authors express concern that the administration of President Donald Trump will repeal critical parts of the ACA. This may make it more difficult to improve health care for minority patients, particularly the uninsured or previously uninsured.

Chandra and his colleagues acknowledge that certain legal avenues are available for patients who have been treated unfairly, but caution that litigation is slow and costly. They offer a few alternative strategies, such as increased federal funding for hospitals and a mechanism to ensure that state governments give fair and equal funding to hospitals that serve minority patients.

“Strengthening the Civil Rights Act might improve minority health care by bolstering minority patients’ trust in the health care system, increasing physicians’ diligence, and as a result increasing the patients’ willingness to seek care,” the authors write. They acknowledge the different challenges facing extralegal solutions, such as the issue of cost. “What is beyond doubt,” the authors conclude, “is that persistent gaps in minority health care remain a civil rights issue.”