The Deep South and Medicaid Expansion

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Historic U.S. Supreme Court Decision Ruling the ACA Constitutional Keeps the Nation on Track to Advance Health Equity

By Brian Smedley, Ph.D.

The U.S. Supreme Court decision upholding the constitutionality of the Patient Protection and Affordable Care Act (ACA) represents a significant advancement in the effort to repair the deeply broken U.S. healthcare system and promote equitable opportunities for good health for all.  As long as its provisions are fully funded by Congress, the law will improve access to health insurance for more than 32 million Americans, prevent insurance companies from cherry-picking enrollees and denying claims because of pre-existing conditions, and incentivize more health-care providers to work in medically underserved communities.  These are among the benefits that the law is already providing, in addition to what is expected as provisions of the ACA come into force over the next two years.

In addition to ruling that the law’s mandate requiring insurance coverage is constitutional, the Court’s decision ensures that other key provisions of the legislation remain intact, many of which hold great promise to address the needs of those who face the greatest barriers to good health—particularly people of color, who are the fastest-growing segment of the U.S. population.

Many people of color face poorer health than the general population in the form of higher rates of infant mortality, chronic disease and disability and premature death.  Not only do these health inequities carry a tremendous human toll, but they also impose an enormous economic burden on the nation at large.  A study released by the Joint Center for Political and Economic Studies found that the direct medical costs associated with health inequities—in other words, additional costs of health care incurred because of the higher burden of disease and illness experienced by minorities—was nearly $300 billion in the four years between 2003 and 2006.  Adding the indirect costs associated with health inequities—such as lost wages and productivity and lost tax revenue—the total costs of health inequities to our society was $1.24 billion in the same time span.

How might the ACA change these dismal statistics?

By expanding access to private insurance through state health exchanges, improving access for more people who live in poverty through Medicaid expansions, and other reforms, more than 32 million uninsured Americans will gain coverage.  All of these provisions would improve the current state of health care for people of color, who are disproportionately un- and under-insured and who face greater barriers than whites to receiving high-quality care, even when insured.

Many other provisions of the ACA have great potential to reduce the risks that make people sick in the first place.  These provisions—particularly those that invest in prevention and improving the distribution of health care resources—can significantly improve opportunities for good health for all Americans, and particularly people of color.

A major reason why health inequalities persist is because of differences in the neighborhoods of minorities and non-minorities.  Research shows that racial and ethnic minorities are more likely than whites to live in segregated, high-poverty communities, communities that have historically suffered from a lack of health care investment, so they have fewer primary care providers, hospitals, and clinics.  To make matters worse, many of these communities face a host of health hazards—such as high levels of air, water and soil pollution, and a glut of fast food restaurants and liquor stores—and have relatively few health-enhancing resources, such as grocery stores where fresh fruits and vegetables can be purchased.

Several provisions of the ACA, such as the authorization to expand the National Health Service Corps, which provides incentives and removes barriers for health care providers who want to work in medically underserved communities, and the Prevention and Public Health Fund, the first mandatory funding stream aimed at improving the public’s health, will directly address these place-related barriers to good health.

Consistent with today’s ruling, efforts to improve opportunities for good health and improve health equity can—and must—be increased.  Government at all levels can, for example, improve health opportunities by stimulating public and private investment to help make all communities healthier.  They can do so by creating incentives to improve neighborhood food options, by aggressively addressing environmental degradation, and by de-concentrating poverty from inner-cities and rural areas through smart housing and transportation policy.

Given that by the year 2042, according to the U.S. Census Bureau, half of the people living in the United States will be people of color, it is imperative that we be prepared to address the health needs of an increasingly diverse population.  Lawmakers should continue to focus on the goal of health equity – a goal that is not only consistent with the American promise of opportunity, but in our long-term economic interest, as well.

Brian Smedley, Ph.D., is Vice President and Director of the Joint Center for Political and Economic Studies Health Policy Institute.

Men’s Health Affairs: Lost, Forgotten or Wasted?

by Jermane Bond, Ph.D.

In recent weeks, President Obama announced a new policy to ensure free preventive care services for women, including well women visits, domestic violence screening and contraception, as recommended by the Institute of Medicine of the National Academy of Science.  According to the new rule under Section 2713 of the Affordable Care Act, starting August 1, women can obtain contraception without a co-payment.

