January 2019 Newsletter

There’s something magical about the first snowstorm of a new year. Outside, the elements can be dangerous – and time seems to stand still. But underneath the blanket of snow covering the earth, billions of microorganisms cultivate and regenerate the soil in preparation for spring. Thanks to the tireless efforts of activists across the country, our grassroots movement enters into 2019 boosted by strong popular support for Medicare for All.

Campaign Updates

Image: Reverend Annie Chambers (red hat) serves cake at the December HCHRMD in Douglass Homes

I’m very excited to announce the creation of our newest Healthcare is a Human Right Chapter, in Baltimore’s Douglass Homes community. Douglass Homes has been holding meetings over the last few months. They’ve got ambitious plans to fight for healthcare equality in 2019. Residents view health justice as a wide umbrella that includes a right to healthy homes, equal treatment in the emergency rooms, dental and vision care, support for mothers and babies – and so much more.

Our chapters across the state are entering into the new year with a bang, sending delegations to educate our Representatives in Congress on behalf of Marylanders who are ready for Medicare for All. We’re also gearing up for a new petition drive in February, working with the Greater Baltimore DSA, Our Revolution and National Nurses United to coordinate a series of canvassing trainings around February 9-13.

All of our work is member-driven. We rely on individual donations – even as low as a few dollars a month – to sustain our work. Your contribution goes directly towards meeting with congressional leaders in support of National Improved Medicare for All, towards educating Marylanders about single payer and training new leaders, and towards the growth of new initiatives like Douglass Homes.

All contributions are tax-deductible.  You can make a one-time donation or sign up as a monthly sustainer by clicking here. We accept credit cards and check payments.  We are grateful for your support!

Upcoming Meetings and Events

All Healthcare is a Human Right and Healthcare Now events are hosted at accessible locations unless noted otherwise.

Baltimore Healthcare Now Meeting
Thursday, January 17, 7:15 PM
Baltimore Episcopal Diocese, at the intersection of N Charles & University Parkway

March with us in the Martin Luther King Jr. Parade!
Monday, January 21, 11:30 AM
Meet at the intersection of Dolphin & Eutaw. Dress warmly!

Medicare for All Week of Action, February 9-13

Baltimore Barnstorm
Saturday, February 9 2:00 PM – 3:30 PM
First Unitarian Church Hall
1 W Hamilton Street (at N Charles), Baltimore, MD 21201

Join Healthcare Now, the Baltimore DSA and Healthcare is a Human Right for a local barnstorming event in conjunction with a national campaign organized by National Nurses United, Healthcare Now, and other national organizations, to generate support for HR-676, National Improved Medicare for All, single-payer healthcare. 

The barnstorming is a special organizer training and strategy summit to kick off a week or two of focused canvassing to mobilize support for Medicare for All in the Baltimore area, targeting the districts of Congressmen Dutch Ruppersberger (2nd), John Sarbanes (3rd), and Elijah Cummings (7th). Don’t worry if you've never canvassed before - we’ve got you covered! 

We will have a kid’s table and refreshments on site. Venue is accessible through a side door.

Columbia Barnstorm
Monday, February 11, 7:00 PM
Oakland Mills Meeting House
5885 Robert Oliver Pl, Columbia, MD 21044

Howard County Meeting
Tuesday, February 12, 7pm
6163 Devon Drive, Columbia, MD 21044
contact: hchrmaryland@gmail.com

Carroll County Meeting
Thursday, February 14, 7pm
Westminster Library small meeting room

Support Healthcare is a Human Right at Tino’s Bistro
8775 Centre Park Drive, Columbia, MD 21045
Reservations: 410-730-8466

10% of all food sales will go towards HCHR-MD.

