Squeaky Wheels: Community Advocacy and Healthcare in Southeast Queens

This post is by Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth’s EJW Fellowship is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.

As we have written about in previous posts, Southeast Queens is a low-income community of color that has long experienced some of the worst health outcomes in New York City across a variety of measures. Despite this, and despite the fact that this community—long designated a Medically Underserved Area—has experienced a continuing trend of healthcare disinvestment. Consider this: over the past year, three hospitals that served Southeast Queens have closed; there are only 48 full-time primary care doctors per 100,000 people in Southeast Queens, almost 2/3 less than in whiter neighborhoods in Queens. All the while, Southeast Queens has the unenviable distinction of having abysmal health outcomes, including some of highest rates of infant mortality, low birth weight, and diabetes in the City.

One might think that the New York State Department of Health (DOH), the state government entity that handles all things health, would move quickly to shore up health services in a community with such a critical shortage of services and such a critical need for them. To its credit, DOH awarded $30 million in HEAL NY grants to spur healthcare services development borough-wide. Southeast Queens United in Support of Healthcare (SQUISH), a community-led coalition, advocated for allocating part of those funds toward fundamental healthcare services that Southeast Queens needs most: primary care; emergency care; and inpatient beds. The DOH grant disbursements signaled a first step—over $5 million was awarded to two community health centers that serve Southeast Queens.

Nevertheless, the grants did little to directly address the community’s most critical needs. For an area that has seen a disproportionate share of hospital and clinic closures in the borough, Southeast Queens simply did not receive funding proportionate to the critical need and unacceptable health outcomes the community faces. Indeed, it ultimately received the least amount of HEAL funding as compared to other areas in Queens.

Part of the difficulty for Southeast Queens—or any low-income community of color in New York, for that matter—is the fact that New York lacks any meaningful, structured way for people who live in the community and who use healthcare services there to provide ground-level input to DOH as to what they see as the most pressing health concerns, and how to best address those concerns. As it currently stands, DOH seems to turn a blind eye to the very individuals who actually utilize healthcare services. This perspective, though, is questionable at best, and will certainly not lead to a reduction of health inequities any time soon.

According to the National Partnership for Action to End Health Disparities, an initiative launched by the United States Department of Health and Human Services, such ground-level input is essential to eradicate health disparities. Three of the primary actions the Partnership calls for include:

Create opportunities to engage stakeholders from all sectors in discussions and actions to ensure community responsiveness and accountability toward ending existing health disparities;

Create mechanisms for individuals (e.g., residents, advocates) who have been affected by, or concerned with, health disparities to share their stories with the public and decision makers at all levels

Develop or support efforts to educate legislators and elected officials about health disparities and the determinants of health

Notwithstanding these recommendations, DOH has continued to take a hands-off stance, maintaining that it is merely a “neutral” government entity unable to actively engage in or commit to correcting the systemic health inequities that persist in the community. As dispassionate and impervious as this may sound, DOH has indicated, however, that it was up to community residents to work with elected officials and other stakeholders to locate and negotiate with healthcare providers who would be willing to serve the community. Only then might DOH get involved.

So, this is exactly what SQUISH has started to do.

SQUISH has initiated conversations with Addabbo Family Health Care to prepare for leveraging any future federal dollars from healthcare reform to bring additional Federally Qualified Health Clinics (that serve predominantly Medically Underserved Areas like Southeast Queens) to the neighborhood.

SQUISH also recently met with elected officials—including Assembly Members William Scarborough, Michelle Titus, Barbara Clark, and New York City Council Member Leroy Comrie—to begin to hammer out a plan to effectively address healthcare needs in the near-term and also to craft a long-term plan to ensure quality healthcare delivery in Southeast Queens.

