MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Martin Luther King Jr.’s Healthcare Justice Advocacy Makes America’s Hospitals Better Today

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Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.

Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.

Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.

A History of Unequal Healthcare

When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.

Notable examples of this include:

While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.

Desegregating Hospitals

King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.

The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.

Legal Gains for Equality in Hospitals

The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.

From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.

While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.

Thank you, King.

 

 

 

 

Number of Uninsured Children Increases by 400,000

https://www.thefiscaltimes.com/2019/10/30/Number-Uninsured-Children-Increases-400000

A new report from the Georgetown University Health Policy Institute says the number of uninsured children in the U.S. increased by more than 400,000 between 2016 and 2018.

Some key findings from the report:

  • The number of uninsured children rose above 4 million by the end of 2018.
  • Insurance coverage losses are concentrated in 15 states — Alabama, Arizona, Florida, Georgia,
  • Idaho, Illinois, Indiana, Missouri, Montana, North Carolina, Ohio, Tennessee, Texas, Utah, West Virginia.
  • States that have not expanded Medicaid, as allowed by the Affordable Care Act, have seen much larger increases in uninsured rates.
  • Children in non-expansion states are nearly twice as likely to be uninsured compared to states that have expanded Medicaid.
  • White and Latino children saw the largest increases in the uninsured rate.
  • Households with low to moderate income – $29,000 to $53,000 per year for a family of three – were the hardest hit.

The report’s authors said it’s no coincidence that the increases in the number of uninsured children have occurred since President Trump took office in 2017.

“This serious erosion of child health coverage is likely due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP,” they wrote in their conclusion. “These actions include attempting to repeal the ACA and deeply cut Medicaid, cutting outreach and advertising funds, encouraging states to put up more red tape barriers that make it harder for families to enroll or renew their eligible children in Medicaid or CHIP (or ignoring it when they do), eliminating the ACA’s individual mandate penalty, and creating a pervasive climate of fear and confusion for immigrant families.”

 

 

 

 

Don’t Confuse Changes in Federal Health Spending with National Health Spending

https://www.urban.org/urban-wire/dont-confuse-changes-federal-health-spending-national-health-spending?utm_source=The+Fiscal+Times&utm_campaign=27ee43ca78-EMAIL_CAMPAIGN_2019_10_16_09_52&utm_medium=email&utm_term=0_714147a9cf-27ee43ca78-390702969

There has been confusion over estimates, like ours, that measure the effect of single-payer (i.e., Medicare for All) proposals on both federal spending and total national health spending.

The two are not the same, and too frequently, people use estimates of both and make misleading apples-to-oranges comparisons.

Federal spending versus national spending

Federal health care spending is the money the federal government spends on health care, whereas national health spending includes all health spending, regardless of who pays for it.

Federal health care spending includes spending on Medicare, Medicaid, the Children’s Health Insurance program, Affordable Care Act Marketplace premium subsidies, the Veterans Administration, US Department of Defense health care programs, support for health care professionals and hospitals providing uncompensated care, as well as other federal programs.

Changes in federal health spending represent amounts that would either need to be added to the federal budget (and funded through tax increases or additional government debt) or which would lead to cuts in other federal programs to free up sufficient federal funds.

National health care spending includes spending by the federal government, state and local governments, households, and employers. National health expenditures (NHE) are estimated annually by the Centers for Medicare and Medicaid Services (CMS) as the National Health Expenditure Accounts. Using our models’ projections and extending the CMS’s estimate for spending categories we do not model, we estimate that NHE for the 10-year period from 2020 to 2029 will total approximately $52 trillion dollars under current law.

What increases or decreases in these estimates mean

It is possible, for example, for federal spending to increase while national health spending decreases, if new federal programs take over some of the expenses currently paid for by employers and households and do it at a lower cost.

But if a federal program takes over some of the private spending and ends up providing more generous benefits, total national spending could still increase. Regardless, it is important to separate changes in federal spending from changes in national spending to understand the implications of any health care reform approach.

In our most recent report, we estimate that a broad single-payer reform (referred to as Reform 8: Enhanced Single Payer in the report) would increase federal government spending by $34 trillion over the 2020–29 period, $34 trillion beyond what the federal government already spends on health care.

However, this reform would shift almost all of the spending currently done by households, employers, and state governments over to the federal government. All people, regardless of whether they have insurance coverage today, would be covered by the new federal program.

How single-payer reform would affect federal and national spending

Under the single-payer enhanced reform, the new federal government program would provide more covered benefits than typical insurance offers today (including typical medical benefits but adding a new home- and community-based long-term services and supports benefit and adult dental, vision, and hearing benefits). All the costs would be covered by the federal government; no one would pay premiums or out-of-pocket costs (i.e., no deductibles and no copayments or coinsurance), including undocumented residents.

As a result, many people would get insurance for the first time, and many others would get significantly more generous insurance than they currently have. And with their new or improved insurance, many people would use more medical care than they do today.

The federal government would limit the fees paid to doctors, hospitals, and prescription drug manufacturers, which would help lower the program’s costs, compared with what it would be otherwise. In addition, the system would be simpler than our current “patchwork” system, so the administrative costs of running the program would be lower than in most private insurance plans; this also helps offset some of the new costs.

However, by our estimates, the increase in spending for people with this new generous coverage would outweigh the savings from lower prices for health care providers and lower administrative costs. As a result, total national spending would increase, even taking into account greatly reduced household, employer, and state government spending.

For this approach to reform, federal spending would increase by $34 trillion over 10 years, but health spending by individuals, employers, and state governments would decrease by $27 trillion, so national health spending would increase by $7 trillion over the same 10-year period, from $52 to $59 trillion.

