The following is excerpted from remarks that John Lumpkin, M.D., M.P.H., delivered at the National Association of Black Journalists (NABJ) Annual Convention in Philadelphia on August 6, 2011.
It’s wonderful to be here and have the opportunity to partner with NABJ. Our mission at the Robert Wood Johnson Foundation is to improve the health and health care for all Americans. By Americans we mean everyone who lives within the United States.
Health insurance is important, and today you’ve heard some stories about how important it is. At the Robert Wood Johnson Foundation, we not only tell the stories but we also try to back them up with data. For instance, there’s a study done in Oregon that came out about two weeks ago. This was a natural experiment because this is the kind of experiment that you can’t do in a medical center. Oregon wanted to increase coverage, but the state only had enough money for about 10,000 people. So officials said, “Please apply for Medicaid.” About 90,000 people applied. They did a lottery, and 10,000 were selected.
We were able to fund, along with others, a study that looked at what happened to the health of the people who were the 10,000 who got Medicaid and the 80,000 who didn’t, and we were able to follow them. What we found was that people who got Medicaid had significantly better utilization, particularly with preventive services. They had less money being spent out of their pocket for their health care services, and they were in better physical and mental health at the end of the study period.
Health insurance is very critical to people’s health, and [as one of the panelists] noted, we shouldn’t be referring to the Affordable Care Act as Obama Care. I’m actually going to call it My Care. The reason is because this law—even though I do have a job and I do have insurance—is significantly important to my family.
My son just finished college at the age of 24. He’s decided that, even though he has a degree in economics, he wants to go into music. He would have no health insurance without the Affordable Care Act, but the fact that the act says that insurers have to offer [adult children] insurance through their parents’ employers up until the age of 26 means that he’s good. And that gets him up pretty close to 2014.
And what happens in 2014? If he still decides he’s going to do his music gig, he’s not going to be able to get any employer-based insurance. But my son, unfortunately, has a kidney problem. In the world before the Affordable Care Act, he would not be able to buy health insurance in the individual market. Come 2014, he’ll be able to.
We need to remember what it was that led people to say that we need to reform the health care system—the kinds of insurance practices where people with pre-existing conditions were denied insurance. We heard about lifetime limits, about annual limits, about the fact that people had health insurance, but when they got sick, they weren’t able to renew their health insurance. People would have health insurance, and then the insurance companies would look back and say, “Well, now that you’ve submitted the claim for $50,000, we realize that you actually missed a statement on your application, so we’re going to deny your insurance retroactively.” Rescissions. All of these are banned by the Affordable Care Act.
In order for these reforms in how health insurance behaves to be implemented, other changes had to happen. If you have to issue insurance as an insurance company, people who have to come into this market are going to say, “I’m not exactly dumb. Why don’t I just wait until I’m sick to buy insurance?” And if only the people who are sick are in the market, insurance premiums will go sky high, and no one will be able to afford insurance. So insurance only works if everybody buys in, and that’s the reason why there is an individual mandate in the Affordable Care Act.
One of the studies that we funded through the Urban Institute, Health Reform: The Cost of Failure, where they do this micro-simulation model, shows that, with the individual mandate, there will be a 50 percent reduction in the numbers of the uninsured. If you don’t do an individual mandate, that reduction is only 20 percent.
Yet once we have an individual mandate, we have to recognize that not everybody can afford insurance. Just a couple days ago I heard a news reporter say, “If people can afford to get Starbuck lattes for $5, then they can afford to buy health insurance.” As you all know, and you don’t have to go very far from this convention hall to find them, there are a lot of people who can’t afford a latte every day at Starbucks. So, the Affordable Care Act provides a subsidy so people up to 400 percent of poverty will be able to afford health insurance.
Let me end by talking about “the goodies” that are associated with the bill. I would recommend that you as reporters look very closely at what happens to these little goodies because they specifically address the needs of minority communities and African-Americans.
There are requirements in the bill to address health disparities through Medicaid and a children’s health insurance program. The Minority Health Office of the Department of Health and Human Services will now report directly to the secretary. There’s a national health care strategy that includes as one of its four pillars addressing disparities in health care related to minorities. There are training provisions to increase the number of primary care providers.
But key is that the ACA provides funds to increase the number of minorities in the health care professions. All of these components are at risk of not being funded, and we would go from what could be a law that would have a dramatic impact upon African-Americans and other minorities [to one] that doesn’t really address the disparities we have in our society.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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