The Fight to Cover Georgia

This post by Renee Bracey Sherman, one of the Echoing Ida writers, was originally posted on the Cornell Policy Review blog.

Access to affordable healthcare has always been an important issue in the United States – but has taken center stage in recent years due to the passage of the Patient Protection and Affordable Care Act of 2010. The Affordable Care Act (ACA) has increased access to health insurance coverage for millions of Americans, ended the denial of services for patients, extended coverage for dependents to stay on their guardians’ insurance plans until age 26, and allowed those with pre-existing conditions to receive health coverage. As part of the ACA, the federal government set up a national health insurance exchange and created funding for all states to create their own health insurance exchanges and expand Medicaid access for low-income families. As of now, 25 states have chosen not to expand Medicaid to more low-income families in their states–including Georgia.

Fortunately, Georgians are standing up and making their voices heard. On February 20th, domestic workers, youth, and families rallied in Atlanta to highlight the need to expand Medicaid and called on legislators to take action. SPARK Reproductive Justice NOW and the National Domestic Workers Alliance Atlanta Chapter held a rally to call attention to the over 600,000 Georgians who could get access to affordable and quality health care if Medicaid were expanded in Georgia. So far, Governor Nathan Deal (R-GA) has refused to take the funds provided by the federal government for the expansion – fully funded for the first three years, 95 percent covered by the federal government until 2017, and 90 percent through 2020. This would total to about $14.5 billion in funds. The Medicaid expansion would give Georgians who earn between 100 to 400 percent of the Federal Poverty Level (between $11,490 and $45,960 per year) without insurance through their employer, access to health care coverage. It seems simple, but it has been an issue rooted deeply in bitter partisan division leaving families out in the cold.

Low-income families, people of color, and youth are disproportionately affected by the decision not to expand Medicaid. On February 17th, I had the distinct honor of meeting several youth leaders and domestic workers in Atlanta, Georgia to discuss the impact the lack of health care and insurance access has had on their families. They shared their experiences and plight in accessing healthcare, even after the implementation of the ACA. One young woman I met, Quita Tinsley, is a youth leader with SPARK Reproductive Justice NOW and has spoken up in support of Medicaid Expansion. She was covered by her mother’s health insurance through her employment as a factory worker. When her mother was laid off, their insurance was canceled and they were stuck with medical bills that they were unable to pay. “[F]or my mother struggling to make ends meet with a daughter in college, this was huge,” Tinsley writes. “Shortly thereafter, she was permanently laid off by her employer, and we have both been without health insurance.”

Sadly, Tinsley’s experience is common: Black families are 55 percent more likely to be uninsured than their White counterparts, while six in ten of the uninsured African Americans would be eligible for tax credits to purchase low-cost insurance, the Medicaid expansion, or the Children’s Health Insurance Program. According to the National Domestic Workers Alliance, 65 percent of domestic workers (home health care workers, nannies, elderly aides, etc.) do not have health insurance and only 4 percent receive health insurance through their employers. This means the very people who are tasked with providing our children, the elderly, and our disabled loved ones with health care, do not have access to the same standard of care. How can this be right?

Currently, Georgia is one of the lowest ranked states with regard to health care coverage access and 20 percent of the state’s residents do not have access to health coverage – that is two million people, one of the highest numbers in the nation. Previously, I have written about the health disparities of the Black community, and in particular the transgender community, which makes access to affordable health insurance a dire necessity.

The Medicaid expansion in Georgia would bring insurance coverage to over 600,000 Georgians increasing revenue to hospitals and decreasing the burden on our healthcare system. Because more people will have health insurance, they will seek preventative health care services instead of using the emergency room and will be able to care for themselves before illnesses enter late stages and cost more to treat. The lack of health insurance for low-income communities disproportionately affects women–41 percent are uninsured, of which 47 percent of whom are young adults and uninsured.

Last week’s rally sheds light on these ongoing policy fights, but it is up to our elected officials to take action. Georgia residents are already contributing to the federal funds that support the ACA, why not allow them to receive the health care associated with it? Are we going to allow our loved ones, families, and neighbors to continue to have second-class health care – or worse, none at all? While the Affordable Care Act has afforded many families the much-needed access to health insurance, it is still leaving out our most vulnerable populations. The federal government has already put up the funds to ensure that Americans across the country are insured and it is up to the governors in half of the states to step up for their people. Leaving low-income families out of the equation is bad policy and extremely costly.

What Black Women Can Teach You About Health Care

Open enrollment has become a household term thanks to the Affordable Care Act (ACA), but healthcare has long been a challenge for Black women and families, who too often face economic and cultural barriers in accessing basic health care. Echoing Ida, a project of Forward Together to support the thought leadership and analysis of Black women, set out to tell our own stories of navigating this new health care system--shedding light on how we approach and experience health.

Idas support one another in writing fiercely.

