On Forgotten Workers

This May Day, here is a brief note about how the division of healthcare benefits according to standards of productive and non-productive work exacerbates certain types of discrimination. This discrimination even exists within the contemporary labor movement - although the rise in teachers' and nurses' strikes suggests a turning point.

Feminized Labor

This time last year, I presented a short speech at a worker's May Day rally in DC on the ways in which our healthcare system punishes working class women, especially immigrants and women of color. Our current economic system categorizes work that is regularly performed by women - what is often called feminized labor - as a type of work that is freely given out of a feeling of duty. Whether it is mothering (uncompensated) or nursing (undercompensated), creating and caring for life is systematically undervalued.

Starting in the late 20th century, activists fighting for the emancipation of mothers and sex workers began to collaborate more closely. In the last few years, there has been a revival of these connections in feminist activism in cities across the globe. The passage of SESTA has escalated the criminalization of sex work, a profession that many mothers and carers turn to in order to support their families.

Last night, at a meeting of local activists in preparation for the Poor People's Campaign, an organizer for the Sex Workers Outreach Project (SWOP) pointed out that sex workers are often excluded from mobilizations for worker's rights. And this made me think - how is the connection between healthcare and (certain types of) employment part of the categorization of some workers as more deserving of benefits than others? Why is it that "good union jobs" are still tied to the idea of the nuclear family, so that they are more frequently attached to masculinized, "provider" professions?

Our current healthcare system ties healthcare plans to employers, furthering the idea that certain types of workers are not productive enough to receive coverage. Whether they are women, trans, nonbinary or even men, these workers are almost always performing feminized (or ethnicized) types of labor. We are living in a society where trans women first sell sex in order to cover the costs of hormones that are not covered under many Medicaid MCO plans, and then find themselves criminalized for doing so. 

Ableism and Work

For many people in the United States, living with a disability is also work. Current government, whether at the state, local, or national level, is inadequate in creating desperately needed infrastructure. This year's budget in Baltimore allocates no money towards accessibility funding. None. How is that acceptable? We have to consider discriminatory policymaking like this as an assault on worker's rights as well as disability rights.

To make things worse, Medicaid is often not accepted by local providers. Without accessible transport options, planning a trip to see a doctor can be a full day's work. Disabled Americans are often in paid work and/or are involved in caring for family members at home. Earned sick leave will help some, but there is more work to be done. This is why in addition to HR-676, which allows people to receive in-home care, Healthcare is a Human Right Maryland supports the Disability Integration Act, which lays out a strong plan for in-home care options that would significantly reduce the burden of labor on disabled Americans who receive healthcare.

If you perform labor, whether it is compensated or uncompensated, you are still a worker. Whether it's the labor of caring for yourself or others, or paid work, it's work. And everyone is entitled to health care regardless of their profession or employment status.

"Hearts starve as well as bodies; give us bread, but give us roses."

Happy May Day! 


Re-insurance in Maryland: What's the Story?

The news is in! After very little publicity during the negotiation of these bills, Maryland governor Larry Hogan and Maryland Democrats are celebrating their collaboration to "stabilize" the individual market - the healthcare marketplace created as a result of the Affordable Care Act.

Hogan, who faces re-election this year, is able to come out of this as if he's saved the ACA from the more militant wing of his own party. Democrat politicians are also calling the re-insurance plan a victory. A closer look, however, shows that it is only a temporary fix.

Here are some key points to consider:

1. Without interference, the individual market will collapse.

There are two insurers left on the individual market, down from eight.  There are currently 154,000 covered by the individual market; Kaiser covers one-third and CareFirst covers the remainder.  The individual market has a higher risk population because those who are eligible but healthier and on tight budgets often are willing to take a risk and save money by paying the fine rather than the premium. Premiums on the individual market have been exploding, and it is now at risk of failure.  If the individual market fell apart, the number of uninsured Maryland residents (at 6% as of 2016 and now likely to be a higher figure) would increase. Maryland’s Medicare waiver, which allows for higher hospital rates, could also be at risk.

2. Insurers are effectively bailing themselves out - but only for one year.

Under SB387 (Individual Market Stabilization Maryland Healthcare Access Act of 2018), which is now law, Maryland will pay insurers for the costs of individuals’ medical expenses between $100K-250K (Corridor). A similar plan was originally part of the ACA but was phased out.

To stabilize premiums in the individual market, Maryland estimated it would need $350 million annually. Insurers in the Maryland Health Benefits exchange have been paying a federal tax (2.75% of premium revenues) to cover the cost of running the exchange. For 2019, the federal government put a one year moratorium on this tax. SB387 institutes a state tax for 2019 only, that will collect these revenues from private insurers and Medicaid MCOs and directs the money to a re-insurance fund. 

General and federal fund expenditures increase in FY 2019 and 2020
to pay the Medicaid share of the assessment for calendar 2019.
($ in millions)

FY 2018

FY 2019

FY 2020

FY 2021

FY 2022

SF Revenue

-

$300.7

$80.0

$0

$0

FF Revenue

$0

$49.6

$49.6

$0

$0

GF Expenditure

$0

$30.5

$30.4

$0

$0

FF Expenditure

$0

$49.6

$49.6

$0

$0

Net Effect

-

$270.2

$49.6

$0.0

$0.0


3. Again, this plan only works for 2019. 

SB387 is emergency legislation and was negotiated by Governor Hogan, Speaker Mike Busch, and Senate President Mike Miller.  Under this law Maryland is applying for a re-insurance waiver for 2020. This approach will be risky. The federal government encouraged states to apply to CMS for re-insurance waivers under section 1332 the ACA in early 2017 - but approval time has been longer than promised. The guidelines for these waiver are: no increase to federal deficit, must maintain comprehensive coverage, no decrease to the number of insured, and no increases to premiums. So far, the CMS has only given out three re-insurance waivers: Alaska, Minnesota, and Oregon. CMS has put off other states and Minnesota’s waiver caused them to lose $375 million in pass through funding.

