Separate is Not Equal in Education. Or Health Care.

We conclude that, in the field of public education, the doctrine of "separate but equal" has no place.  Separate educational facilities are inherently unequal.

- U.S. Supreme Court in Brown v. Board of Education, May 17, 1954

My office sits about a mile from the Monroe School, an historic, if not well known, place.  Monroe was once one of four segregated African-American elementary schools in Topeka.  Today, it is the location of the Brown v. Board of Education National Historic Site, commemorating the landmark U.S. Supreme Court decision to end racial segregation in public schools. 

As all schoolchildren are now taught, a unanimous court ruled in Brown v. Board that separate is inherently unequal.  Unfortunately, many adults – some who have seats in Congress and the state legislature – have still not learned this lesson. 

The American Health Care Act (AHCA), which has passed the U.S. House and is now being rushed through the Senate, proposes to segregate the sick from the healthy in insurance pools, creating separate and inevitably unequal coverage. 

As we strive to develop a health care system that works for all of us, we should not forget the lessons of Brown v. Board.

Prior to the Affordable Care Act (ACA), individuals with pre-existing conditions could have a difficult time finding health insurance.  Some would have to pay more or buy plans that excluded coverage of their condition.  If they couldn’t afford it, they would often go uninsured. 

Others were locked out altogether.  People who suffered from cancer or other serious conditions could not buy insurance at any price.  For them, many states – including Kansas – created special insurance programs, called high-risk pools, that segregated the sick from the well.

The idea was that sick people drive up costs for everyone else.  By segregating them, insurance premiums for the healthy would be lower. 

The problem was that concentrating those with pre-existing conditions – the people who arguably need health care the most – created insurance ghettos that were enormously expensive.  State subsidies were invariably inadequate and the result was very high premiums and deductibles and low annual coverage limits and lifetime caps.  Few of the uninsured could afford to participate. 

Separate was not equal.

The ACA ended high-risk pools.  It requires insurers to sell policies to everyone and prohibits charging the sick more than the healthy.  As a result, thousands of Kansans with pre-existing conditions have been able to find coverage.  Many now receive treatment for long-standing health issues.  Others are able to receive primary and preventive care, perhaps for the first time.  Lives have been improved.  Some have been saved.

Unfortunately, the AHCA will unravel this coverage guarantee and bring back health care apartheid.  It will allow states to waive protections for people with pre-existing conditions, as long as alternatives, such as high-risk pools, are established.  Predictably, proposed funding for these pools is grossly inadequate. 

You don’t need to be a health care expert – or a Supreme Court justice – to know how this will turn out.  Sky-high premiums and deductibles will make high-risk pools unaffordable for many of the people who are segregated from the insurance market.  They’ll no longer get the care they need.  Their health and well-being will suffer.  Some will die.  We’ve already lived this history.

By overturning the legal basis for segregation, the legacy of Brown v. Board extended far beyond public schools.  It provided energy to the voting rights and civil rights movements.  It inspired the Americans with Disabilities Act.  It continues to inform and encourage us as we work to create a society that offers equal accommodation and equal opportunity for all. 

A visit to the Monroe School quickly demonstrates why it would be unthinkable to bring back segregation in public schools.  It should be equally unthinkable in health care.

This was first published in the Topeka Capital-Journal on June 20, 2017

The AHCA and KanCare: Plan will harm vulnerable Kansans, state budget

The American Health Care Act (AHCA), passed by the U.S. House of Representatives on May 4, 2017, will profoundly change Kansas’ Medicaid program, KanCare. The bill is currently under fast track consideration in the U.S. Senate.

For more than 50 years, Medicaid has been a health coverage safety net to the most vulnerable Americans – mostly low-income children, seniors, and individuals with disabilities. Costs are shared by the federal government and the state government and are based on the needs of patients. Three-quarters of KanCare enrollees are children and families and 70 percent of the program’s dollars are spent on care of seniors and Kansans with disabilities.

The AHCA threatens to change that. It would impose caps on federal spending, shifting the risk for covering growing costs to the state. The federal contribution would increase less each year than the actual cost of care, squeezing the state budget more and more over time. The state will lose the ability to respond aggressively to health crises, cover new breakthrough drugs, and meet other needs that require flexibility and funding.

Nationwide, the AHCA will reduce expected federal spending on Medicaid by $830 billion over the next decade.  At least $1 billion of this cut – or about $100 million per year – will come from Kansas. The state will then face an inevitable choice – raise taxes or shift dollars from other programs to make up the difference. Or most likely, cut eligibility and benefits.

That means fewer kids with health coverage. Pregnant women who can’t get prenatal care. Less funding for seniors in nursing homes. And cuts in services to Kansans with disabilities. Because Medicaid covers the most vulnerable Kansans with the greatest needs, they are the ones who will be hurt when the state is forced to make do with less. In turn, there will be increased pressure on local communities and health care providers to fill in the gaps.

These Medicaid cuts won’t save much money. Instead, they’ll be used to deliver tax cuts to the wealthiest Americans. Tax cuts funded on the backs of low-income children and others who rely on Medicaid.  

The AHCA will harm KanCare and the Kansans who rely on it in other ways, as well. It will create bureaucratic barriers to enrollment and coverage. It will lock in the state’s relatively low program financing. And it specifically prohibits the state of Kansas from expanding KanCare, ensuring that Kansas taxpayers will continue to pay the tab for expansions in 31 other states without being able to bring our federal tax dollars back home.

The AHCA is being rushed through the Senate with no plans to hold hearings or gather testimony and public input. Kansans and all Americans deserve better.


This blog entry was originally posted by the Health Care Foundation of Greater Kansas City:  https://hcfgkc.org/kansans-deserve-better-ahca-offers/