Harm Reduction Advocacy Day
Tuesday, February 26, 9AM-4PM
Annapolis, MD

Join Baltimore Harm Reduction Coalition and Healthcare is a Human Right Maryland for the second annual Harm Reduction Advocacy Day! Transportation options will be available. A light breakfast and full lunch will be provided. The day will consist of an advocacy training, meetings with legislators and a rally. Contact Tricia at bhrcpolicy@gmail.comwith questions.

News Roundup

Prescription Drug Prices

An in-depth report by Bloomberg estimated that Pharmacy Benefits Managers (PBMs) have driven up prices for prescription drugs for the consumer - and made billions off of Medicaid prescriptions alone in just one year.

Closer to home, North Baltimore’s Tuxedo Pharmacy announced its closure. Owners Harold and Arnold Davidov told reporters that PBMs were reimbursing them below the cost of prescriptions, forcing them to go out of business after 82 years of service.

Writing for the Washington Post Magazine, Tiffany Stanley examined insulin rationing by diabetics, focusing on the tragic death of 26 year-old Alec Raeshawn Smith and his family’s quest to hold drug manufacturers accountable for unaffordable insulin prices. Meanwhile, NBC News reported on a mother in Wisconsin who has been forced by the government shutdown to ration her insulin.

2019 Congress

For the first time in its history, the House of Representatives will hold hearings on Medicare for All. But first, the bill will be reintroduced in the new Congress. It is expected that Pramila Jayapal (D-WA) will release a new bill soon.

Speaker of the House Nancy Pelosi has also consented to hearings for a Medicare Expansion bill. Here’s our analysis on why the buy-in would be a setback for uninsured young people and a barrier against universal healthcare.

Medicare for All

Healthcare is a Human Right Maryland co-founder Dr. Margaret Flowers appeared on KAWL radio to answer questions about how Medicare for All will work.

But how will we pay for it? Jacobin posed questions about the financing of single payer to Robert Pollin of the University of Massachusetts. Coming from a different angle, Eric Levitz unpacked the role of fact-checkers in the media.

Support Healthcare is a Human Right Maryland

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.

6 Reasons Why a Medicare Buy-In Won't Benefit Young People

What is the buy-in?

The Medicare buy-in is one of many “moderate” alternatives to Medicare for All proposed by centrist House Democrats that offer no solutions for millennials. Led by Rep. Brian Higgins (D-NY), the legislation would allow people between the ages of 50 and 65 to buy into Medicare plans through state health exchanges. According to The Hill, Higgins won the support of Nancy Pelosi in prioritizing the bill in 2019 in exchange for supporting her bid to become the next Speaker of the House.

Higgins’ buy-in plan is yet another version of the public option, which has been floated as a more market-friendly alternative to Medicare for All for decades.  While popular with industry-friendly politicians, research into the likely outcomes of a Public Option – including a Congressional Budget Office scoring of a more expansive proposal floated in 2013 – shows that it would prove useless in reducing uninsurance and underinsurance.

Higgins and his supporters will tell us that the buy-in is “a step to Medicare for All”, that if young people accept it and wait a few more years, we’ll get guaranteed healthcare. But the buy-in does absolutely nothing for young people who are struggling to survive now – and it will only serve to divide us and distract us away from demanding what is owed to us as a basic human right. 

1. The buy-in reveals a lack of loyalty to the young people who built “The Blue Wave”

Medicare buy-ins, Medicare expansions, Medicare being allowed to negotiate prescription prices – these are the primary health policy goals of the DNC at present. Most of them exclude millennials – and a larger public option (Medicare or Medicaid buy-in) would still require us to be able to afford to pay for a premium.

Any healthcare policy that the Democrats choose to pursue must include us. And these promises have to be more ambitious than the ACA. Too often, Medicare for All is dismissed as an idealistic goal. But young idealists have already shown tremendous leadership in resisting Trump’s destructive agenda, in knocking on doors for candidates, in having those difficult political discussions with our parents.

