Health care in flux

For decades, Americans have been worried about their health care: Are they going to be covered? How expensive will their prescription drugs be and how much will their overall costs rise? What happens if their child has a preexisting condition? This was especially acute for the Black and brown communities across the country.

Historically, Black Americans have largely been shut out of America’s health care system, first as patients, then as professionals. This was due in large part to a variety of long-standing institutional and systematic bigotry that has taken place over many years. People of color still feel the stigma and suffer consequential results due to their history. Forced sterilization of women (North Carolina Sterilization law of 1960), withholding of medical attention (Tuskegee Syphillus Study) and outright segregation limiting access to proper care.

Decades later, under President Barack Obama, the Affordable Health Care Act (ACA) was signed into law and by 2016, most of its provisions had been implemented. Before that time many people were not covered because of the high cost of insurance and exclusions based on preexisting health conditions. A key goal of the ACA was to expand health insurance coverage. One of the ways this was done was to expand Medicaid to Americans with incomes of $15,060 or less, the base of the United States poverty level. New healthcare exchange markets were created where individuals and small businesses could purchase coverage and receive financial assistance to afford premiums and cost-sharing. Before the law, about 15% of the U.S. population was not covered at all and by 2023, that number had dropped to lower than 8% according to the Kaiser Family Foundation. The Biden administration’s Inflation Reduction Act further enhanced these measures by controlling drug costs for seniors and allowing Medicare to negotiate lower costs for these same medicines. Further, the IRA capped out of pocket spending for drugs by seniors at $2,000/year as well as curbing insulin prices to $35/month. These initiatives helped Americans live normal and healthy lives without the loss of access or exorbitant bills that would severely burden their financial health. These changes were especially acute for Black and Hispanic Americans who had long simmering problems with the health care system’s disparities and suffered more as a consequence.

During his first administration, the current president tried to eliminate the ACA  by small and frequent cuts only to be thwarted by Arizona’s Republican U.S. senator, the late John McCain. The senator, a disabled vet, voted no on Trump’s proposal to gut the law. McCain who was no fan of the ACA, and had Brain Cancer at the time. realized that the present administration had no alternatives or solutions to make the law better in any way. Then the country faced a COVID-19 virus outbreak and a botched response from the White House. The president continually downplayed the seriousness of the malady, further complicating the rollout of vaccines. The country suffered and incurred almost a million deaths, many of them Black and brown. This stance also bred an anti-vaccination movement that has resulted in higher outbreaks of measles and pertussis while promoting faux cures like Ivermectin. Now, an antivaccine Health and Human Secretary, Robert Kennedy Jr. plans to change the department of 80,000 in his image. He pushed false narratives that vaccines cause autism, but Tom Inglesby, a former senior adviser to HHS, explained that “I think in large part, the healthcare community would continue to move forward on vaccines as they do now, as they are considered to be one of the massive successes of public health in the last 100 years. And I don’t think that would change.”

Kennedy said he’d deprioritize infectious disease research in favor of chronic illness research, in addition to advocating drinking raw milk that is not pasteurized, saying the Food and Drug Administration has indulged in “aggressive suppression” of raw-milk production. At present, raw milk is available in some states but cannot be sold across state lines. It is an odd choice for the incoming secretary of HHS to focus on, but he has considered the largest producer of raw milk in California to work in his administration.

Medicaid cuts are also being proposed by the White House freeze on spending. These program rollbacks could impact people who rely on federally funded health insurance, with the brunt being absorbed by the poor and other minorities.

As a result of the current administration’s downsizing medical research, millions of dollars in healthcare research funding is now  in jeopardy , because of the Trump administration’s proposed  cuts. Schools like Harvard, Yale and smaller research universities stand to lose funding decided by the new leaders at the National Institutes of Health. They explain that the indirect costs are too burdensome on the federal government and will cap the indirect cost rate at 15%. This will cut millions in funding for universities immediately. This initiative, like many others described here, has been met with staunch resistance. Attorneys general in 22 states including Massachusetts have filed suit against the Trump administration the Department of Health and Human Services, and the National Institutes of Health for unlawfully cutting funds. AG Andrea Campbell explained, “We will not allow the Trump administration to unlawfully undermine our economy, hamstring our competitiveness or play politics with our public health.”   

So this is what we have come to, lawsuits against an administration hell-bent on destroying the health care fabric of the United States, and again Black and brown folks will bear the brunt of their ire.

Andre Stark
Associate Publisher, Bay State Banner