In 1852, Frederick Douglass gave an exceptional speech titled “What to the Slave is the Fourth of July?”. He spoke to the hypocrisy of a country celebrating values of freedom and liberty while millions lived in slavery. My name is Dr. Sanjeev Sriram, and I am a pediatrician in southeast Washington, DC, just a few blocks from where Frederick Douglass used to live. Frederick Douglass is a Founding Father to me and millions of Americans. Following his leadership, I want to remind my fellow Americans that the Fourth of July should be a time to challenge ourselves to live by our values and extend health justice to all.
As we speak, the US Senate has a bill that would wreck health care for millions of people by slashing $800 billion from Medicaid. The Senate bill changes Medicaid funding to per capita caps. Under these caps, the federal government gives each state a tiny amount of money based on certain patient populations, and that is all the federal help a state would get for running Medicaid. The Congressional Budget Office has reported that 22 million people will lose coverage for health care under the Senate bill. Of those 22 million, 15 million will lose health care because of these per capita caps on Medicaid. As the Senate takes a recess for the Fourth of July, now is the time to ask: how do we expect our fellow Americans to have life, liberty, and the pursuit of happiness without health? What is the Fourth of July to America’s uninsured?
What is the Fourth of July to America’s uninsured children?
Right now, 95 percent of America’s children have coverage because of Medicaid and the Affordable Care Act. 95 percent of our kids! The Senate’s health care bill ruins that progress and set us on the wrong direction. Medicaid per capita caps will mean my patients, child patients, will lose coverage because states won’t have enough funding. Services like physical therapy or speech therapy will be cut because there won’t be enough funding. States might try to patch things up by using money from other programs. But that means children will see funding cuts to their schools or to infrastructure that provides clean drinking water.
Right now, Medicaid is a vital cornerstone to the health of America’s children. The program provides health care for 37 million children, starting with coverage for almost half of all births in our country. The majority of children from communities of color get their health care through Medicaid. As a pediatrician, I have seen the power and importance of Medicaid in my young patients’ lives. Medicaid matters because it means my patients do not have to be wealthy to be healthy. When my patients get knocked down by birth defects, asthma, learning disabilities, or cancer, Medicaid lifts them up. Medicaid gives my patients a fighting chance. Medicaid makes the pursuit of happiness possible.
If we don’t stand up for Medicaid now, and stop the Senate bill, what are we supposed to tell America’s uninsured children? How do our uninsured children celebrate the Fourth of July when their pursuit of happiness is cut off by caps to Medicaid?
What is the Fourth of July to America’s uninsured disabled?
My patients with disabilities are our fellow Americans. Right now, Medicaid provides comprehensive health care to 10 million disabled Americans. When parents of children with special health care needs are asked to compare Medicaid and private insurance, we learn that the quality of care and availability of care in Medicaid are often better than private insurance. Without Medicaid, many patients with disabilities will be unable to find coverage anywhere else. Under the Senate bill, families with disabled loved ones have a lot to lose and nothing to gain. That is why we have seen so many of our fellow Americans with disabilities fill the hallways and offices of Congress, demanding “no cuts, no caps to Medicaid!” Rather than be given a place at the health policy-making table, we saw patients forcibly removed from their wheelchairs. Americans with disabilities got handcuffs while insurance industry lobbyists got handshakes. What kind of values are these, America?
If we don’t stand up for Medicaid now, and stop the Senate bill, what are we supposed to tell our fellow Americans with disabilities? How do you celebrate Independence Day when Medicaid is slashed and can’t provide the health care and independence so many disabled Americans value?
What is the Fourth of July to America’s uninsured women?
The uninsured rate for women fell to record low levels because of 32 states expanding Medicaid under the Affordable Care Act. The importance of the ACA’s Medicaid expansions must be emphasized here. A single woman with no children earning $5,000 a year does not qualify for Medicaid in Texas, because that state refused to expand the program under Obamacare. That same woman making $5,000 a year does qualify for Medicaid in Louisiana or New Mexico because of the ACA expansions.
It’s bad enough that where a woman lives can determine whether or not she has health care. The Senate’s bill makes things worse by ending the Medicaid expansions and putting caps in place. Millions of women will lose coverage.
The Affordable Care Act gives women better health care by making preventive services like cancer screenings, STD testing, and birth control available with no out-of-pocket costs. The ACA also requires insurance companies to cover 10 essential health benefits, including maternity care. Before the ACA came into effect, over 70 percent of health plans did not cover maternity care, requiring women to pay extra for that coverage.
The Senate health care bill creates many old and new setbacks for women’s health. The bill stops the Medicaid expansions, freezing millions of low-income women out of the program. It allows insurance companies to go back to discriminating against pre-existing conditions, which for women can include things like having a C-section or an abnormal pap smear. The Senate health care bill threatens the funding of Planned Parenthood, a critical source of health and wellness for millions of women who will not find care anywhere else.
If we don’t stand up for Medicaid and the Affordable Care Act now, what are we supposed to tell our fellow American women? How do we celebrate equality on the Fourth of July when women’s health is second-class?
On the Fourth of July, America celebrates the signing of the Declaration of Independence. We hold truths to be self-evident about all of us being equal. Life, liberty, and the pursuit of happiness are supposed to be our inalienable rights. Inalienable. That means those rights can not be taken away by anyone. But right now, the Senate’s so-called health care bill is threatening life, liberty, and the pursuit of happiness for my patients and millions like them across this country. There are many reasons why the Senate health care bill has zero support from medical organizations and public health groups. There scheme takes away coverage from 22 million Americans. Millions of women, children, people with disabilities, people with struggling incomes ― our fellow Americans ― will lose their right to health. And for what? So a few billionaires get more wealth from tax cuts.
This is not an exaggeration. Some people may hear this and wonder, aren’t pediatricians supposed to be nice? I assure you that my patients receive my warmth and kindness. But there are limits to my politeness when a few powerful people threaten the basic human right of health care. I will assert that self-evident truth boldly. I must put principles before politeness, including on the Fourth of July, just like Frederick Douglass did. In his 1852 speech, he said “For it is not light that is needed, but fire; it is not the gentle shower, but thunder. We need the storm, the whirlwind, and the earthquake.”
The Fourth of July is the time to call upon the conscience of the nation. We have to ask: are our values real or just rhetorical? America can not celebrate life, liberty, and the pursuit of happiness on July 4th and then deny health care to children. America can not celebrate Independence Day and then undermine the independence of its disabled by slashing Medicaid. America can not pledge allegiance to equality and justice for all and then make health care unavailable to women or unaffordable to people with low incomes.
This Fourth of July, as a physician and as an American, I am calling upon you to show Congress that America is the home of the brave. Let’s take action for life, liberty, and the pursuit of happiness for my patients, their families, and millions like them. Bring the thunder to your town halls and let members of Congress know: No one is unworthy of wellness. Attacks on Medicaid patients are attacks on all of us. Health care is not a privilege based on age, gender, ability, or income. Health care is a basic human right, and no matter what, we will build health justice for all.