The figure below illustrates our estimates. In the first bar, we divide the $52 trillion estimated current-law spending on health care over 2020–29 into three pieces: $17 trillion in federal spending; $27 trillion in private spending and state and local government spending for medical care and dental care that would be subsumed into the new single-payer program; and $8 trillion in spending (a mix of government and private spending) that would not be affected by a single-payer program.

figure 1

The $8 trillion includes costs associated with an array of expenses, such as medical care for members of the military and their families while military members are deployed, services provided to foreign visitors, acute care provided to people living in institutions (e.g., prisons and nursing homes), and the value of new construction and equipment put in place by the medical sector. This spending also includes long-term services and supports by states and individuals that would continue under reform. For our purposes here, we refer to this $8 trillion in spending as “spending not affected by single-payer.”

The taller second bar shows that the total national spending under a single-payer program would be higher than under current law. The $17 trillion in federal spending under current law would be shifted to help fund the new program, and the federal government would take over the $27 trillion in current health care spending by employers, households, and state and local governments.

Fully funding a new single-payer program would require an additional $7 trillion in federal spending beyond that repurposed $44 trillion. The $8 trillion in spending not affected by the  single-payer program would continue to be funded by a mix of government and private sources.

Thus, it is not appropriate to compare an estimated increase in federal spending of $34 trillion over 10 years with a current-law level of national health spending of $52 trillion over the same period and conclude these are savings in national health spending.

And although many advocates believe that a single-payer system would increase federal spending but with the benefit of reducing national health spending, our estimates contradict that. According to our analysis, a broad single-payer reform, similar to current Medicare for All bills, would increase federal spending and increase national spending.

But as our full report also shows, a single-payer program can be designed to decrease national health spending, as can other approaches to achieving universal coverage.

 

 

 

Why Are at So Many Children Losing Medicaid/CHIP Coverage?

Why Are at So Many Children Losing Medicaid/CHIP Coverage?

Along with the American Academy of Pediatrics, First Focus and Children’s Defense Fund, Georgetown University CCF held a press tele-conference and released a report examining an alarming trend in children’s health coverage. The report shows that more 800,000 fewer children had Medicaid/CHIP coverage at the end of 2018 compared to 2017. This trend comes amid broader efforts to restrict access to health coverage and discourage participation by legal immigrants.

The report found little evidence to support claims that the improving economy was responsible for the 2.2 percent decline in enrollment. Instead data suggest this 2018 could be the second year in a row that the rate of uninsured children increases. The U.S. Census Bureau will release the 2018 child uninsured rate data later in the fall.

Enrollment declines are concentrated in seven states – California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas – which account for nearly 70 percent of the losses. Nine states – Idaho, Illinois, Maine, Mississippi, Missouri, Ohio, Tennessee, Utah, and Wyoming – had decreases of more than double the national average.

Please listen to the recording of the press call or read the report for more details. Here a few excerpts from Thursday’s press conference:

Joan Alker of CCF moderated the call and explained why this drop in child enrollment is so alarming.

“We are extremely concerned about what we are seeing and what it portends for the uninsured numbers these fall,” she said. “For many years there’s been a national bipartisan commitment to reduce the number of uninsured children and the effort have borne fruit. Unfortunately, today we do not feel confident that this national commitment still exists.”

Tricia Brooks, lead author of the report, explained the many factors have likely led to the decline in child enrollment.

“Knowing that the economy had a minimal impact at best, we must call on state and national policymakers to address the factors contributing to the enrollment decline,” said Brooks. “From systems and renewal issues to enrollment barriers to threats like public charge, we must take a hard look at what these administrative actions and barriers to coverage mean for our kids’ health.”

Dr. Laura Guerra-Cardus, Deputy Director for the Children’s Defense Fund of Texas  said overly cumbersome eligibility checks are causing thousands of eligible children to lose coverage in her state. Nine out of every 10 Texas children being dropped are losing coverage due to red-tape. She said this is causing significant confusion for families and throughout the Texas health care system as many families don’t learn their children are uninsured until they show up for an appointment with their health care provider.

“These income checks are erroneously flagging families – at the very least 30% of the time. Families are not being given enough time to respond,” she said. “They are given only ten days to respond and the timeline starts once flagged by the system which could be before the parents even receive notification.”

Bruce Lesley, President of First Focus, pointed out that bipartisan legislation in the U.S. Congress would address the issues raised by Dr. Guerra by requiring 12 months continuous health coverage for children. He also cited polls that show strong support for children’s health coverage in general.

“The American public is with us on this. Kids are a priority but we’re seeing a failure of policymakers to adhere to what voters want and make children a priority,” Lesley said.

Dr. Lanre Falusi, a pediatrician at the Children’s National Health System and national spokesperson for the American Academy of Pediatrics said pediatricians are very concerned about the decline in Medicaid and CHIP enrollment. In addition to cumbersome enrollment process and administrative burdens discouraging families from enrolling eligible children, she pointed out that immigrant families also encounter the chilling effect the proposed public charge rule.

“The public charge proposal presents immigrant families with an impossible choice: keep your family healthy but risk being separated or forgo vital services like Medicaid so your family can remain together in this country. Although the final rule has yet to be issued, the proposal has already caused immigrant families to avoid or even disenroll from programs they are eligible for out of fear, like Medicaid. I have seen this myself,” Dr. Falusi said.

“We need all children in the United States to reach their full potential if we are to reach ours as a nation. Ensuring children are enrolled in health coverage designed to meet their needs is necessary to making that possible. Our lawmakers must pass policies that keep programs like Medicaid and CHIP strong, not those that jeopardize the critical gains we’ve made in children’s coverage.”