competition-cartoonFrom the New York Times:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Their analysis reveals that the 26 states that have rejected the expansion have several things in common:

1) The governors are members of the Republican party.

2) Although they are home to roughly half of the population, they are home to about 68% of America’s single mothers and poor, uninsured blacks.

3) About 60% of the working poor live in these states and will not be covered by Medicaid expansion.

4) In some other states, these folks would have potentially been covered by Medicaid without the expansion but in many of the opting-out states, the requirements are more stringent. For example, in Alabama  income at all disqualifies a family with no children. In other words, the working poor in Alabama are one 2 day hospital stay from bankruptcy without the expansion.

Although Alabama was not highlighted in the Times article (instead focusing on our neighbor to the west), our situation is very similar. Wilcox County (featured in this video) is located in the Black Belt region of Alabama and one of the 15 poorest counties in America. 49% of Wilcoxians live below the poverty line and the median household income is $21,000. There are 4 doctors in Wilcox County, or one for every 4500 people. The County happens to be 71% black.

Had the NYT bothered to Google, we Alabamians did some of the Times’ work for them in a 2010 report entitled Alabama Health Disparities Report,

From the report:

Rural Alabama has got problems when compared to urban Alabama:

  • Eight rural Alabama counties do not have hospitals.
  • Thirty five of 55 rural Alabama counties do not provide labor and delivery service.
  • The average time from call to arrival at the scene of an emergency for rural county emergency medical services is over 27 percent greater than the response in urban counties.
  • The motor vehicle accident mortality rate in 2005-2007 for rural Alabama residents was nearly 46 percent higher than that for urban county residents and was more than double the rate for the nation.
  • Hospitals in rural Alabama counties had 25.1 general hospital beds per 10,000 residents in 2009 compared to 45.0 general hospital beds per 10,000 residents in urban counties.
  • The potential number of patients for each rural Alabama dentist in 2007 was approximately 3,845 compared to 1,774 for those practicing in urban counties.

Black Alabama when compared to white Alabama has problems as well:

  • From 1997-2006, African American men (59.3 per 100,000) had a 14.7 percent higher colorectal cancer incidence rate than White men (51.7 per 100,000) and though both groups showed decreases, white deaths decreased much more than blacks from 2000 to 2008.
  • Nationally, Alabama has the fourth highest death rate from heart disease and the seventh highest from stroke. In 2008, CVD accounted for 25.4 percent of all deaths, down from 28.6 percent in 2002 with the rate in blacks 18% higher in 2000 and 24% higher in 2008 when compared to whites (despite smoking less)
  • For stroke in Alabama, in 2008, black males showed the highest stroke death rate of 58.0 per 100,000 population
  • The diabetes mortality rate for Whites was 25.4 per 100,000. The diabetes mortality rate for African Americans was approximately 43.3 per 100,000, 70 percent higher than the White rate. The prevalence of diabetes among African Americans is higher than the prevalence of diabetes among Whites within every age group.

The New York Times article goes on to speculate regarding the motives of the states who are choosing not to expand:

The disproportionate impact on poor blacks introduces the prickly issue of race into the already politically charged atmosphere around the health care law. Race was rarely, if ever, mentioned in the state-level debates about the Medicaid expansion. But the issue courses just below the surface, civil rights leaders say, pointing to the pattern of exclusion.

In a speech entitled The Enduring Causes of Poverty in the Black Belt, Andrew Zekeri points out that a large concentration of already poor African Americans, many living in families headed by a single female, a lack of existing educational and health care infrastructure, and a global market that is unforgiving have combined to create a region that is noteworthy for enduring poverty.

The Medicaid expansion found in the Affordable Care Act offers a way out of poverty folks in this region. By giving coverage to the 15% uninsured, it provides revenue for hospitals and doctors caring for the folks when they get sick anyway. Access to health care PRIOR to conception predicts healthy pregnancy outcome and helps women avoid unplanned pregnancies. Creating a health care revenue stream allows for the stabilization of the health care infrastructure. Lastly, the global marketplace (“Job Creators”) will not locate in areas lacking health care infrastructure.

Looking at the New York Times map of the census tracts that would benefit the most from the Medicaid expansion, it seems to overlay pretty well with the poor counties found in our Black Belt. Although only 13% of Alabama’s population, it is the home to 307,000 blacks. or about 30% of the state’s African American population. What an opportunity our Governor has to show that this isn’t about race.

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