There is also the matter of figuring out how to influence next steps at the site of Mary Immaculate Hospital, the now-defunct hospital in Jamaica that went bankrupt and shuttered its doors approximately one year ago. The current owners of the site have indicated they “envision[] several options for redeveloping the Mary Immaculate site, including an educational facility, nonprofit organization use, government operations or a religious facility.” No doubt you can see what redevelopment option is curiously absent from this list: reusing the site to provide health services to the community. While reopening a hospital may prove a challenging enterprise, it is not unheard of. The communities of Watts and Willowbrook, low-income communities of color in Los Angeles, California that are similarly medically underserved, were recently successful in forging a pact with various stakeholders to reopen their community hospital, the King/Drew Medical Center, using federal stimulus funds. As put by one community resident affected by the lack of local healthcare services put it,

“The fact that we are in the richest and most affluent society in the world yet don’t have health and medical infrastructures in key urban cities to take care of potentially life-threatening situations is the reason we should have hospitals in communities, particularly underserved communities with large populations of uninsured.”

Three thousand miles from Watts, this sentiment is equally applicable  in Southeast Queens as SQUISH continues to advocate for healthcare for its community.

This Bridge Called My Back: A Retro Look at Women of Color and Power

This post, by Health Justice Director, Nisha Agarwal, originally appeared on the Race-Talk.org blog of the Kirwan Institute for the Study of Race & Ethnicity and in the Huffington Post.

When it was published in 1981, This Bridge Called My Back: Writings by Radical Women of Color was a vermilion ink bloom on the crisp white wedding dress of the U.S. feminist movement. It was meant to be shocking. This anthology of prose and poetry by Black, Latina, Asian, Native American women was the first to express loudly, clearly, bilingually that the “sisterhood” could not be colorblind. Women of color are not the same as white women. They experience America differently. “I’ve had enough,” Donna Kate Rushin wrote in The Bridge Poem:

I’m sick of seeing and touching
Both sides of things
Sick of being the damn bridge for everybody…

I explain my mother to my father my father to my little sister
My little sister to my brother my brother to the white feminists
The white feminists to the Black church folks the Black church folks
To the ex-hippies the ex-hippies to the Black separatists the
Black separatists to the artists the artists to my friends’ parents…

Then
I’ve got to explain myself
To everybody…

It is an apt metaphor, woman of color as bridge. Always liminal. Permanently negotiating. A migrant between gender and race. That is what makes us different: we can never pick a side.

And here is another thing about bridges: they have to be strong. According to a recent report by the Women of Color Policy Network at NYU, Black and Latina women are disproportionately more likely to be poor, have trouble paying the bills, be worried about putting food on the table, and express concern about the accessibility of health insurance than their white counterparts, but they are among the least likely to benefit from the billions of dollars in stimulus funding being doled out to improve economic well-being in this country. However, I think it would be a mistake to view the women of color who face these challenges as passive “victims” of intersecting layers of oppression.

When I sit in church basements in the South Bronx, strategizing with a local community coalition, the vast majority of people I am talking with are women – women of color. The same is true of the immigrant rights organization I work with in Brooklyn. You cannot begin to comprehend the fight that is in the mothers I represent, who do daily battle with the health and education systems on behalf of their children. The foot soldiers of our modern-day civil rights movement are women of color, just as they were a generation ago, when women outnumbered men two-to-one in the local organizations feeding the Mississippi freedom struggle.

In a way, it is quite stunning that the group most disadvantaged within the socio-economic framework of American society would, historically and currently, be its most vital force for democracy. When historian Charles Payne interviewed civil rights activists to understand this trend in the context of Mississippi – for his masterful book, I’ve Got the Light of Freedom, which everyone must read – he found a few explanations. One had to do with the operating style of some of the most effective grassroots organizations from that period, such as the Student Non-Violent Coordinating Committee.

Instead of duplicating gender-biased, hierarchical leadership structures of earlier civil rights groups, SNCC was “structurally and philosophically open to female participation in a way that many older organizations would not have been.” Another factor was the inherent liminality of women of color, or “the fact that historically Black women have had to adapt to so many different expectations and pressures they became relatively open to new situations.” In other words, the ability to see and touch both sides of things could be an engine for liberation as much as it was a source of frustration.

I would like to see today’s social justice movements tap into this creative energy even more effectively than we are. Certainly, there are innovative grassroots groups that support and encourage women of color leadership, but as one moves higher and higher into the ranks of major social justice organizations in the United States, we see fewer and fewer of the women who are so prevalent on the ground. Perhaps this means we need to re-think our organizational structures and unpack the visible and invisible barriers they may impose to advancement by women of color, particularly those without class privilege. I would also like to see women of color band together more effectively and harness our world-changing potential. Yes, we have to work harder, longer, better, louder. But that may be the source of our strength as much as it is a liability:

The bridge I must be
Is the bridge to my own power
I must translate
My own fears
Mediate
My own weaknesses

I must be the bridge to nowhere
But my true self
And then
I will be useful

Update: Immigrants and Health Reform

This update comes to us courtesy of our friends at the New York Immigration Coalition.

Congressional leaders and President Obama are back after taking a break for the holidays and passage on Christmas Eve of the Senate’s health reform bill, H.R. 3590, the “Patient Protection and Affordable Care Act.”  Now that both the House and the Senate have passed their respective bills, they must come together to negotiate a final bill.  Congressional leaders have decided to bypass the Conference Committee process for a more abbreviated negotiation process among Democratic leadership and committee chairs, including Senate Majority Leader Harry Reid; House Speaker Nancy Pelosi; House Majority Leader Steny Hoyer; Senate Majority Whip Dick Durbin; House Committee Chairs George Miller, Charles Rangel, and Henry Waxman; Senate Committee Chairs Max Baucus and Tom Harkin; as well as NY Senator Charles Schumer, Vice Chair of the Democratic Conference.

This negotiation process is the last chance to make the improvements that are of vital importance to immigrant workers and families.

By and large, the House bill better exemplifies the general goals of health reform – making health insurance more affordable for millions of people (including immigrants who are naturalized citizens and lawful residents), helping to contain the skyrocketing costs of the health care system in the United States, and including many provisions to reduce health disparities and improve health outcomes.  However, there are still grave inequities for immigrant community members, both lawfully residing and undocumented, that must be addressed in this final negotiation process.    While naturalized citizens and many lawfully residing immigrants would gain access to more affordable health insurance, the five-year waiting period in federal Medicaid for lawfully residing immigrants remains and undocumented immigrants are excluded from reforms.  Most appalling is a provision in the Senate bill, which will be used as the basis for negotiations, which prohibits undocumented immigrants from buying full-price insurance with their own money in the new Exchange insurance marketplace.  Below is a discussion of the major provisions in the bills and the impact on immigrants.

Undocumented Immigrants & the Exchange. The Senate bill contains a dangerous provision prohibiting undocumented immigrants from buying health insurance with their own money at full price in the Exchange, while the House bill does not.  The exclusion must not make it into the final bill.  This provision is completely counterproductive to the goals of health reform.  Health reform should allow opportunities for more people to pay into the health care system, not less.  It is costlier to the health care system and to tax payers to exclude people – without insurance people avoid care until it becomes more serious, and more costly.  Also, verifying the citizenship or immigration status of each person who wants to pay their own money in the Exchange would be very costly to do and to an inhuman end – to keep people who just want to keep themselves and their families healthy from buying insurance with their own money.  It is unfathomable to think that a provision of health reform would actually cause some people to lose the coverage they currently have.  Finally, creating an immigration status requirement for the purchase of private goods sets a dangerous and unacceptable precedent.

Undocumented Immigrants, Medicaid & Subsidies. Undocumented immigrants are already restricted from most public health insurance programs, including Medicaid and Family Health Plus in New York, and neither bill changes that policy.  Also, neither bill allows undocumented immigrants to be eligible for the affordability/tax credits or subsidies that would make insurance more affordable.

Lawfully Residing Immigrants & Medicaid. Tragically, neither bill restores federal Medicaid eligibility for lawful permanent residents within their first five years.   This means that the most recent, lowest income legal residents will still not have access to a critical safety net benefit that their own tax money supports.  Yet these same people will be required to buy insurance.  Importantly, as a result of a lawsuit in 2001, New York extends Medicaid and Family Health Plus coverage to all lawfully residing immigrants who meet the income guidelines regardless of how long they have been lawful residents, and must continue to do so with state-only money.

The NYIC acknowledges New York Senators Schumer and Gillibrand for cosponsoring an amendment filed by Senator Menendez giving states the option to restore Medicaid to lawfully residing immigrants within their first five years.  Although the amendment did not come to a vote before the Senate bill was passed, Senate Majority Leader Reid made a commitment to the Democratic caucus that this provision would be included in the Senate Conference Report.  We must hold him and Congress to that commitment.

Lawfully Residing Immigrants & Subsidies. Hundreds of thousands of lawfully residing immigrants in New York who currently make too much money for Medicaid or Family Health Plus, do not receive insurance through an employer, and cannot afford to buy insurance on their own are eligible in both bills for the affordability/tax credits that will make insurance more affordable.

The Politics of Reform. The Obama administration will be especially influential in this final bill negotiation process.  The President must hear from you that the exclusion of undocumented immigrants in the Exchange is unacceptable and that the five-year waiting period in Medicaid for legal immigrants must be removed.  Allowing undocumented immigrants to use their own money to buy unsubsidized insurance in the Exchange is consistent with the goal of achieving just and humane immigration reform this year, and not a bargaining point.

As we look to the Senate/House negotiations, we have these priorities:

1) Everyone, regardless of immigration status, should be able to buy insurance with their own money in the Exchange.   Adopt the House policy.

2) Lawfully residing immigrants must be treated fairly.

a. Include Senate amendment 2991 enabling states to restore Medicaid to legal immigrants in their first five years.

b. For legal immigrants who live in states that retain the five-year waiting period, make sure that subsidies for those lowest income legal immigrants are fair.

c. Allow all lawful residents, including non-immigrant visa holders to be eligible for subsidies.

3) Adopt House provisions for verification of citizenship and immigration status, which are more established, streamlined, and protective of individual rights.

4) Protect the safety net health care system so that the millions of people who remain uninsured after reform passes still have access to health care.

Contact:  Jenny Rejeske, Health Advocacy Coordinator, 212-627-2227 x223, jrejeske@thenyic.org.

For more information and talking points, please visit the website of the New York Immigration Coalition www.thenyic.org or the website of the National Immigration Law Center:  www.nilc.org.

A Link to the Hearing World

This piece, by Health Justice Director Nisha Agarwal, will appear in the upcoming issue of NYLPI’s Pro Bono Clearinghouse newsletter.  It discusses a case that the Health Justice team worked on in conjunction with NYLPI’s Disability Law Center and advocates from around the country.

Imagine going to a hospital for heart surgery and not being able to communicate with your doctor or any of the nursing staff.  Imagine that your 13- and 9-year old children are made to serve as your voice instead: to ask questions for you, to explain the procedures to you, to tell you that post-surgery you had a stroke.  Imagine that your children are given pagers and pulled out of school whenever hospital staff need to speak with you, and that the younger child later attempts suicide because he thinks the problems you suffered in the hospital were his fault.  After all, his 9-year old vocabulary couldn’t find the right words to describe what was happening — to you, to himself or to others.

These are, roughly, the facts of Loeffler v. Staten Island University Hospital, a case decided by the Second Circuit Court of Appeals on October 6, 2009.  Robert Loeffler was a man who was profoundly deaf and sued Staten Island University Hospital for failure to provide him with a qualified sign language interpreter, as required under the Americans with Disabilities Act and the Rehabilitation Act.  NYLPI became involved with the case at the appeals level, organizing a broad national coalition of disability and language rights groups to provide amicus support to the plaintiffs.  Our brief highlighted two issues: (1) the proper legal standard to apply in “deliberate indifference” cases of this kind under disability law and (2) the importance of having competent, qualified medical interpreters in the health care setting, not just for people who are deaf but also for individuals with limited English proficiency and other communication barriers.  Our coalition of amici wanted the members of the court to understand not only the legal right they were being asked to clarify but also, more importantly, its significance.

And understand they did.  Oral arguments took place in March and were notable for the impassioned questioning of one judge on the panel, who described as “inhumane” the use of the Loeffler children as interpreters.  The court’s eventual decision found for the Loefflers on all points of law and remanded to the district court for trial.  In the concurrence, the court concluded, powerfully, by recognizing that the case is “not the dawn of never-ending liability for the Hospital, it is what Congress required – a link to the hearing world.”  For NYLPI, the case was an important opportunity to bridge the disability and language access communities and take part in an important victory for many of the communities we serve.

2010 Health Justice Spring Internships!

New York Lawyers for the Public Interest pioneered the practice of community lawyering in the five boroughs of New York City.  With every case and every campaign, we continue to elaborate an approach to working with marginalized communities that is ambitious, participatory, and dynamic.

In our health justice program, a community organizer and a team of attorneys challenge racial and ethnic disparities in the health care system in New York.  For us, health justice is achieved when racism, language barriers and anti-immigrant bias no longer infect the design and delivery of health care in the United States. Our work is rooted in the low-income communities of color and immigrant communities of New York City.  Sometimes we use the courts to make sure health care providers and others within the health care system play by the rules.  Sometimes we go to the legislature to change the rules of the game so that they are more fair and equitable.  But we always do these things in a way that fosters and supports grassroots organizing and activism within the communities where we work.

NYLPI seeks highly accomplished, progressive, community-minded law students to advance the goals of the health justice program.   Students interested in part-time spring internships with our program should submit a resume and writing sample as soon as possible to Peggy Germain at healthjustice@nylpi.org.

NYLPI is an affirmative action employer.  We actively recruit people of color and people with disabilities.

We dare you to find a better spring internship.

DOJ Civil Rights: Back in Business?

Yesterday afternoon advocates from civil rights organizations across the country were invited to a meeting with Tom Perez, the newly confirmed Assistant Attorney General for the Civil Rights Division at the U.S. Department of Justice (DOJ).  The purpose of the meeting was to discuss enforcement of Title VI of the Civil Rights Act of 1964 — a law that has been called the sleeping giant of the civil rights legal pantheon.  The fact that the meeting was happening was symbolic of the change in attitude at the Civil Rights Division of DOJ after the 8 years of the Bush Administration.   Earlier in the week, there was a meeting with language access advocates from across the country as well.  “DOJ is back in the civil rights business,” according to Tom Perez.

What exactly this will look like remains to be seen, but here in the Health Justice program we are cautiously optimistic.  For our work, having the federal government willing to engage in a little bit of oversight and enforcement, or simply issue guidance on critical issues related to health disparities, could have a ripple effect across the health care industry.  It also opens up an entirely new venue of advocacy–the federal government–which had been effectively closed off to us for the past 8 years.  We’ll be working with our community partners to figure out what to do and how – stay tuned!

Reading Between the Lines: Kids of Color & Mental Health Care

This post, by Health Justice Director, Nisha Agarwal, originally appeared on the Race-Talk.org blog of the Kirwan Institute for the Study of Race & Ethnicity and in the Huffington Post.

This weekend the New York Times reported on a new study which finds that kids on Medicaid are four times more likely to be prescribed antipsychotic drugs than their privately insured counterparts, and often for conditions for which the drugs are not FDA approved such as A.D.H.D. and conduct disorders. These drugs may not only have significant psychological impacts on the children who take them, but they also cause long-term physical harm. This is terrible no matter what, of course, but let us be very clear about what we are talking about here. In places like New York City, where African-Americans and Latinos are 3.5 times more likely to be on Medicaid than whites, the kids we are talking about are black and brown.

The children who are being systematically over-medicated and denied high quality mental and behavioral health services are disproportionately young people of color. What we are talking about, then, is race even if all but the most oblique reference to it has been scrubbed from the lines of the mainstream media coverage.

Let us also be clear about how this may be happening. The Times piece implies that certain problems with the Medicaid program, such as low reimbursement rates for therapy, contribute to the over-medication of children by creating incentives for doctors to prescribe antipsychotics or by reducing the availability of psychiatrists who accept Medicaid, thus funneling low-income kids to non-specialists who are more likely to provide treatment through drugs. This may very well be true, but let us unpack these dynamics as well from the racial justice tip.

In New York City, where I work, there are large, well-respected institutions providing high quality mental health services for children that refuse to accept Medicaid patients ostensibly because they don’t pay that well. This can be viewed as a rational dollars-and-cents reaction to an inadequate Medicaid system, but when you consider the close relationship between insurance and race, it starts to look like a modern version of Whites Only. Such policies become all the more difficult to swallow when you compare them to the approach of some community-based health care providers that also exist in the city and manage to make mental health services available effectively and equitably.

The directors of clinical services at these community health centers will tell you about how they’ve figured out their administrative and billing infrastructure so they can work around some of Medicaid’s challenges to provide high quality mental health care to all patients, regardless of their insurance. Providers like these fight alongside consumer advocates to preserve Medicaid and make it better because they recognize how critical it is to the lives of their patients. They don’t retreat from the system or take shortcuts, hoping that poor kids of color and their mental health problems will just go somewhere else. Indeed, they bear responsibility for their colleagues at other institutions, who disguise their discrimination in the form of a “rational” economic calculus.

You can expect to hear more about the doping of America’s children in the coming year, as more studies are released and blue-ribbon policy panels convened to address the problem. What you probably won’t see are many efforts to write race into the story or the solution. That is our job as racial justice advocates: to read between the lines and move in from the margins.

Hospital Mismanagement and the Perpetuation of Racial and Ethnic Disparities

This post, by the Director of NYLPI’s Health Justice Program, originally appeared on the blog of the Committee of Interns & Residents, which is fighting for the right to unionize at St. Barnabas Hospital.  You can read more about CIR’s efforts here.

Last summer, on her wedding night, Juana R. arrived at the St. Barnabas Hospital emergency department with severe abdominal pain.  A Spanish-speaker, Ms. R. needed an interpreter to communicate effectively with her providers, but she was never given one.  Instead, from the moment of her arrival at the ED, to her transfer to the ICU, to her eventual discharge a month later, she was systematically silenced by the hospital.  Invasive tests and procedures were performed without obtaining Ms. R.’s consent (she signed a litany of documents in English only).  Various medication regimens were attempted, many of which caused extreme pain and nausea, but Ms. R had no way of properly communicating these problems to her providers.  Only after legal intervention did this patient receive the communication assistance services she needed in order to understand her diagnosis and the reason for her admission.  Now, over a year after her discharge from Barnabas, Ms. R. remains emphatic that she will never again return to the hospital for care. She describes what she endured as a nightmare. [1]

As previously reported on this blog, Ms. R.’s case resulted in St. Barnabas Hospital being cited by the State Department of Health for failure to comply with public health regulations.  More broadly, her experience speaks to the ways in which poor hospital administration can compromise patient care and exacerbate racial and ethnic disparities in health care.

Well-known studies about the relationship between race and health care have focused on the individual patient-provider interaction – on how inter-personal biases and prejudices can sway treatment decisions.  However, in my experience as a civil rights lawyer in this field, I have found that institutional racism is a more salient factor than individual animus in explaining my clients’ negative encounters with the health care system.  Patients like Ms. R. are denied the interpretation services to which they are entitled not because of the ill will of particular caregivers, but because, more typically, hospitals like Barnabas are not managed well enough to have the policies and practices in place to ensure timely access to important support services – a systems failure that hurts patients and providers.

My office has also found that, across the city, health care institutions will steer Medicaid and uninsured patients, who are disproportionately people of color, into poorly equipped and under-staffed clinic settings while “better” patients (i.e. white, privately insured patients) are sent to the faculty practices.  At the broadest level, this upward redistribution of health care resources has meant that hospitals located in New York City’s low-income communities of color have closed down over the past decade, while facilities located in more affluent white communities have thrived.  In some cases, the hospitals that shut their doors had patient populations that were over 90% African-American, Latino and Asian.

Viewed in this way, the primary way to eliminate racial and ethnic disparities in health care is to overhaul the institutions that create and perpetuate racial and economic disparities within medicine.  This means more people like Ms. R. stepping forward and demanding investigations of unlawful practices at hospitals like St. Barnabas.  It also means more communities raising their voices against hospital policies that enrich some while impoverishing others.  Ultimately, it means more of us—all of us—speaking out against health care institutions designed to promote private gain over the public’s health.

Ensuring Health Equity in Health Reform

Over 250 organizations from across the country signed on to support the inclusion of health equity provisions in the federal health reform package.  Below is the letter that was sent to the Senate Majority Leader and relevant committee chairs.  A similar letter was sent to the House side as well.

