Members of the Congressional Black Caucus have for years sought to add to Obamacare through healthcare provisions targeting racial disparities, but they are now focused on more narrow efforts for passage, even as lawmakers are seeking solutions for addressing racial tensions.

The group that studies and advances legislation on health disparities in the House, known as the Health Braintrust, was focused early in the year on staving off Republican efforts to repeal and replace portions of Obamacare, formally known as the Affordable Care Act. House members narrowly passed a bill, but the effort failed to advance in the Senate.

"We know we are not going to get a comprehensive bill passed," said James Lewis, spokesman for Rep. Robin Kelly, D-Ill., chairwoman for the Braintrust. "We know there is no appetite for that. We are focusing on trying to tweak around the edges and on finding partners."

A previous version, introduced by Kelly in 2016, would collect more data on disparities, increase the diversity of the healthcare workforce, extend healthcare technology, and address mental health disparities, among other measures. It would focus on diseases that disproportionately affect people of color, like cancer, heart disease, hepatitis, diabetes, and HIV/AIDS.

Members of the Braintrust believe that Obamacare was a key step in achieving their efforts because it increased the number of people who health insurance.

"People of color, especially African Americans, continue to be sicker, have less access to care and die sooner than their white counterparts," Kelly said in an email. "Lower rates of insurance coverage, a lack of doctors and services of these communities, food insecurities, historic distrust of medical professionals and poisoned air and water all contribute to these real and shocking disparities."

Overall efforts to reduce disparities should be even broader, say public health experts who have focused on urging policymakers to consider the "social determinants of health." These factors, like work, education, and neighborhoods contribute to how healthy people are and how long they can expect to live, they say.

Despite improvements, black Americans have long had worse health outcomes than whites. Research for the Centers for Disease Control and Prevention has shown that adults who are black are more likely to have or die from heart disease, stroke, or diabetes. Blacks are nine times more likely to be diagnosed with HIV, 2.5 times more likely to die during pregnancy and 40 percent more likely to die from breast cancer.

Jason Purnell, associate dean for social work at the Brown School at the Washington University in St. Louis, has examined social and economic factors on these health outcomes in his research.

"You can't have the ACA in isolation and expect it to solve problems that really have to do with the very poor nature of our safety net," he said. "Even with the ACA completely intact, unless you're dealing with upstream social determinants of health, you're going to see similar disparities."

The national conversation on the media is centered on race following violence that erupted in Charlottesville, Va., involving white supremacist and nationalist protesters clashing with counter-protesters. At the protest, a man reported to have Nazi sympathies allegedly drove a car into counter-protesters, wounding 19 people and killing 32-year-old Heather Heyer.

Since then, state and federal lawmakers have called for the removal of national monuments and symbols across the country. Purnell said he agrees with their removal, but cautions that more work is needed at the policy level.

"It's much more difficult to try to dismantle some of these other monuments that have been built over several decades that precluded generations of people from having the same opportunities to thrive and build wealth and live long and productive lives," he said.

Lewis said House members are working on addressing some of these issues. Rather than pass a larger bill, he said, he said, they are looking for more targeted areas of agreement, such as addressing dental health or food deserts, which refers to the absence of healthful food options in certain communities.

Several individual pieces of legislation introduced this year aim to do that. For instance, Rep. Danny Davis and Sen. Dick Durbin, both Democrats from Illinois, earlier this year introduced the Trauma-Informed Care for Children and Families Act, which would create a federal task force, expand Medicaid coverage to child trauma services and implement mental health programs in schools. The bill aims to tackle toxic stress, which medical experts use to describe repeated stress after exposure to a traumatic event, such as violence, which impacts mental wellness and can impede learning or lead to high-risk behaviors.

Davis said some Republicans have expressed interest in the legislation.

"It's not a race bill, it's not an ethnic bill and it's not a geographic bill," he said. "It's an American bill. It is a bill that will assist individuals and much of the trauma they have with terrorism being what it is and with the number of terrorist threats and acts."

He also introduced the Sickle Cell Disease Research, Surveillance, Prevention and Treatment Act, which reauthorizes grants for educating people about the disease, a red blood cell disorder that particularly affects people of African descent. Davis credited Rep. Michael Burgess, a Republican from Texas and chairman of the subcommittee on health, for showing his support for the legislation and said he believed it had enough support to guarantee re-authorization.

A bill by Jaime Herrera Beutler, D-Wash., would allow federal health officials to study maternal mortality and would provide grants to states that identify and implement programs that identify areas in which to improve.

"While there is still an obvious need to fix the problems caused or left unaddressed by the ACA, the Preventing Maternal Deaths Act is a good example of Jaime's effort to make progress and not let all efforts to improve healthcare stall in Congress," a spokeswoman for Beutler said. "Rather than having Congress and Washington, D.C. prescribe specific directives, this bill helps create teams of experts to identify and begin to solve these problems at the state level. There's no disputing the data that this troubling trend is hitting some ethnicities -- particularly African American women -- harder than others, and these committees will be well aware of the facts and be ready to take whatever action will be effective in improving survival of moms."

Despite concerns about health outcomes, data show improvements have been made. Though blacks aren't living as long as people in other races, they are still living longer than they used to, according to CDC data. The suicide rate for black men has declined since the 1990s, the only group to experience a drop, and infant mortality dropped by a fifth.

Lawmakers also have noticed that the patterns they have seen haven't necessarily hit every community. While these improvements occurred, mortality rates among whites moved in the opposite direction. Health economists have concluded that this reversal is caused by deaths among whites from opioid overdoses, alcohol poisoning, chronic liver disease, and cirrhosis.

Death rates among blacks are still higher, but nevertheless showed a decline of 25 percent from 1999 to 2015.

For Kelly, these patterns by race are apparent in her district, her spokesman said, as it includes parts of Chicago as well as suburban and rural areas.

"As much as race is a factor in this, more and more we're seeing the same disparities and lack of access to care between the urban communities that are brown and black and the rural communities that are white," Lewis said. "You're seeing these rural communities have problems that urban communities had in the 1980s: commercial blight, unemployment, drug use and overdoses, people moving into criminal behavior."

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Healthcare bills aim to remedy racial disparities in the shadow of Charlottesville - Washington Examiner