Where does this leave men?  Doesn’t the status of male health in the United States provide cause for concern about the health of the country and the social context of our society? Shouldn’t men also have access to free preventive health services?  Despite recent improvements in health and life expectancy during the 20th century, men over past decades have shown poorer health outcomes than women across all racial and ethnic groups as well as socioeconomic status.[i]  Poor health not only affects the men who suffer from it, but it can also have a devastating effect on women and families.

Despite the evidence that men are less likely than women to receive preventative health services, have a regular doctor or source of care, and have health insurance[ii] there has been no centralized national effort to coordinate fragmented men’s health services, awareness, prevention or promotion efforts at the local or national level.  Yet, teams and male players in professional sports continue to support breast cancer awareness.  Where is the support for prostate cancer prevention and awareness?  Is it lost?

The premature death and disability of men has a profound impact on wives, children, partners, and families across the nation.  Studies have shown that regular medical exams, preventive screenings, regular exercise, and healthy eating habits can save the lives of men. Appropriate use of tests, such as prostate exams, blood pressure, blood sugar, lipid panel, and colorectal screenings, in conjunction with clinical exams and/or self‐testing, results in the early detection of many health problems while increasing survival rates among men. Wouldn’t it be nice if we had national prevention support and a new preventive health policy? Let’s not forget the health of men.

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[i] Sandman D, Simantov E, An C.  Out of touch: American men and the healthcare system: Commonwealth Fund Men’s and Women’s Health Survey findings. 2000. Available at: http://www.usrf.org/breakingnews/Men_out_of_touch.pdf.

[ii]  Armstrong B, Kalmuss D, Franks M et al. Creating Teachable Moments: A Clinic-Based Intervention to Improve Young Men’s Sexual Health. Am J of Men’s Health. 2010; 4(2):135-144.

Jermane Bond, Ph.D. is Research Associate in the Health Policy Institute at the Joint Center for Political and Economic Studies. More information on Dr. Bond and his work can be found on the Joint Center website.

Medicaid: Why It’s Important

by Brian Smedley, Ph.D.

During one of the first opportunities that I had to present testimony at a Congressional hearing, a member of the committee posed a challenging question to me and other witnesses at our panel:  Would you trade your current health insurance for Medicaid?

The Congressman’s intent was clear:  he and others who oppose expansions of public health insurance programs believe that Medicaid is worse than private insurance, and possibly even worse than no insurance at all.

I was the first witness seated on the right of the panel, so I was to respond first.  I hesitated.  I didn’t want to reinforce the idea that Medicaid was deeply flawed.  Sure, the program has problems, but it remains one of the most efficient health insurance programs in the country and has been a lifeline for millions of low-income and disabled Americans.  But trade the insurance I had at the time?  I caved and answered no.  Almost all of the witnesses at our panel did the same.  But I’ve regretted it since.

Yesterday a landmark new study was released that, for the first time, documents the many ways in which Medicaid improves the health and well-being of its beneficiaries.  Researchers found that “expanding low-income adults’ access to Medicaid substantially increases health care use, reduces financial strain on covered individuals, and improves their self-reported health and well-being.”  The study was remarkable because for the first time researchers were able to compare outcomes for people who were randomly assigned to Medicaid against those who sought Medicaid coverage but could not receive it due to budget constraints.  (http://www.hsph.harvard.edu/news/press-releases/2011-releases/medicaid-benefits-oregon-study.html)

The implications of the study are clear:  efforts to slash Medicaid, such as those being debated in Congress, would increase risks for poor health and financial ruin for millions of children, elderly, and/or disabled people.  These are the very folks who are struggling the most in the current economy.  And given the high cost of poor health for our nation as a whole, these cuts are not only morally wrong but also put our economic recovery at risk.

Medicaid works.  Let’s spread the word.  I wish I had when I was given the chance to correct the record.

Brian Smedley, Ph.D., is Vice President and Director of the Health Policy Institute at the Joint Center for Political and Economic Studies. To learn more about Dr. Smedley and the Health Policy Institute, visit the Joint Center website.