The confluence of racial unrest and Medicaid expansion in Virginia should inspire a national reimagining of how health care can contribute to health equity. Hospitals in particular can leverage their role as economic drivers in communities to equalize health and social outcomes for all. The urgent need for innovative opioid intervention presents a fertile proving ground for new ways that hospitals can act to reduce the impact of racial inequity. Inspired by the role hospitals played to achieve desegregation during the Civil Rights era, this essay proposes an integrated approach to use Medicaid expansion to advance health and racial healing in America.
Get full access to this article
View all access options for this article.
References
1.
See, R. M.Nash, “Compliance of Hospitals and Health Agencies with Title VI of the Civil Rights Act,”American Journal of Public Health and the Nation’s Health58, no. 2 (1968): 246-251 (reporting hospital “freedom of choice” arguments and tactics employed to feign civil rights law compliance during HEW inspections only).
2.
G.E.Thomson, “Discrimination in Health Care,”Annals of Internal Medicine126, no. 11 (1997): 910-912.
3.
P.B.Cornely, “Trend in Racial Integration in Hospitals in the United States,”Journal of the National Medical Association49, no. 1 (1957): 8.
4.
P.P.Reynolds, “The Federal Government’s Use of Title VI and Medicare to Racially Integrate Hospitals in the United States, 1963 through 1967,”American Journal of Public Health87, no. 11 (1997): 1850-1858.
5.
Simkins v. Moses H. Cone Memorial Hospital, 323 F.2d. 959 (1963) For a full discussion of the case, see, D.B.Matthew, Just Medicine: A Cure for Racial Inequality in American Health Care (New York: NYU Press, 2015).
6.
P.P.Reynolds, “Hospitals and Civil Rights, 1945-1963: The Case of Simkins v Moses H. Cone Memorial Hospital,”Annals of Internal Medicine126, no. 11 (1997): 898-906.
7.
P.P.Reynolds, “Professional and Hospital Discrimination and the US Court of Appeals Fourth Circuit 1956–1967,”American Journal of Public Health94, no. 5 (2004): 710-720.
8.
R.M.Nash, “Compliance of Hospitals and Health Agencies with Title VI of the Civil Rights Act,”American Journal of Public Health and the Nation’s Health58, no. 2 (1968): 246-251. (By the close of 1966, 7,160 hospitals agreed to comply with the new federal law; 135 were the subject of administrative proceedings to seek compliance, and 215 of the nation’s hospitals decided to stop accepting federal funds rather than to admit non-white patients to their care.)
A.N.Ortegaet al., “Insurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act, but Latino Youth Still Lag Behind,”Academic Pediatrics18, no. 1 (2018):35-42.
Virginia Health Care Foundation Data, available at <https://www.vhcf.org/data/> (last visited October 31, 2018).
16.
United States Department of Labor, Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, available at <https://www.bls.gov/cps/cpsaat18.htm> (last visited October 31, 2018) (In 2017, hospitals employed more than 7 million people nationally.); see also, United States Department of Labor, Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, available at <https://www.bls.gov/cps/cpsaat18.htm> (last visited October 31, 2018)(They employ a significant portion of the population — more than 7 million people in 2017)
17.
Id (2016 hospitals purchased $852 billion in goods and services from other businesses.)
18.
P.Braveman and L.Gottlieb, “The Social Determinants of Health: It’s Time to Consider the Causes of the Causes,”Public Health Reports129, no. 1, suppl. 2 (2014): 19-31.
19.
Y.Laxet al., “Social Determinants of Health and Hospital Readmission,”Pediatrics140, no. 5 (2017):e20171427.
See, S.Butler and C.Diaz, “Hospitals and Schools as Hubs for Building Healthy Communities,”Economic Studies Report, Brookings Institution (November2016).
M.Hartmanet al., “National Health Care Spending in 2016: Spending and Enrollment Growth Slow After Initial Coverage Expansions,”Health Affairs37, no. 1 (2018):150-160.
Decreased growth in enrollments and reduced supplemental payments to hospitals also explain decreasing growth in per enrollee payments. See, Hartman, supra note 26, at 157.
31.
See, CMS Healthcare Cost Report Information System, FY2011-FY2015.
F.Blavin, “How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data,”Urban Institute U.S. Health Reform – Monitoring and Impact, available at <http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310> (last visited October 31, 2018). See also, F. Blavin, “Association Between the 2014 Medicaid Expansion and US Hospital Finances,” JAMA 316, no. 14 (2016): 1475-1483 (Between 2011 and 2014, hospitals in the 19 expansion states saw annual Medicaid revenues increase by $3.2 million, and uncompensated care decrease by $2.8 million per year on average).
See, e.g., A.Cohen, “How White Users Made Heroin a Public-Health Problem,”The Atlantic, August12, 2015; Here, in my view, is one of the most impactful: Brian Broome for Public-Source, “Amid the Opioid Epidemic, White Means Victim, Black Means Addict,” The Guardian, April 28, 2018, available at <https://www.theguardian.com/us-news/2018/apr/28/opioid-epidemic-selects-white-victim-black-addict> (last visited October 31, 2018); see also, Report of J. Fagan, in United States of America v Alfred Washington and John T. Hummons, No. 1-CR-632 (N.D. of Illinois, Eastern Division), available at <https://www.law.uchicago.edu/files/files/report_of_jeffrey_fagan.pdf> (last visited December 19, 2018).
K.Schorsch, “What it Costs Hospitals to Reverse an Opioid Overdose,”Modern Healthcare, February20, 2018.
41.
D.T.Courtwright, Dark Paradise: A History of Opioid Addiction in America (Cambridge, Massachusetts, and London, England: Harvard University Press, 2001).
A.Cooper and E. L.Smith, “Homicide Trends in the United States, 1980-2008” (November2011, NCJ 236018), available at <https://www.bjs.gov/content/pub/pdf/htus8008.pdf> (last visited October 31, 2018).
44.
In contrast, D. Courtwright’s work estimates the number and ratio of black and white heroin users in treatment peaked around 1970 when just under 6,000 whites and nearly 8,000 blacks entered treatment.
D.T.Courtwright, Dark Paradise – A History of Opiate Addiction in America (Harvard University Press, 2001).
47.
P.A.Langan, “Race of Prisoners Admitted to State and Federal Institutions 1926-1986,”U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, NCJ-125618 (May1991).
48.
S.Galea and D.Vlahov, “Social Determinants and the Health of Drug Users: Socioeconomic Status, Homelessness, and Incarceration,”Public Health Reports117, Suppl. 1 (2002): S135-S145.
49.
M.R.Betz and L.E.Jones, “Wage and Employment Growth in America’s Drug Epidemic: Is All Growth Created Equal?”Ohio State University’s Institute for Population Research (December15, 2017).
50.
See generally, id., Betz and Jones (Though the impact is concentrated at the low end of wage distributions and plays a larger role in non-metro counties.)
51.
Id., Betz and Jones.
52.
Diane Wescott, interview (1982).
53.
College Entrance Examination Board, “Equality and Excellence: The Educational Status of Black Americans” (New York, 1985).
54.
Id. College Board.
55.
J.B.Leitner, E.Hehman, O.Ayduk, and R.Mendoza-Denton, “Blacks’ Death Rate Due to Circulatory Diseases is Positively Related to Whites’ Explicit Racial Bias: A Nationwide Investigation Using Project Implicit,”Psychological Science27, no. 10 (2016): 1299-1311.
