The Leadership Conference on Civil and Human Rights

Health Care Reform: A Major Civil and Human Rights Issue

Opinion by David Goldberg

The Current Health Care Crisis
Health care is a fundamental civil rights issue because it is inextricably linked to every aspect of social and economic justice.

When people lack access to quality and affordable healthcare, a medical emergency can bankrupt a family. As long as families face this danger, they have no economic security. Without access to quality and affordable healthcare, chronic medical problems can prevent a worker from changing or keeping jobs and advancing at work, which destroys equal employment opportunity. Without access to quality and affordable health care, poor health can keep a child out of school, which denies that child educational opportunity. And the sad truth is that health disparities may begin before birth and last a lifetime.

Hispanic and African-American women are more than twice as likely as White women to receive only very late prenatal care or none at all. Native American women are more than three times as likely to do without timely prenatal care.

Given the racial and ethnic disparities in prenatal care, it is not surprising that there are similar racial disparities in low birth-weight babies. For example, African-American women are twice as likely as White women to give birth to low-weight babies.

In our nation's cities, these disparities are even worse than the national averages. In Washington, D.C., White women have even better access to early prenatal care, but both Black and Hispanic women are even less likely to have access to timely care. Taken together, minority women in the District are more than 3.5 times more likely to go without first trimester prenatal care than White women; and the incidence of low-weight births among Black women in the District of Columbia is almost triple the rate for White women.

These racial disparities continue, and often increase, during children's school years. Perhaps the most dangerous long-term health crisis facing the nation is the obesity epidemic, with its profound array of economic and health consequences. While there is no official definition of obesity for children, the numbers of overweight children have skyrocketed over the last three decades. According to the National Center for Health Statistics, the percentage of overweight adolescents has increased two-and-a half-fold, from six percent in 1974 to 15 percent in 2002. Among elementary school children, the rate has nearly quadrupled, from four percent to 15 percent. Those numbers double to 30 percent if you include children who are deemed "at risk" of becoming overweight.

The overall numbers are alarming for all Americans, but they are far worse for minority children, with African- American and Latino youth approximately twice as likely to be overweight than their White counterparts. Being overweight has profound and often immediate health consequences for children. It can result in chronic conditions such as diabetes, asthma, high blood pressure and cholesterol, sleep apnea, and a wide range of bone and joint problems. All of these health problems impose catastrophic costs on families and further detract from a child's ability to learn. And with so many of the nation’s low-income and minority children overrepresented in failing, underresourced schools, access to health care becomes essential for real educational opportunity.

Fast forward a few years, and all these problems diminish the opportunities of adult workers, just as they shrink the futures of our children. When adult Americans have chronic medical conditions and have received inadequate educations, they have trouble qualifying for good jobs, keeping such jobs, and moving ahead in their careers. Still later, they are less likely to have adequate pension plans. And they also have a harder time just providing for themselves – much less accumulating and passing along family wealth to future generations.

Health Care Reform
As Congress wrangled for months on health care reform legislation, the stark reality of our health crisis was nearly lost, obscured by a divisive national debate in which facts mattered less than partisan diversions and attacks. Even so, Congress has managed to make significant progress on this critical issue, with the House of Representatives passing its health care reform bill in early November and the Senate completing its bill in late December. In the civil rights community, we are fighting to expand access, eliminate discrimination, and make sure that the reforms are financed in an equitable way that will maintain the lofty goal of universal health insurance coverage. The House and Senate bills have taken very different approaches to these issues and The Leadership Conference on Civil and Human Rights has been working with both chambers to ensure that there will be real support and protections for disadvantaged individuals and communities.

We are trying to expand access to Medicaid and ensure meaningful subsidies for people left to buy insurance on the market, regardless of whether they are buying a private plan or any type of public option. For Medicaid, for example, we support the House’s decision to raise the floor for eligibility to 150 percent of the poverty line for every state and for every class of potential beneficiaries.

Central to our advocacy are enforceable antidiscrimination provisions. We had advocated for language that prohibits discrimination based on “personal characteristics” unrelated to the provision of health care, because it would be broad and inclusive, and we had coupled it with a powerful enforcement provision that would have addressed both intentional discrimination and practices that had a disparate impact. The House-passed bill adopted the “personal characteristics” approach, but did not include the enforcement clause.

The Senate was not receptive to this approach. Instead its bill, as introduced, uses a more traditional formulation that would bar discrimination based on race, national origin, gender, age, and disability (categories already protected by other federal laws) and only in federally funded programs. However, unlike the House bill, the Senate bill does include an enforcement provision. Taken together, the House and Senate bills have the building blocks of a powerful antidiscrimination law and we will work to help craft a final version that includes the best of both approaches.

Finally, we have been fighting against a financing measure known as the "free rider" provision. This provision would require employers of firms with 50 or more employees who do not offer health coverage to pay the average subsidy cost per person for all employees who are eligible for a subsidy (in general, low and middleincome families) and who purchase coverage in the new health insurance exchanges, which are state-based marketplaces to purchase private insurance.

By imposing a tax on employers for hiring people from low- and moderate-income families who would qualify for subsidies in the new health insurance exchanges, the measure would discourage firms from hiring such individuals and would favor the hiring — for the same jobs — of people who don’t qualify for subsidies (primarily people without children or with spouses who had jobs with good pay or health benefits). The House bill does not have the free rider provision, and the Senate bill has changed substantially, but still has elements of free rider in it.

The health care reform bills are large, complicated pieces of legislation and there are many parts that still need work and refinement, but we are committed to ensuring that the best possible bill makes it to President Obama’s desk.

David Goldberg is senior counsel and senior policy analyst for The Leadership Conference on Civil and Human Rights and The Leadership Conference Education Fund and specializes in education, health care, and equal opportunity issues.