As the Ida's are known to do, their pieces brought attention to issues seldom talked about in mainstream media and social justice circles: from Black women dying in childbirth to navigating one's doctor's office as a queer woman. While it seems that decision-makers are continuously deciding against our health, our voices, our stories--we know the solutions are ready. We continue to stand for our health and that of our communities. Let these powerful stories enlighten and inspire you to take action--enrolling for health care by March 31 and advocating for the kind of care we all deserve. All the while we'll be by your side beating the drum for better, more expansive health care for ourselves, our families, and our communities.

In "Improving health equity in Georgia," Malika Redmond addresses how Medicaid expansion would help a create healthier future for thousands of Georgians and the medical facilities that serve them.

Having health insurance and access to care is not simply an issue of health, but also one of economics and human rights. Expanding Medicaid to more Georgians at or near the poverty line is not just the right thing to do – it’s what our state and the rest of the deep south wants to do...Atlanta’s Grady Hospital and the 174 hospitals affiliated with the Georgia Hospital Association agree that expanding Medicaid would ensure the financial stability of their facilities who serve those without insurance. It will also help reduce the health disparities that already affect communities of color, disparities that will continue to grow if we do nothing. Half of Georgia’s 1.6 million uninsured will gain coverage if we expand Medicaid.

Medical mistrust is a major issue in communities of color. For the Affordable Care Act to truly impact these communities Amber J. Phillips outlines what needs to be done to address this issue and get people enrolled. Here's what she notes in "Love Thy Self Fiercely: How Self-Love Makes for Better Health Care":

Though the Obama administration has nearly solved the functionality of the ACA website as a barrier to enrollment and extended the enrollment deadline to March 31, the fear and distrust communities of color have toward our medical system may prove to be a greater roadblock if they continue to be ignored...As navigators and organizations continue to go into communities of color to enroll people in the ACA, we need to acknowledge the historical and current failures of the medical care system in communities of color as well as push for cultural competency to further increase Black communities’ access to care. This looks like ensuring that medical professionals are trained to be culturally competent and aware as well as intentionally making attempts to rectify the fear communities of color feel toward the medical system. This will go a long way in encouraging people of color to do more than enroll in health care but to proactively access medical care that sees us as whole beings. We must understand and promote that quality health care is culturally competent health care.

The Affordable Care Act will likely also bring many more LGBTQ people into the health care system. In "Exam Rooms and Bedrooms: Navigating Queer Sexual Health," Taja Lindley writes about the need for greater provider education in dealing with LGBTQ patients.

With the roll-out of Obamacare, thousands of previously uninsured LGBTQ folks who haven’t seen a health-care provider in years are navigating plans, finding providers, and likely going through this same trial and error that I did to find someone who gets them. Thankfully, there are resources to aid in this journey, and yet the exam room isn’t the only place where the conversation is awkward and where their questions will be sometimes avoided.

In providing affordable access to health services, the ACA has the power to improve health in communities of color and low-income communities through preventative care. In her piece, Stress Kills: Economic Insecurity and Black Women’s Maternal Health Outcomes, Elizabeth Dawes Gay outlines how economic justice can eliminate the stresses that cause health disparities for Black women.

Earning a low income and living in impoverished areas not only directly impedes access to health-care services, but indirectly affects health outcomes through the stress of financial insecurity. The Center for American Progress asserts that “the best ticket out of poverty is a job that pays a living wage.”

As the ACA is implemented, there also needs to be significant work to challenge long held stereotypes among providers. "Chronic Pain, and the Denial of Care for Black Women" details Alex Moffet Bateau's experiences in navigating the health care system as a young Black woman dealing with a chronic illness. Depending on where she was living in the country, her identity created frustrating barriers to accessing necessary services.

I never had any problem with pharmacists or doctors during the six years I lived in Chicago, but after I moved to Virginia to finish my dissertation in 2012 I was frequently accused of being a drug seeker, doctors refused to treat me, and pharmacists regularly interrogated me...Overall, research finds that doctors are more likely to discriminate against Black patients who are seeking pain management.

We are in the early stages of the Affordable Care Act implementation and there are a host of challenges to ensure marginalized communities are getting the support they need. As we continue on this road to increase and improved health care access, the Echoing Ida team will be raising our voices so that others may find theirs and we'll all be heard loud and clear.

Echoing Ida Represents at the #NotMyBossBusiness Rally

A few of the "Idas" at the #NotMyBossBusiness rally: (L to R) Amber Phillips, Elizabeth Dawes Gay, Gloria Malone, Renee Bracey Sherman. Photo credit: Renee Bracey Sherman

Earlier this week, the Supreme Court heard arguments about the “Hobby Lobby” case, which essentially will decide if employers can restrict insurance coverage of contraception on the grounds of their religious beliefs. Legally, this would allow companies to refuse to cover contraception as part of their employee’s health care plan, thus making employees pay out of pocket for birth control.

