Tag Archives: public health

Medicaid Reform and Retrenchment: Your Voice is Needed NOW

As many of you know, Governor Cuomo has created a “Medicaid Redesign Team” to help him cut New York’s Medicaid program by $2 billion and redesign it for the long-term.  This 27-member team is made up of only one statewide community organization and has little representation from the public sector. It is primarily dominated by the hospital industry and is led by two men with ties to large, private hospitals. Given the imbalanced composition of the Redesign Team, we are concerned that the “savings” and “reforms” it will propose will also be imbalanced, resulting in cuts to Medicaid benefits, long-term and primary care services in the community, and safety net providers. In New York City, people of color are more than twice as likely to be publicly insured than whites. This means that cuts and bad decisions about reforms to the Medicaid program will have a bigger negative impact on immigrant populations and communities of color.

What can you do in response?

1. Make your voice heard! The Medicaid Redesign Team is hosting a series of public hearings across the state, including two in New York City on Thursday, January 27th. The focus of the hearings is to solicit input on how to achieve savings in the Medicaid program. Consumer advocates and allies must be out in full force at both of these hearings to provide testimony about how savings can be achieved without breaking the backs of low-income New Yorkers who depend on Medicaid for critical health benefits. Click here for more information about time & location for these hearings.

2. Join the campaign! The Save Our Safety Net-Coalition (SOS-C) is mobilizing to keep the voices of consumers and labor front-and-center during the redesign process. If you would like to get involved or simply keep informed about what is happening, please contact the Commission on the Public’s Health System at 212-246-0803 or email soscny@gmail.com.

3. Spread the word! Please tell your friends, colleagues and fellow fighters about the upcoming public hearings, encourage them to attend and provide testimony, and urge them to join SOS-C. Important public policy decisions should not be made without the active involvement of the people most impacted. Click here to download a flyer about the Medicaid Redesign Team hearings to share with your networks.

We look forward to working with all of you to ensure that New York’s Medicaid reform is humane, just and participatory.

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Knowledge is Power

This post is by Julina Guo, a Columbia University student and intern for the Health Justice program.

Disparities in health care impact thousands of lives every day.  One of the biggest challenges in the fight for equal health care is lack of awareness. We can help ourselves to become more knowledgeable and informed so that our own voices are heard in the healthcare debate. Below is a list of notable works that have highlighted pressing issues in health care equality as it relates to race, immigration, gender, and socioeconomic status. Although numerous reports and research studies have been published on the topic of health disparities, we focus in this bibliography on more journalistic works that tell a story of how health disparities impact real human lives.  We hope you find it useful!  And if, in the course of your travels through this literature, you discover other wonderful texts you’d like to share, please email us  (healthjustice@nylpi.org) and we’ll add them to this bibliography.  Thanks!

Abraham, Laurie K. 1993. Mama Might Be Better Off Dead: The Failure of Health Care in Urban America.  Chicago: University of Chicago Press.

Abraham examines the real impact of unequal health care on the Banes, a low-income African American family, in Chicago. Through stories of inadequate medical attention, visits to the emergency room, struggles to qualify for Medicaid, and other misfortunes that befell this family, Abraham depicts the need for health care reform through the eyes of the poor.

Byrd, W. Michael and Linda A. Clayton. 2001. An American Health Dilemma: Race, Medicine, and Health Care in the United States, 1900-2000. New York: Routledge.

An extensive chronicle of the African American experience within the larger context of health care in the United States and global racism in the last 2,000 years. Byrd and Clayton posit that that the denial of quality health care to African Americans originated in colonial era, a tradition that quickly transformed into a social norm to deprive African Americans of their rights.

Fadiman, Anne. 1997. The Spirit Catches You and You Fall Down:  A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux.

This book describes the emotional and medical tragedy of the Lee family, a refugee Hmong family from Laos, in the 1980s. When their child Lia Lee was diagnosed with severe epilepsy at an early age, the Lees tried to negotiate with doctors in a culturally mismatched setting only to find tragedy.