The “Blue Wave” wouldn’t have happened without this idealism. Young people traditionally have a lower turnout in midterms. But in 2018, the youth vote was three times its size in 2014, with 67% voting democrat. It is not naïve for young people to expect more from politicians. They work for us – not the other way around.

2. We want Medicare for All – not Medicare for Some.

69% of millennials and 72% of 18-21 year-olds favor Medicare for All. We’re pretty vocal about it, too.

Young people today are in a worse economic situation than was faced by our parents or grandparents. Two thirds of us between the ages of 21 and 32 have zero retirement savings. The costs of food, housing, utilities, fuel and healthcare have gone up, while wages have stagnated for decades. We are less likely to own a house or have kids because we can’t afford it.

Good jobs with healthcare benefits are increasingly sparse. The situation is most difficult for women of color in full time low wage work, who are more likely to be uninsured or dependent on a partner for healthcare. 41% of all women under 25 are dependent on a partner or parent for healthcare. And with nearly a quarter of all women relying on a spouse for insurance, it forms a substantial barrier that prevents women and their children from leaving abusive relationships.

All economic indicators point towards an increase in automation and the expansion of low-wage service work. The unemployment rate may have improved, but with the rise of contractual and temporary work in skilled professions, these problems aren’t going away.

In addition to these economic challenges, our generation faces new, climate-induced health risks, from the Zika virus to asthma attacks caused by raging forest fires. A vast body of disaster management research shows that universal healthcare systems (without fees, co-payments or deductibles) are necessary to sustain a population through major disasters like floods and hurricanes.

Single payer won’t fix our economic woes – but it will ease the disproportionate burden that young people face. 

3. The Medicare buy-in is a government handout to the insurance industry.

Medicare works because everyone is automatically enrolled as soon as they qualify. The administrative costs of running payments, processing applications and uploading new people into the system will compromise these savings.

As for the buy-in, only states with health exchanges will be able to offer it. Undocumented immigrants will not be able to purchase a plan – in contrast to Medicare for All, which would cover everyone living in the US.

And here’s a crucial thing for young people to know about the way that Medicare is run today: a third of Medicare enrollees have purchased private “Medicare Advantage” plans, administered by insurance companies who make sizeable profits off of government money. Medicare Advantage is attracting huge investments from venture capital firms, with investor websites advising people that buying stocks in these new companies will offer guaranteed high returns. But to the taxpayer, it’s a rip-off.

Previous versions of the Medicare buy-in (the new bill hasn’t been released) stipulated that insurance companies will administer the new plans on the exchange. If there’s no evidence that a public option can work, and if even just a fraction of the buy-in customers are expected to use private plans – that means that the main purpose of the policy is first to line the pockets of the insurance companies – not to get healthcare to the people who need it most.

National Improved Medicare for All would eliminate the insurance industry. It’s the only way to reduce costs so that we can create a federally-financed system. No plan that encourages the expansion of Medicare Advantage can be compatible with Medicare for All.

4. Any plan to bring down costs has to include us. 

When healthy people (and younger people tend to be healthier) buy insurance, it lowers costs for everyone. Democrats know this. For years, the shortcomings of the ACA were blamed on young people who didn’t buy plans.

The health exchanges have brought healthcare coverage to many people who need it – and those of us who have been able to afford it are grateful for the extra opportunity. But high premiums, high deductibles and high copayments have meant a sicker risk pool (i.e., people who expect to spend thousands on healthcare costs are more likely to buy them).

The only way to drive down the costs of healthcare is to put everyone into the same pool – and the experience of the ACA shows that incentives and subsidies and even tax penalties can’t force healthy young people living in economic precarity to buy healthcare.

As an expansion of a public social program into a privatized marketplace with even more limitations than the ACA, the Medicare buy-in risks yet another step towards the overall privatization of Medicare, compromising the very structure that has made the Medicare program so successful.

