A number of national initiatives have focused attention on persistent racial and ethnic disparities in health and health care. The rising tide of improvements in health has not raised all boats; in some cases, the health gap between whites and minorities has widened. Although many social and economic forces contribute to this gap, inequitable access to health care also plays a part. This Issue Brief examines a common strategy that managed care organizations use to reduce emergency department visits—gatekeeping—and describes a study of the differential impact it may have on African Americans.