Hilfiker, David. 1994. Not All of Us Are Saints: A Doctor’s Journey with the Poor. New York: Ballantine Books.

Hilfiker documents his experiences as a physician in a Washington, D.C. ghetto. In 1983, Hilfiker moved his family into the Christ House, a medical recovery shelter for homeless men, and later founded an AIDS shelter in 1990. This moving narrative depicts vivid personal encounters with a ravaged health care system divided by race and poverty.

Jones, James. 1993. Bad Blood: The Tuskegee Syphilis Experiment. Free Press.

An analysis of experimentation by the United States Public Health Service from 1932 to 1972 on poor African American men infected with syphilis. Jones argues that by purposing deceiving and depriving the men of medical treatment, doctors perpetuated an ugly symbol of racism that has survived to this day.

Smith, David B. 1999. Health Care Divided: Race and Healing a Nation. University of Michigan Press.

Telling first-hand accounts and statistical evidence of inequality in health care outcomes move this narrative as it details changes from the 1920s to the present. Smith examines efforts by the federal government and courts over the years, giving special attention to the 1964 Civil Rights Act in the health care arena.

Vigen, Aana Marie. 2006. Women, Ethics, and Inequality in the U.S. Healthcare: “The Count among the Living.” Palgrave Macmillan.

A perspective of the disparities of healthcare as seen through African American and Latina women with breast cancer. Vigen crafts their stories in the context of current healthcare research, giving a voice to those marginalized in the healthcare debate.

Washington, Harriet A. 2006. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Harlem Moon.

Washington examines the history of unethical medical experimentation of African Americans. She details practices in the colonial era, following the introduction of Darwinism, social eugenics, and the Tuskegee Experiment

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Keeping the Community in Health Planning

Last week, the Commission on the Public’s Health System (CPHS) and NYLPI collaborated to comment on proposed legislation that would streamline the certificate of need process—the administrative procedure healthcare providers generally must go through in order to increase or modify their infrastructure (e.g., equipment, buildings and parking lots), or services they provide.  While a more efficient health planning process is a laudable goal, our organizations believe that it should not come at the expense of further removing community stakeholders—the very people who use the services—from the healthcare planning process.

Instead of simply deregulating the process even more, CPHS and NYLPI have called for three recommendations to amend the proposed legislation to still achieve efficiencies, but give communities a continued role in the process.  Our recommendations were not only made with an eye toward ensuring that community stakeholders have a voice in healthcare decision-making, but also that the State Department of Health is well-situated to strategically allocate healthcare resources in the most equitable way possible, especially for medically under-served communities of color and immigrant communities.  Read our memo and stay tuned for further developments.

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A First for NYC and the Nation

Yesterday, the New York City Council passed the Language Access in Pharmacies Act by a vote of 36 to 7, making it the first jurisdiction in the country to enact legislation ensuring that limited English proficient (LEP) individuals have equal and safe access to prescription medications.  We worked closely with Make the Road New York and the bill’s sponsor, Public Advocate Betsy Gotbaum, to draft the bill, negotiate its provisions and lobby for passage.  You can read/view articles about this in the Gotham Gazette, Channel 7 News, El Diario and the Daily News Blog.

The bill builds upon the agreements reached by the New York State Attorney General with major chain pharmacies in New York State in that it expands the number of pharmacies subject to stricter language access requirements (any pharmacy with 4+ stores), provides for fines and penalties in case of violation and does not expire after 2013, as the agreements do, among other things.

This is a huge victory for immigrant New Yorkers and for anyone concerned with public health, but we’re not quite ready to hang up our hats and call an end to the campaign.  There are a lot of things that the state regulates in terms of pharmacies (and that the city has no power over) that should be improved to ensure that LEP New Yorkers statewide are guaranteed equal access to prescription medications.  So, we plan to take our show on the road: from City Hall to Albany.  Stay tuned for more on these efforts and how you can get involved!

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