5. It wouldn’t have helped the people who died from rationing insulin.

Alec Raeshawn Smith(26). Antavia Lee Worsham(22). Shalynne Vilela(22). Just a few names of young people who have died in the last two years because of insulin rationing. More and more patients are dangerously spreading out doses in order to save money. A cartel agreement between the producers of insulin – a drug that costs little to manufacture – has engineered massive price hikes for the consumer.

In the richest country on the planet, it is barbaric and unacceptable that these deaths happened. Any politician proposing an alternative to Medicare for All must be asked this: would it have saved them? The Medicare buy-in wouldn’t, and most of the drug price proposals from Democrats wouldn’t, either – except for Medicare for All.

6. A healthcare policy that doesn’t help young people is austerity under a different name.

Most often, austerity is a decision of a government to cut public services in response to an economic crisis. And while a buy-in isn’t a cut, it follows the same logic used by pro-austerity governments to justify citizens as lazy or undeserving of government support.

Centrist Democrats love to tell us that they think healthcare is a human right. This bill doesn’t match that declaration. Instead, it conveys the message that only people who have earned the right to healthcare through decades of supposed participation in the workforce can have it – if they are ready to pay for it.  Never mind that we work longer hours and face higher living costs than our parents did. Never mind that with climate change running out of control, we (and our children) will endure more risks to our physical and financial security.

There are many reasons why a Medicare buy-in, despite what its proponents say, is not a bridge to Medicare for All. The buy-in encourages the assumption that some people are more deserving than others when it comes to the provision of a basic human right. No healthcare policy that divides people into categories of moral worthiness in this way can contribute productively to a policy that requires a national mood of solidarity and mutual interest.

“Everybody in, nobody out” is a mantra that millennials feel more than any other generation. Considering that we hold the keys to the future, politicians would do well to listen to us.

This International Drug User Day, it's time to #ReframeTheBlame

Today, November 1, marks International Drug User Day, a moment which seeks to #ReframeTheBlame, to restore the dignity and humanity to people who use drugs and the families who love them. A large body of policy research makes it clear that addiction is a disease, not a sign of moral failure, and that it should be approached with public policy solutions just as we must do for cancer, HIV, or Hepatitis.

As I write this today, I think of people from the rural town I grew up in who are no longer alive. Their memory has been clouded by the shame that would accompany any acknowledgement of drug use, an overdose, or the ways in which stigma and social isolation form a barrier between disease and treatment. 

I went back to Easton this spring to speak at an event about the opiates crisis, and brought friends from the Baltimore Harm Reduction Coalition (BHRC) and Bmore Power to speak about policies that seek to meet drug users “where they’re at”. Harm Reduction policies begin with the administration of Naloxone and the use of clean needle exchanges, both of which have been implemented in Maryland. 

This past legislative session, Healthcare is a Human Right supported a bill that would expand on these policies with the creation of Safer Consumption Spaces (SCS) in Maryland. A SCS operates as a clinic where people can access treatment services and safely use drugs under the supervision of medical professionals who can intervene in the event of an overdose.

The Safer Consumption Spaces bill did not make it past committee this last session, and a new, statewide network has been created to connect Baltimore-area activists with allies in rural counties. Deaths from overdoses are not new to Baltimore, nor are they new to Easton, where the effects of systemic poverty and racism across multiple generations cut just as sharply - albeit at a much smaller scale. Many in the room at the event I attended a few months ago acknowledged that overdose deaths had only become a political issue in Talbot County because of the spike in deaths among white people.

This acknowledgment, and the growing awareness of rural Marylanders that the War on Drugs affects them too, holds the potential to build new alliances and to shift policy away from the criminalization of drug use. But to get there, white Marylanders who come from rural counties must come to terms with the racist origins of these failed policies, which have more to do with controlling and hiding people from view than connecting them to treatment.

With medical consensus showing that opiate addiction is a public health crisis which cannot be resolved through the criminal justice system, one would think that policymakers would be looking into alternatives to criminalization. Unfortunately, this is not the case.

