The $1 Million Price Tag: Health Care Exclusion and Federal Policy

Health care in the U.S. is inundated with bureaucratic and administrative logjams and snafus, as well as intentional efforts to deny people the care they need. A recent article is illustrative of how myopic policies and procedures serve to deflect attention from core health care needs and further impede access to care in the U.S. According to an article by Scott Rothschild, posted on June 19, 2008, Kansas spent around $1 million dollars enforcing a federal mandate intended to prevent undocumented migrants from receiving Medicaid benefits through documentation requirements for eligibility. As a result, 20,000 eligible Kansans lost health insurance and only one undocumented person was identified during this state enactment of a 2006 ancillary federal directive.

Moreover, according to a 2007 report, from the Center on Budget and Policy Priorities, black children showed the greatest enrollment decline for benefits in Kansas during this enforcement period; hence, this measure is particularly problematic in terms of its pronounced effect on a specific racial/ethnic group. And, according to Unequal Health Outcomes in the United States, a 2008 report to the U.N. Committee on the Elimination of Racial Discrimination, “[r]ecent data shows that the new law actually has the biggest impact on poor U.S. citizens, especially African Americans. This group lacks documentation of their citizenship and the financial means to afford the application process.” This then illustrates how structural inequalities in our health care system (read the Kansas flub here) lead to racial and ethnic disparities in health outcomes in the U.S.

In the midst of renewed vigor in the debates regarding health care in the U.S., fuelled by primary races and caucuses over the past months, this story highlights the need to look beyond rhetoric and political smoke screens and demand true policy changes that will give all people access to their right to health care. We must stay focused and demand that our political leaders enact legislation that truly addresses the right to health care and universal access in the U.S. The citizenship documentation policy also highlights the readily accepted paradigm in the U.S. that it is legitimate to exclude people from access to health care, as this federal directive was attempting to do just that – and, unfortunately, succeeded in excluding hundreds of thousands of low-income people across the nation. Yet, a human right to health means that eligibility is not a consideration for accessing heath care. All people have the right to health care because they are human beings and not based on income or one’s documentation or status.

In essence, health care should neither be a privilege nor a commodity to be traded and regulated by private insurance companies. Moreover, it is not a system that we can afford to inundate with administrative mazes or xenophobic and racist mandates that not only fail do address the core issues in health care reform but, quite literally, further alienate people from access to care and grossly misappropriate funding. We all have a fundamental right to health care in the U.S.; and, we have the right to demand better of our federal government than a health care directive that intentionally seeks to exclude people from health care – for the price tag of $1 million in Kansas alone.