News

For this issue of ABFE News and Updates (ANU), ABFE sought clarity and perspective on propsed Healthcare legislation before the U.S. House and Senate.

For the better part of one year we have seen the healthcare reform debate argued and sensationalized from one extreme position to the other. Public debate that has led to even more confusion for lay people as well as those who are highly skilled.  The muddling of facts and information over healthcare reform and expanding coverage to more - not all - uninsured Americans is at the cost of organizations and people working on behalf of underserved communities and specifically those working on issues impacting Black communities.

For insight and perspective, ABFE spoke with Dr. Brian Smedley about proposed Healthcare reform legislation and how it will – or will not - impact Black communities. Dr. Smedley is Vice President and Director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, DC where he oversees all of the operations of the Institute. 

ABFE: What are the key areas of the House and Senate healthcare legislation that have important implications for Black communities?

BDS: Both the House and Senate bills attempt to expand health insurance coverage, contain costs, and improve the quality of health care, all of which are issues that disproportionately affect African Americans and other people of color. In that respect, African Americans are the canary in the coal mine of our broken health care systems, and this is unacceptable. So almost every aspect of health reform is important for communities of color. I’ve argued that unless Congress prioritizes equity as a key goal of the legislation, we will not contain costs, improve quality, or expand insurance coverage.

More specific to the legislation, both the House and Senate versions are expected to expand coverage to millions of Americans, which will clearly help people of color, who are half of the uninsured. And the insurance reforms—no cherrypicking enrollees, no denying claims on the basis of pre-existing conditions—will also help minorities, who have higher rates of chronic disease and disability. In addition, both bills strengthen federal incentives to increase the diversity and number of health professionals working in underserved communities.

Perhaps more importantly, both bills also increase the federal investment in prevention, particularly community-based, primary prevention focused on improving community conditions that shape health. Public health and prevention trust funds are being considered that address problems like access to healthy foods or recreational facilities.

ABFE: What is your impression of the Bill as it is written now?

BDS: Any effort to expand health insurance coverage will be important, as both bills would do. And the other provisions I just spoke about will be particularly important to improve health and access to health care for people of color. But this legislation will not be enough to help everyone enjoy the fullest opportunity for good health. It’s a first step to eliminate health inequities, but it will not be sufficient to remedy the problem.

To improve population health and eliminate health inequities, we also have to address social and economic conditions that shape health. Neighborhoods often shape social and economic conditions in powerful ways. They shape the kinds of foods that are available to eat, the level of safety, the quality of schools, and the ability to enjoy recreation and exercise. Future Congressional action should focus on investments to improve these kinds of conditions.

ABFE: For grantmakers who do not fund healthcare specifically, but rather fund education, housing, youth development, jobs, etc., help us connect the dots. What should they be looking for in health care reform? What can they do to address the social and economic conditions that shape health and lead some in Black communities to get sick in the first place?

BDS: Structural inequities have health consequences. For instance, as a result of the recession we will see health inequities increase. We may see higher rates of infant mortality, and a higher burden of disease and disability among African Americans relative to whites. Health is about equity in all areas: education, criminal justice, economic opportunity. The work that the philanthropic community does in these areas is important not just to achieve equity in these areas but also in health. Funders don’t have to work specifically in health to have an impact on a community’s health. The philanthropic community understands that there are broad health benefits to work on social, economic and environmental justice issues. At the core of the work that many funders do is to organize communities and empower them politically, which can be one of the most important things that we can do to improve a community’s health.

ABFE: Does the reform legislation address issues key to Black men and boys specifically? What might be the impact of the legislation on this population?

BDS: The health reform legislation doesn’t specifically address the needs of African-American men and boys, despite their needs. For example, many Medicaid programs often leave out unwed fathers and single men. The Medicaid expansion will not in all likelihood benefit Black men and boys where it is desperately needed. And we haven’t dealt with their reproductive health needs, which can contribute to high infant mortality rates in the black community.

ABFE: Can you tell us about the impact of Post Traumatic Stress Disorder (PTSD) on Black communities and how legislation is or is not addressing this issue?

BDS: PTSD and the issue of violence and trauma in communities of color are significant. Many children in our communities have been exposed to violence in schools, neighborhoods, and their homes. This has huge implications for a children’s ability to learn and fully develop physically and emotionally. There are provisions in the House and Senate bills that expand access to mental health services. For example, mental health benefits are required to be part of the benefit package offered by insurance companies through the proposed health insurance exchange, which should make insurance more affordable to those who don’t have coverage through their employer.

More importantly, we should focus on prevention when it comes to issues of trauma and violence. We can reduce levels of violence and trauma through cost-effective, comprehensive, community-based prevention strategies. Violence is often socially constructed, in that our social, economic and political arrangements either encourage or discourage it. We can mitigate these problems and reduce violence by building community networks and resources to deal with violence. The health reform bills fall short in this area.

ABFE: Will you explain public option and who is most impacted by it?

BDS: The public option was a proposal to offer a publicly-funded health insurance plan that would cover all applicants and offer a comprehensive benefit package at low cost. The idea was that the efficiencies of a government-backed plan would put more of enrollees’ premium dollars in to health care, given that it would forgo advertising and profits. Most analysts expected that a public option would disproportionately benefit people of color and working families whose employers do not offer health benefits.

Many saw the public option as a way to increase choice and competition in the health insurance industry. This is an important objective, but ultimately we need to focus on achieving universal health insurance coverage. If the United States were to ensure that all residents have health insurance, we’ll be a step closer to recognizing health care as not just a privilege, but a human right.

ABFE asked leaders in the field of philanthropy and in direct services for their thoughts on healthcare reform and healthcare inequity

ANU is a quarterly publication that reaches our membership of grantmakers in philanthropy as well as practitioners in the field who are working to improve socio-economic conditions in Black communities. For questions or comments please contact Sharon Toomer at stoomer@abfe.org or 646.230.0307