4. Maryland’s re-insurance plan showcases the failures of the individual marketplace.

This legislative session, the “Improve the Affordable Care Act” camp was initially divided into two approaches. The first, proposed by civil society groups closely connected to the center of the Democratic party, argued that premiums on the individual market could be stabilized if more healthy people were “punished” for their behavior and called for replacing the now repealed federal mandate penalty with a similar state law. Healthcare is a Human Right took a firm stance against this bill, with Anne Arundel County chapter leader Robert Smith testifying that his income couldn’t provide for the costs of a monthly premium - and that the suggestion that this made him a selfish non-contributor to the general welfare of Maryland’s risk pool was an insult to many people in the state who haven’t been able to buy into the marketplace. The real problem, as we all know, is our for-profit healthcare system.

The other approach - the re-insurance plan - was introduced more quietly, with many decisions made in back rooms and without public input. Co-written by the two insurers that remain in the individual market, the re-insurance plan deserves a great deal of public scrutiny as industry-funded politicians continue to assert that the shortcomings of the Affordable Care Act can be fixed. 

5. Public hearings offer an opportunity to spread the message that the only way forward is Medicare for All.

The state has announced four public hearings in April and May. We encourage our members and supporters to attend these hearings to make the case that this is a last-minute solution from a political class that is out of ideas, and that pretending that the status quo is sustainable puts many people at risk after it runs its course in 2019 - in addition to the 6% of Marylanders already uninsured. We deserve better - we deserve Medicare for All.

EASTON - THURSDAY, APRIL 26, 5-6PM
Talbot Co. Dept. of Parks and Recreation (Chesapeake Room), 10028 Ocean Gateway

BALTIMORE - THURSDAY, MAY 3, 4-5PM
Maryland Health Benefit Exchange, 750 E. Pratt St, 6th Floor

FREDERICK - MONDAY, MAY 7, 3-4PM
Frederick County Local Health Dept, 350 Montevue Lane

WHITE PLAINS - THURSDAY, MAY 10, 5-7PM
Charles County Local Health Department, 4545 Crain Highway

Contact Information:  hchrmaryland@gmail.com; brittany@hchrmd.org or 410-310-4589;
www.hchrmd.org

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“You can’t just show up for the Claire Huxtables of this world”: Facing Black Women’s Maternal Mortality

Researchers and advocates for Black women’s maternal health have been sounding alarm bells for years. Their message reached critical mass at the start of 2018, when two back-to-back events propelled this issue into the media spotlight. First, the death of 27-year-old activist Erica Garner – daughter of Eric Garner, who was murdered by the NYPD –  four months after the birth of her second child. 

Rachel Cargle of the State of the Woman newsletter remarked at the time that Erica Garner “fought hard not only against a system of racial inequality within our justice system but she bore the weight that so many in the US do and that is being a woman of color in the healthcare system.”

Commentators looked to Erica’s asthma, trauma, class background and her status as a survivor of domestic violence as causal explanations for her death. Then, less than two weeks later, a profile of Serena Williams in Vogue revealed that she nearly died after giving birth to her daughter. After experiencing a shortness of breath that she believed was caused by a pulmonary embolism, Serena had to plead with doctors and nurses for the CT scan and heparin drip that ultimately saved her life. 

Writing for Quartz, Annalisa Merelli commented that “even Serena Williams… is just another black woman when it comes to being heard in the maternity ward – and when it comes to being dismissed.” 

Maternal mortality and morbidity are on the rise in the United States, to which the World Health Organization has assigned a higher maternal mortality ratio than Kazakhstan and Libya. On top of this, Black mothers are 243 percent more likely to die within a year of giving birth than white mothers. A 2016 publication by Black Mamas Matter identified poverty, quality of care, access to care and racial discrimination as causal factors of this disparity. 

Last week, I attended a seminar hosted by the African American Policy Forum titled “From Birth Control to Death: Facing Black Women’s Maternal Mortality”. It was the final event in #HerDreamDeferred, a week of action on the status of Black women in Washington, DC. With a panel moderated by Kimberlé Crenshaw that included some of the top experts and activists from across the country, there was a lot of catching up to do.

Catholic Hospitals and Maternal Mortality

The failure of Catholic hospitals to provide adequate care for Black mothers was one of the biggest themes of the afternoon. Laurie Bertram Roberts, Executive Director of the Mississippi Reproductive Freedom Fund, started off by telling her own story. Roberts went into her local hospital with a discharge and was told she was having a miscarriage. Because of the existence of a fetal heartbeat, the hospital sent her home. She began hemorrhaging and returned to the hospital, where she received the surgery she needed to live.

Roberts was lucky, as was Tamesha Means, who went through a similar experience at a Catholic hospital in Michigan. As an Irish American and a recovering Catholic myself, I came into the seminar mindful that two days earlier, the Republic of Ireland had set a date (May 25) for a referendum on repealing a constitutional ban on abortion. The main driver towards this was the 2012 death of Savita Halappanavar, a 31-year-old dentist from India who suffered a sepsis-induced heart attack after her medical team first failed to diagnose a blood infection and then denied her abortion because of a presence of a fetal heartbeat – even though a miscarriage was inevitable. If the referendum passes, it will be celebrated as the beginning of a new era in Ireland for women’s rights. But that victory will always be tainted with its own original sin: the double disadvantage that Savita faced as a woman of color in a Catholic country. 

