In 1964, President Lyndon Johnson laid out a broad social agenda – including both Medicare and Medicaid – in the state of the union address:
“The program I shall propose will emphasize this cooperative approach to help that one-fifth of all American families with incomes too small to even meet their basic needs.
Our chief weapons in a more pinpointed attack will be better schools, and better health, and better homes, and better training, and better job opportunities to help more Americans, especially young Americans, escape from squalor and misery and unemployment rolls where other citizens help to carry them.
Very often a lack of jobs and money is not the cause of poverty, but the symptom. The cause may lie deeper — in our failure to give our fellow citizens a fair chance to develop their own capacities, in a lack of education and training, in a lack of medical care and housing, in a lack of decent communities in which to live and bring up their children.”
Recent reports indicate that income inequality in the United States has been growing for several decades and, in 2012, reached the highest level since 1927. At a time when the Affordable Care Act expands opportunities for health insurance to many low income Americans, what challenges does this increasing income inequality create for improving health and health equity in the U.S.?
[ These comments appear courtesy the Health Policy Leadership Fellows at the Satcher Health Leadership Institute (SHLI) at the Morehouse School of Medicine. , a Policy Prescriptions ® contributor, is a former SHLI fellow and recently served as the interim associate director of the fellowship program. The best discussion points put forth will be featured on our site. ]
From LBJ to ACA, poverty is at the root of the problem
Posted by Tee Gee Wilson, MD
“Doctors are the natural advocates of the poor, and social problems are largely within their jurisdiction.” – R. Virchow
I wholeheartedly agree with Dr. Virchow’s maxim and I am alarmed that, just in my lifetime, the gulf between the US rich and the US poor has grown
to reach a severity not seen since the days of the French Revolution. Of course in Marie Antoinette’s time, this poverty chasm meant crushing
starvation for the poor which led to a bloody national uprising. The French Revolution connected directly to the formation of a brand-new egalitarian
democracy known as the United States. The state of things in today’s US economy and politics is therefore bitterly ironic. Unfortunately, the poor in
this country cannot eat irony, nor be healed by it.
The Affordable Care Act is a long overdue but welcome band-aide to our cancer of social inequity. Alone, it can’t do much. We must continue to empirically identify the social determinants of disease and stamp them out one by one.
Affordable Care Act Gaps
Posted by Vatrice Perrin, JD, MPH, CPH
Medicaid expansion and health insurance subsidies will provide greater access to health insurance for those who cannot afford to buy mandated coverage. However, unless there are policies addressing a livable wage, job quality or affordable childcare, etc., the Affordable Care Act (ACA) will not level rising health inequities. Insurance premiums and quality vary from state to state in the health care exchanges. Under the ACA, families and individuals will qualify for subsidies to assist in the payment of coverage. In some cases the premium will be totally subsidized, in others the subsidies will reduce the premiums.
There are many who cannot afford to pay rent or buy food; payment for health insurance premiums will be last on the list. Additionally, being insured does not always manifest as adequate coverage. There appears to be a lack of uniformity and gaps in the law and its coverage. The ACA is a beginning, not an end to health inequities. Other social and infrastructure problems must also be addressed.