USA – The poor pay dearly for the lack of free access to health


Unlike most other developed countries in the world, the US, the world’s largest economy, does not have a universal health care program. The health insurance of their residents is based on a private insurance system through employers. In fact, in addition to wages, companies offer employees more or less preferential insurance packages – or, at times, no insurance at all.

At the same time, there are state and federal insurance programs, which are financed by the taxation of citizens, with the most famous among them “Obamacare” introduced in 2010, offering access to health to low-paid people who were not entitled to insurance for the poor. However, the manner of application of this federal legislation is applied by each state to a different degree and with different criteria for the beneficiaries.

At the same time, insurance, private or public, not only does not exempt insured persons from health care costs in hospitals, a small percentage of which are state-owned, but often hospitalization even for a simple problem, such as a fracture, can lead patients to debts of thousands of dollars.

It is noteworthy that in a 2009 study conducted in five states, it was found that medical debt was the cause for 46.2% of all individual bankruptcies, while in 2017 in bankruptcy applications 62.1% relied on medical expenses.

And this does not mean that the country is exempt from high public spending on health – a favorite argument of those calling for the privatization of Europe’s health systems. By contrast, at $ 9,403 per capita per year, the country has, according to a 2017 study, the most expensive health system and at the same time the one with the worst performance among 11 developed countries in the world. By comparison, per capita public spending on health in Greece for 2019 was limited to $ 2,238.

Inequalities from one state to another

An article published by the Guardian sheds light on how this lack of universal access to medical care translates into practice. The British newspaper examines the case of Mississippi, the poorest US state, which also has the highest percentage of black citizens. Unlike neighboring Louisiana, Mississippi does not have public insurance for employees who are not covered by their employer’s insurance package, no matter how low their income is, if they are single and have no children.

After all, Louisiana is the only state in the South where most of the 2 million workers with limited health insurance in the United States live, which has made such a prediction. According to the Guardian, the legacy of the slavery period continues to shape health policies in the region and block efforts to alleviate the poverty of thousands of black people.

78% of Mississippi residents would have access to health care if the state extended the right to public health insurance to the needy who have not had children.

“If you are poor, make money so you do not die”

“The blockade by Medicaid is scandalous,” Don Simonton, a retired professor at Alcorn State University, told the Guardian. “It’s a classic for the power structures of the South, from the time of slavery to the present day: If you are poor, you will make some money if you do not want to die.”

Inequalities in access to health persist not only despite the pandemic, but also despite Obamacare’s stated goal of ensuring common standards across the country. This is because some states have refused to take part in it.

Gabriel Muhammad, a 40-year-old Mississippi man who spoke to the Guardian, had to pay $ 1,394 for an CT scan in October. The cause of the difficulty in breathing had to be identified. He is a worker, but his income barely reaches $ 10,000 a year.

The benefits of expanding insurance rights

A few miles away, in Louisiana, the situation is completely different after Medicaid expanded in 2015. Uninsured adults in Madison, for example, have since fallen by 8%, and many hospitals have been on the brink of bankruptcy because of free care provided to the needy managed to escape. Unreimbursed health costs were reduced by 55% in county hospitals, according to a 2021 study, while hospitals are generally in better shape than those in states that have chosen not to extend public insurance.

In Jefferson County, where Muhammad lives, by contrast, the hospital is in danger of closing. And if that happens, residents fear it will drag on – also private – prisons and schools. Until slavery was banned, the county was one of the richest in Mississippi. It is now one of the poorest, with 37% of the population living below the poverty line set for the US at $ 26,500 for a family of four. Almost 70% receive some form of state support.

A matter of economics or ideology?

In September, a report was published showing that if the state decided to expand Medicaid implementation it would add 11,300 jobs from 2022 to 2027, significantly reducing the costs incurred by hospitals due to patients’ inability to pay for their treatment. and it would eventually cover its costs and become profitable within a decade. But Governor Tate Reeves insists such a move would be dangerous.

In his budget proposal last year, Republican Reeves wrote: “I firmly believe it is not a good policy to add another 300,000 residents to state-funded health care.”

But Jefferson County needs the extra jobs that the expansion of insurance rights would bring. Unemployment stands at 18.4%.

What has slavery got to do with care?

In 1965, in a very important year for civil rights in the United States, the Lyndon Johnson administration attempted to introduce a federal care program for vulnerable populations – which consisted largely of black citizens. But it was the politicians of the South who put up the greatest resistance to citizens’ rights, who finally shaped the framework of federal health policy. To reassure their own resistance, it was decided that health would depend on state programs. Since then, the image remains fragmented.

Even so, says Jamila Misner, one of the directors of the Cornell Center for Equal Access to Health at Cornell University, it took constant political struggle to keep Medicaid alive. “The political compromises that emerged from these struggles paved the way for geographical inequalities.”

Federal law stipulates that states must cover specific groups of low-income beneficiaries, such as families, people with disabilities, the elderly, pregnant women and children. But each state decides independently who else is entitled to coverage.

In 2012, the U.S. Supreme Court ruled that each state has the right to decide how to implement the Obamacare insurance coverage extension. The result has been a huge gap in some states: some people are too poor to be included in Obamacare, but not poor enough to qualify in the states to be admitted to Medicaid.

Twelve of the country’s fifty states, eight of them in the South, have refused to expand insurance coverage.

Louisiana Gov. John Bell Edwards chose to do so. Insured adults in his state have since increased by 40%.

Security in practice

Alvin Brown of Madison would have paid $ 9,000 for an emergency visit if he had not joined Medicaid. “Suddenly, I felt bad last May,” he recalls. His back hurt, while urination was painful. The next day he went to the emergency room and was informed that he had a kidney stone. His doctor prescribed him a medicine.

Two days later, he was still not feeling well. Eventually he had to be hospitalized, an hour away from his place of residence.

“It was the first time I went to the hospital,” he says. Eventually, he suffered from dehydration, which caused his kidneys to malfunction. “It was scary,” the 46-year-old father of a 15-year-old told the Guardian.

He did not know he was eligible for public insurance until a hospital employee asked him if he would be interested in joining the program. Coverage of the public treasury eventually amounted to $ 7,000 out of a total of $ 9,000.  

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