How is it that in the 21st century, we still see reproductive justice constricted by religion? As Roberts put it, “If you don’t have autonomy over your own body, there’s no birth justice. It can’t be separated out”. 

Image: Brittany J. Burnham

Kira Shepherd is the Director of the Racial Justice Program at Columbia Law. She gave an overview of Ethical and Religious Directives (ERDs) that restrict reproductive services in Catholic hospitals. The ban on sterilization procedures stuck out, considering the disproportionate rates of sterilization, often without consent, that were experienced by Black and Brown women after the procedure was introduced in the 20thcentury. Even as recently as 2010, California prisons were illegally sterilizing female inmates

The unavailability of this procedure to women seeking care at religious hospitals adds insult to injustice, as women of color rely disproportionately on Catholic hospitals in comparison to white women. Shepherd spoke of a study in showing that while half of all women in New Jersey of reproductive age in the state are Black or Latinx, they represent an overwhelming 80% of births at Catholic hospital. That same study found that women of color accounted for 75% of births in Catholic hospitals in and 48% in non-Catholic hospitals in Maryland.

Many Catholic hospitals aren’t even advertised as such, meaning that women who enter them seeking care are often unaware of the restrictions on the type of care they can receive. According to Roberts, who had spoken about her own experience of nearly dying from her miscarriage, “I didn’t know it would be different in a Catholic hospital. I know so many women in my position who also don’t know. And then there’s being uninsured. Poor Black women internalize that this is the sort of trauma we have to take”. 

The next speaker, Dr. Joia Crear-Perry, is the President of the National Birth Equity Collaborative. She revealed that the only Medicaid providers in some states are Catholic hospitals. “They are using us for profit”, she said. Roberts later cited statistics from the Mississippi state government showing that in some majority-Black areas like Jackson, 83% of mothers were receiving C-sections. The World Health Organization recommends a maximum rate of 15%. Mortality rates for Black women in the state are still 70% higher than white women. 

Misogynoir in America’s Healthcare System

Misogynoir – a word that describes the intersecting experience of racism and sexism faced by Black women – also marks its presence in our healthcare system through a series of discriminatory and punitive policies and laws, along with the substandard level of care that they often receive due to provider bias. Even Black mothers who are college educated experience a higher maternal mortality rate than women of all other races who never finished school. 

Jennie Joseph, midwife and CEO of The Birth Place, drew attention to the need for medical providers to receive antiracist training, citing a study that found a widespread belief among medical providers that Black people can endure higher thresholds of pain. “It’s about understanding the impact of your bias. Without looking at racism as part of it, we’re going in these circles where we’re not getting to solve the problem”. Joseph added that providers struggle as well, pointing to burnout, which “often overruns the good intentions that people bring to medical professions in the first place”. On top of this, providers who are Black women struggle to navigate the need to “have it all” as women of color.

The conversation turned towards how the War on Drugs has punished and incarcerated Black mothers. According to Dr. Perry, “Black women are judged more on what we’re putting into our bodies than what we’re putting into our communities”. The difference between the reporter-led witch hunt against “crack mothers” in the 1980s that was used as an excuse to escalate the War on Drugs with the more empathetic coverage of the effects of opiate abuse on white mothers today stands out.

Meanwhile, the rise of state laws that criminalize women who suffer miscarriages intersects with Black women’s poor access to birth control, abortion and other critical services to create a perfect storm. Aarin Michele Williams of National Advocates for Pregnant Women chimed in: “We’re helping people defend women who have abortions and women who have children at home. And if their home birth results in a miscarriage or stillbirth, they are prosecuted and robbed of their lives.”

Despite its in-depth evaluation of the intersecting oppressions faced by Black mothers in the United States, the panelists’ concluding mood was overwhelmingly positive and hopeful. Jennie Joseph, who runs a midwifery practice for Black mothers, said that this “is generational work we're going to have to do. We can start community-based work sooner than we can get any larger organizational to do anything besides a quick training." Roberts, who is part of the Black Mamas Matter Alliance, shared photographs of a new birthing center she was opening in Mississippi. “You can’t just show up for the Claire Huxtables of this world”, she said. “You’re either with mamas, or you’re against mamas.”

The Black Mamas Matter Alliance is preparing for #BlackMaternalHealthWeek starting next week. Click here for more information.


April News

DavidBartonSmith.jpgTickets are selling fast for the Maryland PNHP Annual Dinner - register now!

We invite you to join us for the annual dinner for the Maryland chapter of Physicians for a National Health Program on Tuesday, April 24 2018 from 6-9 p.m. in support of Healthcare is a Human Right Maryland.

To purchase your ticket for the dinner on Tuesday, April 24 at the Turn House in Columbia, click here.

Our special guest for the evening will be David Barton Smith, author of The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America's Health Care System. He will be presenting on the topic of race relations in the U.S. health care system.

David Barton Smith is Emeritus Professor at Temple University and Adjunct Professor in the Department of Health Policy and Management in the Dornsife School of Public Health at Drexel University. He is the author of seven books, more than forty journal articles, and numerous research projects. He was awarded a 1995 Robert Wood Johnson Health Policy Research Investigator Award for research on the history and legacy of the racial segregation of health care and continues to lecture widely on this topic. His most recent book, The Power to Heal: Civil Rights, Medicare and the Struggle to Transform America’s Health System (Vanderbilt Press 2016 in press) received the Goldberg Prize for the best book in the area of medicine this year. Prof. Smith is also assisting in the development of a companion documentary supported by the National Endowment for Humanities, produced by Barbara Berney. Currently in the editing process, it will air on PBS stations later this year.

