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Wednesday, June 29, 2016

Orlando, HEAA, and Medicaid: June Health Equity Update

Nygel Williams

Villers Fellow

June brought us some encouraging highs and devastating lows in the world of health justice. This month, we remember the lives cut short in the Orlando shooting, who were mostly young LGBTQ people of color, and reflect on the health equity dimensions of the attack.

On the positive side, we also celebrate the introduction of the Health Equity and Accountability Act in Congress, the hundreds of thousands of Louisianans who just got covered under Medicaid, and the status of California’s efforts to cover unauthorized immigrants.

The Orlando massacre’s implications for health equity

The nation is still reeling from the horrifying news of yet another mass shootingone of the deadliest in U.S. history. This devastating hate crime targeted Orlando’s LGBTQ community, particularly Latinxs. And as we remember and honor the lives of the 49 people who were murdered and send our condolences to the family, friends, and community that are suffering their loss, we reflect on the health equity implications of this massacre.

One key health equity dimension of this tragedy is the intersectional analysis of health risk and health opportunity—how a person’s different identities that put them at risk for health disparities can have more than an additive effect. Risk of violence is a fundamental social determinant of health.

For example, while African Americans face a higher risk of violence than whites, and LGBTQ people are more likely to be victims of hate crimes, being both a person of color and LGBTQ puts you at an even higher risk (and even more so if you are transgender). When we layer on the devastating effects of the public health crisis of gun violence, which is more acute in communities of color, the health equity implications are clear.

In the meantime, as Orlando’s LGBTQ community works to pick up the pieces and move forward, this tragedy has shone a spotlight on some serious underlying racial and ethnic health care disparities that persist. For example, at least three of the people recovering from the shooting are undocumented, without access to health insurance to cover them on the long road to recovery ahead.

Similarly, given the fact that a disproportionately high share of Florida Hispanics are uninsured—nearly 1 in 4—it is likely that some of the survivors will face financial challenges as well. In addition, as the community works to recover from this trauma,  persistent mental health care disparities that have come to the fore, particularly the lack of mental health professionals, let alone those who can speak Spanish.

Devastating Supreme Court decision casts shadow over California’s push to expand health access for immigrants

Early in the month, health justice advocates celebrated the fact that California Governor Jerry Brown signed legislation aimed at increasing access to health care for undocumented immigrants. SB 10 would allow undocumented immigrants to purchase health insurance through California’s state exchange, albeit with their own money, and without access to the subsidies and cost-sharing reductions available to others. An estimated 300,000 people could benefit if the federal government approves the1332 state innovation waiver that California intends to submit.

However, even as that effort moves forward, the Supreme Courts’ stalemate last week on the USA v. Texas case will dial back progress on another front.  The 4-4 decision left a Texas judge’s injunction standing that blocked President Obama’s executive action to provide temporary relief from deportation for certain undocumented immigrant parents, known as “deferred action.”

California is one of a handful of states that allows people with deferred action to sign up for Medicaid, so one more negative impact of this devastating decision is that an estimated 620,000 Californians have lost their pathway to accessing affordable healthcare.  

Louisiana’s Medicaid expansion already helping over 200,000 Louisianans

Earlier this year, Louisiana Governor John Bel Edwards made good on his campaign promise to expand Medicaid on his first day in office, making Louisiana the 31st state and first southern state to take advantage of extending health coverage to more residents by expanding Medicaid under the Affordable Care Act.

Enrollment began on June 1 and coverage begins July 1. More than 225,000 Louisianans have already signed up. This rapid uptake demonstrates the great need for affordable health insurance. It also represents a huge opportunity for Hispanic and Black Louisianans who are roughly twice and three times as likely, respectively, to live in poverty than their white counterparts.

Comprehensive Health Equity and Accountability Act introduced in the House

On behalf of the Tri-Caucus, Rep. Robin Kelly (D-IL) introduced this month the Health Equity and Accountability Act of 2016 (HEAA). If passed, the HEAA would build on the success of the Affordable Care Act and further reduce disparities by providing a comprehensive approach to addressing the multiple barriers communities of color face in achieving good health.

For example, this expansive bill includes measures to improve access to culturally and linguistically appropriate care; make health insurance available to all who reside in the United States; strengthen data collection to enable the identification and tracking of disparities; develop specific strategies to tackle high-minority impact conditions and increase the diversity of the health care workforce.

Top Health Equity Reads and Resources

Health Equity Spotlight: HEAA: Forging a Path toward Health Equity. The Health Equity and Accountability Act of 2016 is the most recent iteration of the Tri-Caucus Health Disparities bill that dates back to at least 2007. The National Health Law Program’s Elizabeth Taylor published an insightful blog about how the HEAA would build on the Affordable Care Act to move us in the direction of health equity and meaningful opportunity for everyone in the nation to enjoy good health.

A Framework for Advancing Oral Health Equity, June Glover, Mary Boudreau, and Zulayka Santiago, Center for Health Care Strategies, Inc.

New Rule Banning Discrimination Will Promote Health Equity and How to File a Discrimination Complaint under Section 1557, Sinsi Hernandez-Cancio and Neah Morton, Families USA

Closing Gaps in Native American Health, Wisconsin Council on Children and Families

Achieving Health Equity: How Academic Medicine is addressing the Social Determinants of Health, Association of American Medical Colleges

HIV Prevention Toolkit: A Gender-Responsive Approach, Dr. Nancy C. Lee and Dr. Richard Wolitski, Office of Women’s Health

Rural Children at Risk for Worse Health Outcomes, Higher Health Care Costs, Alon Peltz, et al. University of Alabama at Birmingham

Finding Health Care in the Desert, Deborah Fallows, The Atlantic

SAMSHA: Increasing Access to Behavioral Health Services and Supports through Systems of Care, Substance Abuse and Mental Health Services Administration

Disparities in Adolescents’ Residence in Neighborhoods Supportive of Physical Activity – United States, 2011 - 2012, Kathleen b. Watson, et al., Centers for Disease Control and Prevention

Upcoming Health Equity Events

John’s Hopkins Summer Institute on Health Equity Research
Baltimore, MD
July 13-14, 2016

Our Lives Matter Our Votes Count, NAACP Annual Convention
Cincinnati, OH
July 16-20, 2016

NCLR 2016 Annual Conference
Orlando, FL
July 23-26, 2016

Save Our Cities, 2016 National Urban League Conference
Baltimore, MD
August 3-6, 2016

The 2016 Healthcare Quality and Equity Action Forum
Boston, MA
September 29-30, 2016

Looking Back and Forging Ahead: A Conversation on Racial and Ethnic Disparities in Health Care with the Family of Henrietta Lacks
Faneuil Hall, Boston, MA
September 29, 2016, 7:00 – 8:30 PM EDT