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
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