 

This Month in the Fight for National Improved Medicare for All (NIMA)

Image: A CVS advertises bottled water during the Elk River chemical spill that poisoned the drinking water of 300,000 West Virginians

We Have Much to Learn from the West Virginia Teacher's Strike

Brittany Shannahan
Statewide Organizer
HCHR-MD

The West Virginia Teacher's Strike inspired a number of articles from single payer advocates inside and outside the state. Writing for JacobinCathy Kunkel said:

"The underfunding of public employee health insurance is not a problem unique to West Virginia. Labor militancy around this issue could ultimately pave the way for a national Medicare-for-All solution. West Virginia teachers and service personnel have not focused on federal policy yet, but the PEIA issue will not be going away as long as medical and drug costs continue to skyrocket."

The surprise victory of the teacher's strike against a Trump-like governor shows us that we have more to learn from our sister state than the other way around. As an organizer, I have a long history with social movements in West Virginia. In 2011, I wrote my Master's dissertation on the strength of a decades-old environmental movement in remapping Appalachian labor history and identity. The 2014 Elk River chemical spill that contaminated the drinking water of 300,000 people brought the struggles that rural West Virginians had faced for decades to white-collar families in Charleston. Continue reading on our Campaign Blog

Remembering Dr. Richard Humphrey, 1934-2018

We are sorry to share the news that Dick Humphrey passed away last week. A passionate and dedicated Oncologist and Associate Professor at Johns Hopkins Hospital for 56 years, Dick was a lifelong campaigner for human rights. A true citizen doctor, his activism spanned from issues including racial justice, gun control, worker's rights, environmental justice, and nuclear disarmament. He also played a foundational role in the development of the Healthcare is a Human Right Maryland campaign. 

There will be a private burial and a memorial service will be held later this spring at the First Unitarian Church of Baltimore. We will be sharing the details on our calendar and our Facebook page.

 

Healthcare is a Human Right Maryland featured on AJ+

AJ+ interviewed Dr. Eric Naumburg and Brittany Shannahan about the prospects of universal healthcare in Maryland.

Watch the video here.

Read more about House Bill HR-676, the Expanded and Improved Medicare for All Act, here and the prospects for universal healthcare in Maryland here.



Other key moments in March:

March 7
HR-676, the Expanded and Improved Medicare for All Act, has more cosponsors than ever! After signing on in January 2017, Rep. Keith Ellison (D-MN) announced that he would be taking on the role of lead cosponsor following the retirement of Rep. John Conyers (D-MI):

“The United States is the outlier among large industrial countries. Everybody else has decided that healthcare is a right and they’re working to make sure that it is. We as a nation need to move in that direction for the welfare of our people.”

March 9
Healthcare is a Human Right and the Baltimore Harm Reduction Coalition participated in a packed town hall event on the Opiates crisis in Easton, hosted by Talbot Rising. It was a lively evening discussion about racial justice, access to care in rural areas, overcoming stigma and the urgency of a universal (i.e., single payer) healthcare system in providing treatment. 

March 21
National Nurses United is teaming up with nurses at Johns Hopkins Hospital to hold a ballot on whether to form a union. With Chase Brexton staff having formally unionized last month, nurses and staff at other hospitals in the state are likely to follow suit. 

March 24
It is time for Americans to move away from celebrating our ability to harm one another through wars and weapons and towards caring for one another. With this in mind, Healthcare is a Human Right Maryland members from across the state participated in the March for Our Lives in Washington, D.C. We stand in solidarity with all people resisting gun violence, from the streets of Baltimore to Parkland survivors. 

March 29

David Shulkin, the former secretary of the Department of Veteran's Affairs writes an op-ed for the New York Times, alleging that he was fired by Donald Trump for refusing to implement an agenda of privatization:

"They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans."

 

April Events

Saturday, April 7 – Tuesday, April 10, Washington, DC
Health over Profit for Everyone Action Camp
First Trinity Lutheran Church
309 E St NW, Washington DC 20001

Health Over Profit for Everyone, in partnership with the Backbone Campaign, is offering the first Single Payer Action Camp to build participant’s skills in strategy, messaging and direct action to win National Improved Medicare for All. The camp will include workshops in tools for developing strategic campaigns, how to make your message visible, creating media, nonviolent direct action and more. We will put those skills to use on Monday and Tuesday through actions in Washington, DC on the Monday and Tuesday.

Visit http://healthoverprofit.org/spring-2018-single-payer-action-camp/ for more details and to register. You must register to participate. Lodging is limited - reserve your space when you register.


Monday, April 9, Washington, DC
March for National Improved Medicare for All
Washington, DC Area (location TBC)

Health Over Profit for Everyone is holding the first National Improved Medicare for All Action Camp in Washington, DC from April 7 to 10. You can learn more about the camp hereWhether or not you can participate in the camp, you are invited to the community march for National Improved Medicare for All on Monday, April 9 in downtown Washington, DC. We will gather at noon.

More details will be released as we get closer to the date, but we can say that it will be a fun, festive and child-friendly march.

Tuesday, April 10, Columbia 
Howard County Chapter Meeting
7:30 PM, Home of Dr. Eric Naumburg
6163 Devon Drive, Columbia, MD 21044

RSVP

Thursday, April 12, 7pm-9pm
Carroll County Chapter Meeting
Carroll County Public Library
50 E Main St
Westminster, MD 21157

For more information, contact brittany@hchrmd.org or call 410-310-4589.

