Journal of health politics, policy and law
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Donald Trump's rhetoric and leadership are destroying the "culture of community" necessary for progress on health equity. His one-line promises to provide "quality health care at a fraction of the cost" smack of neoliberal nostrums that shifted ever more costs onto patients, thereby preventing many people from getting care. The dangers of Trump go far beyond health policy, however; Trump's presidency threatens the political and cultural institutions that make any good policy possible.
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J Health Polit Policy Law · Oct 2017
How the ACA Addressed Health Equity and What Repeal Would Mean.
This commentary reviews the many different ways the Affordable Care Act (ACA) explicitly and implicitly attempted to improve health equity, and then assesses how the Republican proposal to repeal and replace the ACA (the proposed American Health Care Act) would impact efforts to improve health equity. Although the American health care system still had a long way to go to achieve health equity, it may be argued that the ACA was a major step forward in creating new programs and regulations that had the potential to improve health equity. In stark contrast, Trumpcare makes no mention of health equity as a goal and-if passed-would result in an increase in health inequity. It would shamefully represent the first time in modern US history that a major federal health reform bill would actually move us further away from creating more equal access to health care coverage and toward reduced health equity.
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This special issue of the Journal is devoted to understanding the many roads that lead toward achieving health equity. The eleven articles in the issue portray an America that is struggling with the clash between its historical ideal of pursuing equality for all and its ambivalence toward achieving equity in all social domains, especially health. Organized in five sections, the issue contains articles that examine and analyze: the role of civil rights law and the courts in shaping health equity; the political discourse that has framed our understanding of health equity; health policies that affect health equity, such as the Medicaid program, as well as related strategies that might help to improve equity, such as the use of mobile technologies to empower individuals; immigration policies and practices that impact health equity in marginalized populations; and commentaries in the final section that explore how the Affordable Care Act has addressed health equity, how repeal of the law would jeopardize equity gains, and how the political discourse and culture of the Trump administration could adversely affect health equity.
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J Health Polit Policy Law · Oct 2017
Viewing Health Equity through a Legal Lens: Title VI of the 1964 Civil Rights Act.
Enacted as part of the watershed Civil Rights Act of 1964, Title VI prohibits discrimination by federally assisted entities on the basis of race, color, or national origin. Indeed, the law is as broad as federal funding across the full range of programs and services that affect health. Over the years, governmental enforcement efforts have waxed and waned, and private litigants have confronted barriers to directly invoking its protections. ⋯ Enforcement efforts confront problems of proof, remedies whose effectiveness may be blunted by underlying residential segregation patterns, and a judiciary closed to legal challenges focusing on discriminatory impact rather than intentional discrimination. But Title VI enforcement has experienced a resurgence, with strategies that seek to use the law as a basic compliance tool across the range of federally assisted programs. This resurgence reflects an enduring commitment to more equitable outcomes in federally funded programs that bear directly on community health, and it stands as a testament to the vital importance of a legal framework designed to move the nation toward greater health equity.
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J Health Polit Policy Law · Oct 2017
Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens.
Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. ⋯ Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities.