Monthly Archives: January 2010

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.

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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

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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.

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