Tuesday, April 24, 6pm-9pm
Maryland PNHP Annual Dinner
The Turn House
11130 Willow Bottom Drive
Columbia, MD 21044

We invite you to join us for the annual dinner for the Maryland chapter of Physicians for a National Health Program on Tuesday, April 24 2018 from 6-9 p.m. in support of Healthcare is a Human Right Maryland.

To purchase your ticket for the dinner on Tuesday, April 24 at the Turn House in Columbia, click here.

 

Thursday, April 26, Baltimore 
Baltimore City Chapter Meeting
7:00 PM, Episcopal Diocese Center
4 E University Parkway, Baltimore, MD 21218

Members, friends, newcomers all welcome. Free ample parking (enter from N. Charles St.). (Come early for snacks/social time at 7:00 PM!). For more info, email info@mdsinglepayer.org.

RSVP   

 

Get Involved!

Baltimore Healthcare Students and Professionals for Single Payer
Our first happy hour was a massive success! BHSPSP aims to bring together people who study and work in healthcare fields from across different disciplines to meet one another and plug into the movement for human rights in healthcare. In the near future, we will be hosting more happy hours as well as lectures and other special events. For more information, join our Facebook group or contact Brittany@hchrmd.org.

Media training – share your story!
We occasionally are approached by news outlets looking for people to interview about their experiences in struggling with healthcare in the US. Is that you? Please get in touch! Brittany@hchrmd.org

Donate to HCHR-MD!
Healthcare is a Human Right Maryland relies on your donations to support our work. All contributions are tax-deductible and you can make a one-time donation or sign up as a monthly sustainer by clicking here. We accept credit cards and check payments.

Contact your Representative about HR-676, National Improved Medicare for All! 
Steny Hoyer, Andy Harris, John Delaney and Dutch Ruppersberger have not signed on to HR-676. Click here to locate your congressperson and to send them a message that it's time for them to become a champion for Medicare for All!

Business for Single Payer Campaign 
Single Payer works for business! If you are a business owner and would like to talk to us about how National Improved Medicare for All can save you money, or if you'd like to join us in reaching out to gain business support for our campaign, contact sdunbar91@gmail.com


We have much to learn from the West Virginia Teacher's Strike

The West Virginia Teacher's Strike inspired a number of articles from single payer advocates inside and outside the state. Writing for JacobinCathy Kunkel said:

"The underfunding of public employee health insurance is not a problem unique to West Virginia. Labor militancy around this issue could ultimately pave the way for a national Medicare-for-All solution. West Virginia teachers and service personnel have not focused on federal policy yet, but the PEIA issue will not be going away as long as medical and drug costs continue to skyrocket."

The surprise victory of the teacher's strike against a Trump-like governor shows us that we have more to learn from our sister state than the other way around. As an organizer, I have a long history with social movements in West Virginia. In 2011, I wrote my Master's dissertation on the strength of a decades-old environmental movement in remapping Appalachian labor history and identity. The 2014 Elk River chemical spill that contaminated the drinking water of 300,000 people brought the struggles that rural West Virginians had faced for decades to white-collar families in Charleston.

If I were to identify a single defining moment, though, it would be November 9, 2016, when West Virginians woke up to Donald Trump as US president and Jim Justice as governor at the same time. Justice, a coal baron, came into office with the agenda of slashing the social safety net in order to drive West Virginians further into dependency on the coal industry for jobs and economic development. With diverging groups that haven't always gotten along finding a common enemy in the new administration, resistance at a grand and unprecedented scale was inevitable.

As one of the states most positively affected by the Medicaid expansion under Obamacare, West Virginia has seen growth in the number of citizens demanding Medicare for All. When Bernie Sanders held a town hall in McDowell County, WV, it was one of the most unifying issues that emerged from the discussion. But outsiders looking to Charleston for inspiration or for political allies in the movement to secure single payer should note that the teachers' victory there was built on decades of long-term organizing in a state very different from ours.

First of all, while Maryland can count on a generally progressive state government to pass laws during Republican presidential administrations, these movements in West Virginia were created in a political environment where short-term change was just as improbable as long-term change. Direct action campaigns by groups like Mountain Justice and RAMPS peaked during the Obama years. These movements were loud, disobedient, and thoroughly radical in articulating their vision for Appalachia's future. West Virginia's teachers refused to compromise on a bad deal with the state government precisely because "no compromise" as a tactic has a long and stubborn history in that state. Activists in deep blue states are accustomed to compromising on our values in return for short-term policy gains at the legislative level. At a time when the financing of our healthcare system requires a complete overhaul, "no compromise" is a tactic we should learn to get used to.

Secondly, Maryland's robust economy and status as one of the richest states in the nation comes in part from the historic supply of cheap coal to our factories and steel mills, while West Virginia remains one of the poorest thanks to the legacy of extraction. It is easy to overstate the likelihood of West Virginians joining this movement in large numbers until activists in more prosperous states make a strong effort to show solidarity with Appalachian struggles. At the moment, most union campaigns for universal healthcare are focused on state-level legislation in richer states. There are already serious doubts to whether a universal healthcare system is possible in Maryland at the state level.

State-level universal healthcare would be impossible to finance in poor states. West Virginians know this and look at activists in rich states with suspicion. The last time outsiders showed up telling mountaineers how to improve their liveswas the War on Poverty in 1967, a legacy that stings to this day. The best way to bring Appalachians into this movement is to articulate a national insurance program that covers all of us - and to show up more when we're asked to. Healthcare isn't just a right for West Virginians: it's a debt that more developed parts of the nation owe in return for over a century's worth of immiseration and plundered natural wealth.