This case has serious implications on future of health care access and on Tuesday leaders in the reproductive justice movement showed up strong--to influence the both the US Supreme Court and the court of public opinion. Along with hundreds of colleague organizations and thousands of concerned Americans, we took it to the streets rallying at the steps of the Supreme Court, and on social media to say that our personal health care decisions are #NotMyBossBusiness. A few of our awesome Echoing Ida leaders, a project of Forward Together that supports and heightens the visibility of Black women's thought leadership, attended the rally in person. Idas Gloria Malone and Renee Bracey Sherman gave speeches about youth parenting and the difficulties of birth control access for women of color and low-income communities.

Gloria Malone, a fierce advocate for young parents (pictured below rocking her #SoyPoderosa shirt) told the crowd: "It is not a decision we should be forced to make because we cannot afford #birthcontrol! It is a matter of salud, dignidad, y justicia!"

Gloria Malone of TeenMomNYC and her daughter, Leilani, at the #NotMyBossBusiness rally. Photo credit: Planned Parenthood Action

She also tweeted how amazing the experience was for her and how grateful she was to share it with her 7 year-old daughter, Leilani.

Having my baby girl in attendance looking up at me while I spoke for both and all of us made me emotional. #NotMyBossBusiness
Having her watch me and be part of my early life, dreams, & future is beyond my wildest dreams as a mother #NotMyBossBusiness #SCOTUS

Later that morning, Renee Bracey Sherman broke down why bosses need to stay out of our health care decisions:

"The court’s decision will have far reaching effects - not only does it impact each and every employee, but it also impacts an employee’s family and their healthcare needs. This is not right. While my father and his boss didn’t need birth control, I did. While my father and his boss didn’t need a Pap smear, I did. I'll say it loud and proud. While my father and his boss didn’t need an abortion, I did. The personal beliefs of someone’s boss shouldn’t matter. Premiums pay for our health insurance and it should cover the care we need."

You can watch the entire speech below.

The Hobby Lobby case has implications beyond setting boundaries within the Affordable Care Act but could open the door for companies deny coverage for anything they disagree with under a religious exception. As comedian and activist Lizz Winstead tweeted: "What if your boss's religion believes psychiatry is a hoax? Could they deny medicine AND therapy coverage?"

The decision is not expected to be announced until June so the countdown begins. In the meantime, to get more updates and coverage of this case and the #NotMyBossBusiness rally, follow Echoing Ida on Twitter.

Building Our Collective Power: A Student's Experience

My name is Cecy Velasco and I’m a student at the University of New Mexico and an intern at Strong Families New Mexico (SFNM). I was introduced to the amazing work of Strong Families through one of their partners, New Mexico Dreamers in Action, which I have been a part of for two years. I have been interning for almost seven months now and each day has been an important learning experience. The greatest part is the ability to witness all the hard work that goes on behind the scenes, the growth and strength of the Strong Families network, and the passion and heart that the Strong Families New Mexico staff puts into their work. They embody the Strong Families values and frame, which is why it is successfully reflected in their work.

One of my favorite experiences so far has been my involvement in the legislative session with SFNM and a few of their partners such as the Men of Color Initiative (MOCI) and the New Mexico Coalition for Equity and Justice (NMCEJ). This was my first time at the New Mexico state legislature and I had never talked to a legislator before. I have to admit it was a bit intimidating at first. Would the legislators even care about what I had to say? I quickly learned that they did. They listened intently as I talked about the importance of having licenses for immigrants and how instating a two-tier license system would exclude hard-working immigrants that contribute to the economy and push them further into the shadows. It was also a great experience to learn from my group members from different organizations. We highlighted each other’s issues and built collective power through our collaboration. I gained new skills, confidence and knowledge that will help me in my current and future policy work.

This feeling continued as our Strong Families New Mexico partners debriefed about the legislative session a few weeks ago. Every group recapped the results of their efforts and shared our successes, experiences and areas for improvement. NMCEJ discussed their campaign to keep the Lottery Scholarship accessible for all students especially low-income students and students of color. The chair of the organization, Virginia Necochea, talked about the coalition’s plan to measure the impact of the increases in course requirements on our students and to use that information for future policy changes. Andrea from Encuentro spoke about the success in passing Senate Bill 44 which supports adult education by offering options besides the GED. Micaela from Young Women United explained how they used their expertise, knowledge and experience to leverage Strong Families partners. All of us greatly appreciated the value and experience Young Women United brought to our efforts this legislative session.

You could feel our collective power and in turn it empowered me! It was evident that our unity and collaboration made our individual groups stronger. Through the Strong Families network, connections and resources, we were reminded that even though our focuses are different, we are together because we all believe in and envision a future where our families will have the rights, resources and recognition needed to thrive. Everyone left inspired, motivated and ready to keep moving forward together. We will only grow stronger and together we will create change!