At the Democratic National Convention in Philadelphia this week several prominent speakers highlighted the need for universal health care, which they said could be achieved by expanding the reach of the landmark Affordable Care Act (ACA).
But why should our country make such an investment? Simply put, the pursuit of liberty and happiness requires health - and not just for the wealthy. Right now great health disparities fester in our country, affecting people who have systematically been denied quality health care because of race, ethnicity, socioeconomic status, gender, age, mental health, physical disability, sexual orientation and gender identity. The U.S. Department of Health and Human Services (HHS) has been reporting and updating information about these disparities for many years. HHS's studies show that health outcomes vary according to geography, such as in southern states that have not expanded Medicaid, but that different zip codes in the same metropolitan area may have significantly different access to health. The low income neighborhoods fare much worse than other neighborhoods on access to health care and the opportunity to be healthy.
If health disparities cannot be overcome and health injustice persists, our society suffers, and communities are rightly angry. Health disparities and injustice keep those communities mired in poverty and unable to achieve their potential to help make this a stronger country - one where genuine equality and liberty for all thrive.
Just this week, Lannis Hall, Arnold D. Bullock, Angela L. Brown and Graham Colditz, in a piece for The New York Times highlighted the fact that African American men die of prostate cancer at much higher rates than white men. The authors noted that many physicians do not screen black men for prostate cancer because, four years ago, the U.S. Preventive Services Task Force recommended that physicians should halt routine prostate screenings for all men. The problem with that recommendation, as the authors noted, is that the Task Force's guidance was based on clinical studies that did not include enough black men. The result is fatal health care for black men, cutting short their valuable lives.
In June, a Georgetown University report found that African Americans in Washington, D.C. are "six times more likely than whites to die from diabetes-related complications." The report, by Professors Maurice Jackson and Christopher King, also found that black men in D.C. live "15 fewer years than their white counterparts and are three times more likely to die of prostate cancer."
Socioeconomic forces are fueling those troubling disparities, such as the fact that black families in the District are "3.5 times more likely to live below the poverty line." Poverty contributes to health disparities in ways that we cannot totally eradicate with clinical health care, but the Medicaid program gives us important tools for the battle.
Fifty-one years ago on July 30, President Lyndon B. Johnson signed Medicaid, a federal and state program, into law as an amendment to the Social Security Act. Today, Medicaid is the primary public health insurance program for people with low incomes, covering nearly 70 million people, including more than a quarter of the children in the United States. Children eligible for Medicaid are entitled to comprehensive, periodic physical, developmental, and mental health assessments and services. Medicaid's coverage for children also includes case management services to assist young children and their families with gaining access to medical, social, educational and other services. And finally, Medicaid must coordinate with other state and federal public health, educational, food and nutrition and related programs to help ensure child health.
Medicaid is our nation's strongest tool to combat health disparities, moving us, albeit slowly, toward a day when all people have the ability to attain the highest level of health. As executive director of the National Health Law Program, founded in 1969 to fight for access to quality health care for low income people, I can tell you firsthand that securing the rights that Medicaid guarantees is an ongoing battle, but one well worth the fight. At NHeLP we see lawmakers and conservative advocacy groups who strive to limit access to Medicaid, for myriad reasons, though politics is often a major driver. For example, the ACA provides states the ability to expand Medicaid to low-income individuals, who are not elderly or disabled. Thirty one states and D.C. have expanded Medicaid pursuant to the ACA, but nineteen states have rejected health care for their low income residents and some have attempted to expand Medicaid by changing it in troubling ways. Kentucky Governor Matt Bevin is seeking a waiver from the federal government to tie work requirements to Medicaid coverage, a qualification that we know accomplishes nothing good and leaves health care out of reach for the people who need it most. All states have great leeway in administering Medicaid, but they must do so within federal guidelines; the Centers for Medicare and Medicaid (CMS) have rejected such proposals, and they should continue doing so. Medicaid is a unique program aimed at providing the most vulnerable among us quality health care - again, it's one of our few tools to combat health disparities. Indeed a study released this spring by HHS shows that Medicaid expansion is helping low-income individuals to finally access treatment for mental illnesses or substance use disorders. According to the HHS report, nearly 30 percent of individuals in the states that expanded Medicaid were using their coverage to obtain treatment for behavioral health needs.
There are many factors that produce and perpetuate health disparities, including lack of access to adequate housing. In the words of U.S. Housing and Urban Development Department Secretary Julián Castro, "housing is health care." Secretary Castro in early July announced $2.4 million in grants to assist more than 1,200 low-income individuals living with HIV/AIDS to help ensure they can remain in their homes. The secretary noted that research "shows that a stable home is critical to health of persons living with HIV/AIDS, and results in better health and reduced transmission of the disease. The combination of housing assistance and supportive services are critical to sustaining housing stability, promoting better health outcomes, and increasing quality of life, which promotes self-sufficiency efforts for those able to transition to the private housing market."
Health disparities do not result from a single cause and we cannot fix them with a single cure, but we must use the tools we have effectively as we continue to push for more solutions. On this anniversary of Medicaid, let's celebrate the fact that this noble government program is a major tool that we can use even more creatively to battle health disparities. Health justice for all people is what is ultimately needed. Until that day comes, far too many people in our country will be unable to enjoy liberty.