Medicare Advantage vs. Medicare for All

medicare-advantage-780x290-2.jpg


A new twitter campaign led by The Coalition for Medicare Choices promises to mobilize two million seniors to “preserve and strengthen” Medicare Advantage. But who is the Coalition for Medicare Choices? With Medicare Advantage now covering 33% of Medicare enrollees, what does the state of Medicare Advantage plans mean for the fight for National Improved Medicare for All?

Medicare Advantage, also known as Medicare Part C, allows elderly and disabled Americans to choose between “traditional” Medicare (fee-for-service) and private healthcare HMO plans. The initial idea behind Medicare Advantage was based on a belief that allowing private sector HMOs to have a slice of the Medicare pie would offer better consumer choices and reduce prices. A more cynical explanation would categorize Medicare Advantage as the privatization of an essential government service, with the primary aim of producing large profits for the corporations involved.

Over the last few decades, insurers participating in Medicare Advantage have schmoozed Congress into compensating them with more money per person than is allocated to traditional Medicare. Don McCanne of Physicians for a National Health Program writes: 

“Each year the administration, whether Democratic or Republican, uses quirky arcane rules to ensure an adequate revenue buffer so that private insurers can compete favorably with the traditional Medicare program by offering lower premiums and cost sharing and expanded benefits… Once a critical mass has enrolled in private plans, Congress will gradually reduce the relative value of the voucher-equivalent, reducing the government component of the funding of Medicare by shifting more costs to the Medicare beneficiaries.”

We see this happening right now, with top leaders of Republican Party expressing a strong interest in cutting Medicare. In response, physician advocates argue that the private Medicare Advantage HMOs should be isolated as a source of wasteful government spending, and that benefits offered by these plans should be expanded into traditional Medicare.  Physicians for a National Health Program (PNHP), the doctor-led think tank for single payer policymaking, has been putting forward a strong case against Medicare Advantage for some years

PNHP points to a number of studies that show the Medicare Advantage HMOs cherry pick healthy patients and lemon drop expensive, unhealthy ones. This is done through narrow coverage networks and poor access to specialized care , driving patients with heavy medical burdens into traditional Medicare – where they can choose their own providers.  A 2015 Brown University study  showed that  of Medicare Advantage patients who had long-term stays in nursing homes,  17% switched to traditional Medicare the next year. The report’s lead author, Momotazur Rahman, told NPR news that there are incentives, including “steep cost-sharing as patients need more expensive care” and “limitations on expensive treatments”,that because sick patients to drop out of Medicare Advantage plans. A 2017 Government Accountability Office (GAO) report found that of 126 Medicare Advantage plans, 35 plans saw disproportionally high numbers of sick enrollees dropping out into traditional Medicare.

In 2017, a Kaiser Family Foundation (KFF) study found one out of every three Americans enrolled in Medicare Advantage plans were given narrow physician networks. It concluded that plans offering broader networks tended to have much higher premiums than narrow-network plans. KFF also found that one out of every five plans do not include a regional academic medical center in their networks, and estimated that 40% of Medicare Advantage networks included top-quality cancer centers. 

The Medicare Advantage insurers can also increase their profits by upcoding the severity of the diseases that their patients have.  HMOs are paid per capita based on the number of patients they cover.  The payments are also risk adjusted according to the severity of the illnesses of those covered: the more severely ill, the higher the compensation. So it is to the Medicare Advantage plans’ advantage to upcode, to make patients seem sicker.   Investigations by the Center for Public Integrityand the work of academics show that there is both direct and indirect evidence of massive upcoding in Medicare Advantage, costing the government and taxpayers tens of billions of dollars.     

While Medicare Advantage is not an efficient or an equitable means of offering care to senior and disabled Americans, it’s important to look into some of the benefits that satisfied patients (who tend to be healthy) are grateful for. All of these benefits would be offered (and enhanced) through a national health insurance system like National Improved Medicare for All (NIMA).

NIMA would eliminate copays, narrow networks and provide long-term care, bringing both sick and healthy Americans into the same risk pool while extending that pool to include everyone. There is a growing consensus that Medicare Advantage, while masqueraded as offering better choices to patients about the type of care they receive, doesn’t extend those choices to sicker enrollees. 

Too often, privatization of essential public services is framed as an opportunity to offer better consumer choices and a reduction in costs. The irony of the relatively skimpy proposals put forth by the Campaign for Medicare Choices is that National Improved Medicare for All would actually give seniors and disabled Americans more choices than Medicare Advantage does, with the addition of long-term care, dental care and other essential medical services.

What is the Campaign for Medicare Choices fighting against? It’s not the movement for Medicare for All – yet. The real motivation is a very modest reduction in government subsidies for private Medicare Advantage plans, which are already inflated well above real costs to the point of making these insurance companies record profits. What this initiative is doing is picking up on the very real fears of Medicare coming under threat and redirecting it to protect corporate interests. Meanwhile, Republicans in Congress are pushing for substantial cuts to Medicare and Medicaid. As advocates for a system that provides healthcare as an essential human right, our attention is better focused on resisting this agenda and demanding National Improved Medicare for All.

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Statement on Health Bills in the 2018 Maryland Legislative Session

1. HEALTHY MARYLAND ACT (HB1516/SB1002) 

Introduced by Senator Paul Pinsky and Delegate Erek L. Barron.

Summary: This legislation seeks to expand health coverage to all Marylanders by obtaining waivers from the federal government and changes to federal laws. All state and federal healthcare dollars could then be  pooled into a single fund that would cover the healthcare needs of all Maryland residents..  New federal waivers and changes in federal law will be difficult to obtain and could have unintended consequences such as harming Medicare.