Across the US, police are using drug-induced homicide laws to charge friends and family members of people who are dying with second-degree murder. Under these laws, the person who delivers a drug involved in a fatal overdose is guilty of a crime. This strategy isn't favored because it will actually save lives or steer people towards treatment. Many of the laws go back to the 1980s and have not been utilized until now. They have regained popularity so that our elected officials can look like they’re actually doing something. But an overdose death is not murder, and drug-induced homicide laws are counterproductive and inhumane.

The momentum behind criminalization goes beyond the War on Drugs. It is part of an ideology that justifies the immiseration of millions of poor, sick and dying people in the US and categorizes them as disposable because their humanity is a thorn to the interests of a for-profit healthcare system. 

In a country where it is easier for many to buy drugs than a cancer screening, why do we continue to lock people up for using? It is time to take the criminal justice system out of the equation, and to work with people who use drugs to create and implement new policy strategies that show respect to human life - and the human right to healthcare.

In Maryland, access to treatment for people with substance use disorders (drugs and alcohol) remains poor. Often, it is tied to the criminal justice system. Back in Talbot County, the local government has made the St. Michaels police station a designated go-to space for people seeking intervention. It's hard to imagine a more inappropriate location. 

As it turns out, access to comprehensive medical care - especially mental health services for children and adults with PTSD - is an essential part of a preventative approach. For this, we need a universal healthcare system. We need National Improved Medicare for All.

Confronting Racism in Healthcare

On Tuesday, September 25, Healthcare is a Human Right Maryland hosted a special screening of the PBS documentary Power to Heal, which tells the story of how civil rights activists used the implementation of the Civil Rights Act of 1964 and Medicare to desegregate thousands of hospitals. The event was a success, selling out days in advance and generating much-needed discussion about race and healthcare in Baltimore City.

At a time when people in the United States feel pressured to look for exceptional political leaders to guide voters towards progressive change, Power to Heal reminds us that social movements provide the real leadership.  It’s important to take a moment to appreciate the magnitude of the victory that was won by the activists who worked together to push through the healthcare reforms of the civil rights era.  The success of their efforts should serve as an example for us to keep up the struggle for National Improved Medicare for All. 

Whose victory?

Dr. Karen Kruse Thomas, author of Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954, specializes in the history of racial health disparities in the 20thcentury. She worked as a researcher and interviewer on the film and attended the screening as a panelist. Her opening remarks drew attention to the centrality of Black advocacy organizations in the formation of Medicare, a history that stretched back to well before Johnson entered office:

“All the major Black organizations lined up and testified in Congress on behalf of the Truman Health plan, which included national health insurance”. It was because of a shared interest in universal healthcare that Truman was the first president to address the NAACP. US involvement in World War II had already created an incentive to implement a national healthcare program.

At the same time that Truman was lobbying for a national insurance system, the British National Health Service was created. This year marked the 70thanniversary of the NHS and has brought much media attention to the role of Clement Atlee’s leadership as Prime Minister. But the momentum that created the NHS came from returning servicemen and a population devastated by war who demanded healthcare as a human right. Truman felt similar pressure, a tension that increased through the presidency of John F. Kennedy and into Johnson’s term.

“Healthcare was a unique part of the civil rights movement because there was white self-interest in healthcare when there wasn’t in anything else,” Dr. Thomas remarked. The mutual interest of both white and African American citizens in healthcare was the glue that brought the Johnson administration and grassroots activists together.

Black leadership in movements for health justice

If Power to Heal has a villain, it must be the American Medical Association, which first lobbied against Truman’s national health plan as “socialized medicine” and hired then-actor Ronald Reagan in 1961 to record an album attacking Medicare as a precursor to “a socialist dictatorship.” The AMA also supported hospital segregation and was a frequent target of protests during the civil rights era.

