Category: Uncategorized

Falling Through the Cracks

Why Hispanics find it especially difficult to access care

Originally published with Newsweek.

During her first semester at college at the University of North Carolina at Greensboro, in 2006, Georgina Uresti-Mandanado began having strange rashes and chest pains and feeling dizzy. But she put off seeing a doctor because she did not have health insurance—in fact, she had never had health coverage. Her mother’s jobs as a farm laborer, poultry processor, and construction worker never provided insurance for her kids. Uresti-Mandanado, the granddaughter of Mexican immigrants, says that when she was growing up, “I only went to the doctor when I was really sick and my grandma’s home remedies wouldn’t fix it.” But by winter break of her freshman year, she decided she needed to see a doctor. She waited until she was visiting her family in the Mexican city of San Luis Potosí, because it was cheaper to visit the doctor there. The blood tests came back with bad news: lupus.

Uresti-Mandanado’s story—her inability to pay for care and her reluctance to seek it out until seriously ill—is a common one in Hispanic communities. While millions of Americans of all backgrounds face the problem of being unable to access care because of a lack of insurance or inadequate coverage, Latinos are far more likely than people in other racial and ethnic groups to be unable to afford or get care when they need it. Continue reading

For Hispanics, One Size Does Not Fit All

Not when it comes to health-policy strategies.

Originally published with Newsweek.

Kids watching one of the puppet shows that are part of the Hartford, Conn., Hispanic Health Council’s nutrition campaign might hear dialogue like this, “I come from Mexico, and I like fruits and vegetables,” says puppet No. 1. Puppet No. 2 responds, “I’ve been here a long time, and I don’t like to eat what I used to eat in Puerto Rico.”

HHC’s nutrition puppet show, says the group’s director, Jeannette DeJesus, is based on a study conducted with the populations the council serves that found that “the longer you’re in this country, the poorer your eating habits.” But the study also found that unhealthy habits differed depending on where those surveyed came from. People of Mexican origin account for only 10 percent of Hartford’s Latino population, and they are largely new immigrants. HHC’s research found that that group is more likely to have fresh produce in their diets than people from the Puerto Rican majority, a community that has been in Hartford for decades.

With Latinos now accounting for more than 15 percent of the U.S. population, there is a great deal of emphasis on health outreach to the “Hispanic community.” (Different members of the community have different preferences for using “Hispanic” and “Latino” to refer to those with backgrounds in Latin America, though generally speaking, they are interchangeable.) But the truth is, the diversity of the Hispanic population means that to be truly effective, outreach must target many different Hispanic subcommunities. Knowing that someone is “Latino” or “Hispanic” does not tell a health-care worker what language she speaks, what foods she eats, or where she was born. Continue reading

Echoes of Kennedy’s Battle With Nixon in Health-Care Debate

This originally appeared at Newsweek.com.

It must pain those fond of Senator Ted Kennedy that his death comes just when the current health-reform effort is threatened by the same kind of attacks that tanked previous efforts. In fact, the Obama health-reform package Kennedy supported in his last days is similar to one Kennedy helped defeat when proposed by President Richard Nixon. If anything, the Obama plan is more conservative. Nixon would have mandated that all employers offer coverage to their employees, while creating a subsidized government insurance program for all Americans that employer coverage did not reach. It would take a miracle to pass such a plan today—a public insurance plan and an employer mandate are two provisions of the proposals now in Congress that are most in doubt.

But Kennedy helped kill Nixon’s proposal not only because he preferred a government insurance option for everyone, but because he believed it was politically achievable. Medicare, the government program for the elderly, was then only nine years old, enacted as part of President Lyndon Johnson’s campaign to expand the social safety net. Liberals hoped this would be a first step toward a national health-insurance program that the next Democratic president could enact. That victory seemed around the corner—Nixon proposed his plan in 1974, while embattled in the Watergate scandal. Continue reading

Healthcare: Heat Is On

Published in The Nation.

As the healthcare reform fight unfolds in Washington, one can imagine that this summer will be remembered in one of three ways. In one account, healthcare reform marks the moment when Democrats learned to work with advocacy groups to enforce party unity and push for the most progressive legislation possible. Another version is a familiar caution to progressives who are told they are too idealistic: liberals are demanding more than the Senate can swallow, and that could prevent anything passing at all. The third is perhaps the most familiar–much is compromised in the name of pragmatism, and the bill that passes isn’t strong enough to get the job done.

That seemed to be the track that the Senate Finance Committee was on in early July. Chairman Max Baucus signaled that he was prepared to give up much in order to hang on to a few GOP votes. Moderate Democrats were also skittish, making it easier for Baucus to trade away a public health insurance option. In addition, he was covering a third of the bill’s $1 trillion cost by taxing employer-sponsored insurance, a change vigorously opposed by unions, whose members are 50 percent more likely than workers in nonunionized shops to get health benefits.
With the Senate leadership wavering, advocacy groups played bad cop to enforce party unity. The netroots organization Change Congress went after Nebraska Senator Ben Nelson online and in direct mail, alleging that he was swayed against the public option by the $2 million he received in campaign contributions from insurers. He recanted. North Carolina’s Senator Kay Hagan signed on to the public option–albeit the fairly weak version endorsed by the health committee on July 15–when threatened with a similar campaign. Unions had begun broadcasting ads back in May opposing a tax on benefits. By mid-July, Senate majority leader Harry Reid reportedly told Baucus to back off these concessions because he would lose as many as fifteen Democratic votes; the Finance Committee went back to the drawing board.

But if this activism has won some victories in the Senate, some party leaders–including President Obama–have suggested they may regard it as counterproductive. “We shouldn’t be focusing resources on each other,” Obama said during a conference call with Congressional leaders, according to the Washington Post. “We ought to be focused on winning this debate.”
Continue reading

Dropping the ‘A’ Bomb

Debate over the role of abortion in publicly funded health care could be one more stumbling block.

Published in Newsweek.

When asked whether compromise was possible on hard health-reform issues like the creation of a public health insurance plan, the lead Republican negotiator, Sen. Charles Grassley of Iowa, has long been optimistic that common ground can be found. “I take a view that there is almost anything compromisable in public affairs,” he said in March, adding the counterexample he often employs for rhetorical effect when discussing difficult negotiations: “Abortion is about the only issue I know of that’s not compromisable.” With negotiations between Grassley and Senate Finance Committee Chairman Max Baucus, the Montana Democrat, seemingly deadlocked over the fundamental structure and financing of reform, NEWSWEEK has learned that Grassley has also been pushing for the inclusion of measures that would prevent reform from leading to “taxpayer-subsidized abortion.”

“Senator Grassley is opposed to mandating abortion coverage in health-care legislation,” said Jill Kozeny, the spokesperson for this staunchly pro-life lawmaker. Groups supporting abortion rights—including NARAL Pro-Choice America and Raising Women’s Voices—mobilized earlier this month because negotiations on the subject between Grassley and Baucus had intensified. Grassley’s office appeared to confirm fears among some abortion-rights advocates that Baucus was weighing at least some concessions on abortion coverage, adding, “At one point during the recent negotiations, there was a [compromise] solution that didn’t work out.”

Senator Baucus’s office would not comment, citing “longstanding Finance Committee policy not to discuss the specifics of ongoing negotiations.” But in e-mail messages, his press secretary, Erin Shields, noted Baucus has a 100 percent approval rating from NARAL and stressed, “He has always fought for a woman’s right to choose and will continue to do so.” Continue reading