Position: Not endorsed/Not opposed. Healthcare is a Human Right Maryland supports attempts toward universal coverage at the state level. We recognize that due to federal barriers, a single payer healthcare system is most achievable at the national level.
 

2. SAFE CONSUMPTION SPACES (HB326/SB288)

Introduced by Senator Brian Feldman and Delegate Dan Morhaim.

Summary: This legislation authorizes the establishment of an Overdose and Infectious Disease Prevention Supervised Drug Consumption Facility Program by a community-based organization to provide a place for the consumption of pre-obtained drugs, provide sterile needles, administer first aid as needed, and provide certain other services.

Position: Support. The provision of safe and supervised space for drug consumption is an important step for reduction of harm to the individual user, including preventing death from overdose, and protects public health. It begins the process of treating drug consumption as a public health issue rather than a punitive approach. 

There will be a lobby day organized by the Baltimore Harm Reduction Coalition to advocate harm reduction policies on March 7, with buses traveling from Baltimore.
 

3. PROTECT MARYLAND HEALTH CARE ACT (SB1011/HB1167)

Introduced by Senator Brian Feldman and Delegate Joseline Pena-Melnyk.

Summary: Starting in 2020, Marylanders who are without health insurance will be assessed a penalty that will either be used to enroll the person in a ‘zero cost’ health insurance plan or held in escrow to be applied as a ‘down payment’ on health insurance during the next open enrollment period. If health insurance is not purchased, the penalty is forfeited.

Position: Oppose. Marylanders who cannot afford health insurance should not be penalized on top of being without health insurance. And Marylanders should not be forced to purchase cheap and shoddy private health insurance that requires high out-of-pocket spending before coverage is provided. Insurance mandates line the pockets of private health insurers that already have high cash reserves. Health Care is a Human Right Maryland supports a National Improved Medicare for All, as embodied in HR 676: The Expanded and Improved Medicare for All Act.


Millennials vs. The Mandate

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Shifting the blame away from greedy companies and our for-profit healthcare system onto young people living in economic insecurity isn’t going to win equitable healthcare for everyone.

This week, it is likely that more details will emerge about proposed state legislation to cement the Affordable Care Act’s mandate requirement. The law would impose penalties on Marylanders who do not purchase health insurance plans

At a time when it is clearer than ever that National Improved Medicare for All is the only viable solution to our healthcare crisis, the bill would also carry the message that Maryland Democrats are too cosy with the insurance industry. 

With many sources of healthcare funding under attack by the current presidential administration, proponents of the bill will argue that there’s no alternative: enforce the mandate or watch the healthcare marketplace fail. 

We are repeatedly told that the reason why our healthcare system isn’t working is because healthy young people aren’t buying insurance. In order to see savings in the future and to curb health care costs for everyone else, the argument goes, young people need to be nudged by the mandate to pay up.

The trouble with this argument is that the reason why millennials aren’t buying health insurance has nothing to do with selfishness and everything to do with economics. While wages have stagnated for decades, living costs have skyrocketed. In 2016, more young people lived with a parent than a spouse. In 1976, 14.7% of 18-34s were living with their parents. In 2016, the number was 22.9%. This is according to U.S. census data: a study by real estate company Trulia two years ago gave a much higher estimate of 40%.

Millennials are tired of being called selfish. We’re told that our inability to buy a house is because we are buying avocado toast - not because housing prices are up. We’re called lazy and unambitious at a time when the challenges of setting up a successful new business have never been so difficult. We’re criticized for favoring bike lanes and public transit over parking lots and sprawl at a time when spending almost $9,000 a year on a car just isn’t an option. 

At the same time, we hear stories about our parents, who paid their way through college by waitressing, who were able to buy houses, who had the security of being able to work for the same employer for decades. We are a generation that is being asked to pay more for less.

In the infancy of the new marketplace, it was hoped that premiums would be reasonably priced. That is not the case now, and with all but two insurers having pulled out of the MD Healthcare Connection, it is hardly a market at all. When your finances are scarce, none of the options given to you by the mandate look attractive. Do you spend $200 a month on a plan with a $5,000 deductible, $500 month on a platinum plan and stay with your parents another year, or do you pay $700 for no coverage at all? The mandate is supposed to lessen the imbalance between healthy and sick Americans paying into the system. In practice, it doesn't do much for low-to-middle income people ($25k-$50k annual income), who are more likely to pay the penalty than any other group. 

I don’t believe in the “baby boomers screwed millennials” narrative. But if the Democrats decide to pursue that as their political goal in 2018, it will exacerbate an "us vs. them" mentality between the two generations that has been very convenient for political elites and the owning class. And maybe that's the point of all of this. The legislation probably won't even help the Democrats. But it will definitely be beneficial for insurance and drug companies.

The paternalistic cry that "the least you can do to help everybody else is pay money that you don't have in order to not have insurance - or you're selfish and ungrateful" is, like, 2017. As it is for everyone else in this country, millennials deserve more than being forced to pay money for something that most developed nations provide as a human right. National Improved Medicare for All isn't a luxury - it's something we deserve as human beings. And if we can get some avocado toast along with it, that would be super cool.

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"Because we are citizens": Homeless Baltimoreans Speak on Healthcare Rights

KARINA

MY FRIEND OR LOVED ONE'S NAME IS

My grandmother

THIS IS WHAT HAPPENED TO MY LOVED ONE

Depending on the time of the year, her insurance will only pay a certain amount for her medication. Sometimes it will cost a couple thousand dollars per month.