October 15, 2009

Dear Senators Reid, Baucus, Harkin, and Dodd:

As you and your colleagues continue to work on health reform legislation, the over 250 undersigned coalitions and organizations urge you to ensure that the final legislation includes provisions to address health inequities and to reduce and eliminate health and health care disparities.

A recent report from the Joint Center for Political and Economic Studies found that from 2003 to 2006 the combined cost of health disparities totaled $1.24 trillion in our country. This report also found that in the same time period, eliminating certain health disparities would have reduced direct health care  expenditures by $229.4 billion. These potential savings would be realized not only by improving the health of populations and communities that suffer from health disparities and barriers to health care and public health services, but by reducing the costs resulting from the disproportionate burden of disease faced by these populations. As a result, the final health reform legislation must, at a minimum, include:

• Data Collection, Analyses, and Quality to ensure collection and reporting of data on race, ethnicity, gender, disability status, geographic location, socioeconomic status, primary language, sexual orientation, gender identity, and, especially for subpopulation groups, as well as the development of standards for measuring these factors to improve health status and quality in health care.
• Health Care Quality Improvements, including the National Strategy for Quality Improvements in Health Care, Quality Measure Development, Community Health Needs Assessment, and Cultural and Linguistic Competence in health care and public health services by providing grants and demonstration projects to support research and community-based programs designed to reduce health disparities and barriers to health services through education and outreach, health promotion and disease prevention activities, and health literacy and services.
• Health Workforce and Infrastructure Investment to strengthen the recruitment, retention, training, and continuing education of health professionals, and increase their diversity, distribution, cultural competence, and knowledge of treating the unique needs of populations impacted by health disparities.
• Access to Language Services for Limited English Proficient Patients, including funding for these services under federal programs and new coverage programs, training of interpreters, and evaluation of and accountability for provision of these services.
• Prevention and Wellness provisions, including the National Prevention and Health Promotion Strategy and Prevention and Public Health Fund.

We want to underscore that our support for these crucial health equity provisions in no way signals an endorsement for reducing affordability protections in order to reach a specific spending threshold. Nor should providing affordable coverage prevent us from making progress on reducing health disparities. These provisions are critical to efforts to help us succeed in closing the gaps in health status and health care.

Thank you for your ongoing leadership and support of issues impacting populations and communities that continue to suffer grave health and health care disparities. We would also like to thank you for your thoughtful consideration of this request and offer our assistance in addressing this critical issue. Please contact Daniel E. Dawes, J.D., at (202) 682-5110 or ddawes@apa.org, if you would like any additional information.

Sincerely,

Saving Health Care in Queens

This post, about our ongoing efforts to encourage investment in health care in Southeast Queens, first appeared on the Equal Justice Works blog.

This is a guest post from Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth is a graduate of Brooklyn Law School and is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.

When NYLPI helped organize the Southeast Queens United in Support of Healthcare (SQUISH) coalition back in 2006, they may not have realized how big a role they’d have to play in developing New York’s health policy.  Today, SQUISH is an independent community coalition that continues to give a voice to New Yorkers desperate for adequate medical care by raising awareness about issues that affect the delivery of services and advocating against the reduction and removal of critical health services.  As part of NYLPI, I help provide legal and technical support on health policy issues for the organization.

Recently, local health facilities have been coping with the strain of hospital closures, including St. John’s Hospital and Mary Immaculate Hospital, bringing the total number of Queens hospitals closed in the last year to three. In response, $30 million in grants has been awarded by the State to be split among 12 medical facilities in the borough – four in Southeast Queens.

SQUISH and many advocates say this is a great first step, but argue that this isn’t enough. I agree. It is vital for health care in Southeast Queens – which is racially and ethnically diverse as well as severely medically under-served – to be improved, and the Department of Health has signaled an interest in doing so. But the State government is still responsible for coordinating a plan for the future of health care delivery in Queens. One suggestion is that a task force of all stakeholders be convened – including community leaders – around health care concerns in the area.

Read more about the grant and health care issues facing Queens here: http://www.queenstribune.com/news/1254415740.html.