The National Medical Association, founded and run by Black doctors barred from the AMA, was a key advocate for Medicare. To this day, the NMA remains committed to a single payer program. This underscores one of the most important takeaways from the film: that we must take time to learn from the stories of the people who started this fight. We shouldn’t be surprised that the AMA still refuses to support single payer in spite of its current popularity among doctors.

Civil rights activists’ involvement in healthcare didn’t end in 1966. The influence of the community clinics created and run by the Black Panther Party, for example, is very much alive in the present. In Baltimore City, grassroots and peer-driven advocacy work towards harm reduction combine a historical perspective of the racialized origins and impact of the War on Drugs with the urgency of saving lives now.

Our second panelist at the event, Marvin “Doc” Cheatham, brought the discussion to the topic of health injustice in Baltimore. Cheatham is the former head of the Baltimore NAACP and now organizes with the Green Party. “Since 1975”, he told the audience, “minority health status has steadily eroded and there have been no significant improvements in the removal of barriers that are due to institutional racism”. Reports issued by Baltimore City and the Johns Hopkins Hospital in 2008, 2011 and 2017 “clearly documented significant and continued health disparities in many communities”.

Cheatham introduced a theme that was repeated during the panel discussion and in the audience comments that followed: community health goes beyond the need for good medical care. As an example, he cited food deserts—neighborhoods that lack easy access to fresh, nutritional food—as a significant barrier to improving health outcomes in Baltimore City. The problem of food deserts has gained increasing recognition, thanks to the work of grass-roots community activists.

Dr. Richard Bruno, our final speaker, is a family physician who lives and practices in Baltimore City. He reminded the audience of the lead paint epidemic affecting thousands of poor Black children in Baltimore, of asbestos in schools, of a city government that has not prioritized the lives of Black youth. Even now, Bruno said, a landlord can still get away with renting a property that is contaminated with lead paint.   

Moving into the discussion, audience members brought up a number of problems that single payer alone won’t fix. One attendee talked about the demonstrated impacts of the stress and trauma of living in a racist society on Black people in the US. Audience members also highlighted the need for more and better recreation facilities and services for city youth. All of these issues affect the health of city residents.

Michael Coleman of United Workers brought up housing injustice and the efforts to push the City to fund community land trusts. A year or two ago, I attended the launch for the campaign, where I watched Mayor Pugh promise to give funding to this project in front of a large public assembly – a promise that she neglected until pressure from the housing rights movement ensured her renewed support.

In regards to building a national health insurance system, the audience wanted to know more about ways to work for results now, in addition to pressuring legislators to sign on to HR-676. How can social work students, who know that they face high levels of burnout in the field, stay hopeful? Dr. Bruno answered that keeping conversations going about single payer and educating fellow healthcare providers is critical.

Medicare for All and Health Inequality

“Single payer healthcare has the potential to address poverty, inequality, discrimination and provide a more efficient and effective healthcare system for everyone. I can’t think of another reform that can do so many things at once,” Dr. Thomas remarked. She noted that this issue has the potential to bring together groups and interests that often diverge. Many people from different communities and political perspectives feel that they have been wronged by our current healthcare system.

Our movement must continue to show up for racial justice in housing, in education, in food and nutrition. Working together, we can be stronger than any powerholders who stand in the way.

Healthcare is a Human Right Maryland has copies of Power to Heal for in-home use and we are working with local groups across the state to arrange screenings of the film. If you would like to purchase a copy of the film or arrange a showing in your community, please contact me at brittany@hchrmd.org.

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






FF Revenue






GF Expenditure






FF Expenditure






Net Effect






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.

Talbot Co. Dept. of Parks and Recreation (Chesapeake Room), 10028 Ocean Gateway

Maryland Health Benefit Exchange, 750 E. Pratt St, 6th Floor

Frederick County Local Health Dept, 350 Montevue Lane

Charles County Local Health Department, 4545 Crain Highway

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











“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

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


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.



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


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.