WHEN I SAW MY LOVED ONE SUFFERING, I FELT

sad because she will suffer without her medication

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Nobody should be in pain when we can help it.

 

LEVITA

I AM FROM

Philadelphia

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

Sometimes I can't pay my copay, so sometimes I don't go to the doctor because of the copay

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

bad because they will be wondering why you took so long to go

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Everybody should be healthy and have healthcare

 

ANTOINETTE

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

I have been disabled since 2001. I am on Medicare and Medicaid. I have had the same fillings in since 1984 and they need to be replaced, but I can't afford it. My teeth are falling out.

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Everybody should have the right to their health.

 

JACKIE

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

In 1978, I got hurt and had to wait all day to be seen in the ER because I didn't have insurance.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

angry

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Whether you have insurance or not, people are obligated to treat you.

 

THOMAS

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

In 1975, I was shot by police during an armed robbery. Hospital staff were harassing me for the bill and started harassing my parents because they couldn't pay.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

Honestly, I didn't feel anything because I was in a really bad place at that time. But I still should have been treated differently.

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Nobody in regards to how they're living should be mistreated or stigmatized.

 

VIOLETTA

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

they don't have proper insurance or none at all

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

disrespected and I feel that the system does not work for me

HEALTHCARE IS A HUMAN RIGHT BECAUSE

we are citizens and as citizens it is a human right to have insurance

 

DEVON

MY FRIEND OR LOVED ONE'S NAME IS

Sue (my mother)

THIS IS WHAT HAPPENED TO MY LOVED ONE

My mother had Hepatitis C. This was a few years ago, before the new drugs were available. She got three months treatment of Infuron, which made her sick. After three months, her insurance wouldn't pay for it anymore. When the new treatments came out, it was too late - she had experienced hepatitic encephalopathy and liver failure. They refused to put her on transplant because they considered her an at-risk patient. She suffered the last year of her life in pain.

WHEN I SAW MY LOVED ONE SUFFERING, I FELT

Helpless and angry. When she died I was relieved because she was no longer in pain.

HEALTHCARE IS A HUMAN RIGHT BECAUSE

It is. And it should be free like in other countries.

 

MICHELLE

MY FRIEND OR LOVED ONE'S NAME IS

Gisella

THIS IS WHAT HAPPENED TO MY LOVED ONE

She was not able to get help when she really needed it.

WHEN I SAW MY LOVED ONE SUFFERING, I FELT

Sad, lonely and disappointed.

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Nobody should be in pain when we can help it.

 

OHU

I AM FROM

Lagos

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

When I do not have insurance

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

bad

HEALTHCARE IS A HUMAN RIGHT BECAUSE

It enables everyone to be healthy.

 

SIMONE

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

I've always known - there was that one time I got a really big bill from an ER visit

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

I felt so mad that I had to take a walk

HEALTHCARE IS A HUMAN RIGHT BECAUSE

The [the government] have got the money for everyone to have it!

 

TERRELL

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

 I went to the hospital with the flu. I had no insurance and was made to wait for hours while people with Blue Cross Blue Shield went straight through.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

disrespected and upset

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Everybody is human and it doesn't matter how much money you have

 

DAMIEN

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

I had low level Hepatitis C and my insurance wouldn't pay for the drug to treat it. I was able to get the drug by participating in a medical study.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

I was upset because I had insurance

HEALTHCARE IS A HUMAN RIGHT BECAUSE

we are already putting money into it

 

VANESSA

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

As I got older, I noticed a difference. There used to be more free stuff - dentists, glasses, etc. University of Maryland dental school used to provide free care. They don't now.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

Sad, hurt and angry

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Everybody should have the same care

 

CHARLES

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

I broke my left clavicle gwhen I was going to college. My mom's health insurance didn't cover it and I couldn't pay for it because I was attending college instead of working. They kept harassing her with bills she couldn't pay and it it went to a collection unit.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

I felt bad because it made credit score go down

HEALTHCARE IS A HUMAN RIGHT BECAUSE

At the end of the day, humans should care about one another.

 

URSULA

I AM FROM

Chicago

I FOUND MYSELF IN MEDICAL DEBT WHEN

I have been blessed to have insurance AND knowledge of how to care for myself

HAVING TO DEAL WITH MEDICAL DEBT MADE ME FEEL

incentive to learn acupuncture

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Every human being needs to have their health to live a healthy, successful, satisfying life.

 

PAMELA

I AM FROM

Baltimore

I LEARNED THAT THE HEALTHCARE SYSTEM TREATS PEOPLE LIKE ME DIFFERENTLY WHEN

A few months ago, a caseworker told me that in order to get insurance and housing I would have to drop my doctors for in-network providers. I did not want to drop my doctors, so I did not sign up for the insurance.

WHEN MY RIGHTS ARE DISRESPECTED, I FEEL

Annoyed. I wondered what was wrong. Pathetic.

HEALTHCARE IS A HUMAN RIGHT BECAUSE

Other countries are doing well with universal healthcare systems.


Call Senator Sanders: We need a Senate Companion to HR-676

At Healthcare is a Human Right Maryland, we are thrilled that Senator Bernie Sanders has promised a Medicare for All bill in the Senate. HCHR-MD urges Senator Sanders to pursue the strongest bill possible, as companion legislation to HR-676, National Improved Medicare for All. In addition, we urge Senator Sanders to act quickly in introducing this legislation, and to not delay while the Senate debates the inadequate AHCA.

We encourage our supporters to call Senator Sanders' office using the call-in tool below, or to sign this petition.


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