Editor’s Note: This National Health Law Program blog series authored by Executive Director Elizabeth G. Taylor delves into the achievements and challenges the organization continues to face in its 50-year fight to make health care a reality for low-income people and underserved communities. The first post in this three-part series centers on the nation’s aversion to health care for all. Read Part 2 here and Part 3 here.
On behalf of the National Health Law Program, which turns 50 this year, I offer these birthday reflections on our 50-year fight to ensure that low-income people have access to quality health care and the opportunity to achieve their full health potential.
The National Health Law Program was born in 1969, a period of national tumult. The year capped a decade that brought out the best and worst of us – brilliance and courage in the fight for civil rights and hatred and fear of the change those rights would bring. There were many reasons to be discouraged about where our country was headed. A year earlier, two beacons of hope, Dr. Martin Luther King, Jr. and Robert F. Kennedy, were killed, adding their names to a long and gruesome tally in the fight for equality and justice. But four years earlier, in 1965, Congress passed the Social Security Act and, with it, the Medicaid program, offering the nation’s long overdue commitment to provide health care for its neediest. It was into this mix of idealism, despair, and, finally, a concrete commitment to provide for the nation’s poorest, that the National Health Law Program was born. Now, 50 years later, it is appropriate to look at where we have been and where we must go.
To a large and sobering extent, the battles we are waging to ensure that low-income people have access to health have not changed since 1969. Although the Affordable Care Act was a major step forward, we have not, as a country, recognized what the rest of the world understands, that health care is so essential to the ability to live a happy and productive life that it must be treated as a fundamental human right. Compounding that limited vision, our country’s shameful history of slavery, Jim Crow, and continuing racism has haunted our efforts and will doom them unless we confront racism head on. And finally, the gap between the rich and the poor – or rather between the very rich and everyone else – profoundly impacts health. Income is a primary predictor of a person’s health. The fact that the power to address that disparity rests with people whose privilege insulates them from the struggles faced by the rest of the people in the country means that policymakers will continue to sacrifice the health of many for the economic success of the few. Lest those obstacles sound overwhelming, there is reason for optimism and there are things we can all do to advance the cause. But first, the obstacles.
Our national aversion to health care for all.
In most of the world, health care is a celebrated fundamental human right and governments accept responsibility for ensuring that right. Not so in the United States. The Universal Declaration of Human Rights, adopted by the then-very-new United Nations in 1948, includes the declaration that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care …” Led by Eleanor Roosevelt, the U.S. voted in favor of the Universal Declaration, but it also considers it non-binding – our nation is not bound to follow it. Similarly, the U.S. has declined to ratify the International Covenant on Economic, Social and Cultural Rights. The state parties to the Covenant recognize the right of all people to the enjoyment of the highest attainable standard of physical and mental health, and commit to take steps that include: “The creation of conditions to assure to all medical service and medical attention in the event of sickness.” No other country that claims to be a world leader has declined to ratify the Covenant.
For at least the last century, visionary U.S. leaders have pushed unsuccessfully for health care for all. Daniel Dawes, in his book 150 years of Obamacare, chronicles how generations of presidents have fought to expand health rights in the U.S., including Theodore Roosevelt, Franklin Delano Roosevelt, and Harry Truman. While advocates notched small victories in the first half of the last century, meaningful expansion of health rights was hampered by moneyed interests and the specter of socialized medicine.
The passage of Medicaid and Medicare in 1965 was a significant step forward, but it’s initial impact limited. Only so-called deserving or needy individuals – people with disabilities, seniors, and children – were entitled to health care through Medicare and Medicaid. Thanks to the leadership of U.S. Congressman Henry Waxman and other activists, Congress expanded the reach of Medicaid several times since 1969, but, before 2009, there was no federal program that promised health care to all. Specifically, many low-income adults were left without access to a regular source of health care.
The Affordable Care Act (ACA) was a bold commitment to health care for everyone (except undocumented immigrants, and some other lawfully present immigrants, such as those individuals enrolled in Deferred Action for Childhood Arrivals or DACA), which built on the private market system for most people above the federal poverty line (until Medicare kicks in), and built on Medicaid to cover everyone below the federal poverty line. While not perfect, the ACA is successful. Between 2010 and 2016, 20 million people gained access to health care as a result of the ACA. Despite the Trump administration’s effort to sabotage the program, enrollment in plans offered on the health care exchange has stayed strong and premiums have actually gone down in many states. Yet there are still states not taking advantage of the expanded federal funding for Medicaid coverage of low-income adults, still lawsuits seeking to declare the ACA unconstitutional, and still periodic rumblings in Congress about repealing the ACA.
Much of the current work of the National Health Law Program and many others is holding on to what we have – fighting repeated partisan efforts to kill the ACA, to cut funding for Medicaid, or to add obstacles to Medicaid enrollment that serve no purpose other than to knock people off of state Medicaid rolls. For example, under a partisan plan launched in Kentucky in 2017, the state acknowledges that about 100,000 people will lose health care if the plan is implemented. Shockingly, state and the Trump administration tout the plan as good for the people of Kentucky. Luckily for those 100,000 Kentuckians, we’ve taken Trump to court over this violation and Medicaid beneficiaries continue to receive benefits. The situation is even worse in Arkansas, where 17,000 people have already lost health care under the state’s new plan. We are challenging that plan in court too, but court challenges have done little to reduce the Trump administration’s appetite for rollbacks. As a nation, we still do not understand that health care for everyone strengthens our country. A two-tiered health system that caters to the rich and those with “the right kind of jobs” leaves us weaker (and sicker) as a people.