Hostname: page-component-cc8bf7c57-8cnds Total loading time: 0 Render date: 2024-12-11T23:06:17.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Next Steps in Health Reform: Hospitals, Medicaid Expansion, and Racial Equity

Published online by Cambridge University Press:  01 January 2021

Dayna Bowen Matthew
Get access Rights & Permissions [Opens in a new window]

Abstract

The confluence of racial unrest and Medicaid expansion in Virginia should inspire a national reimagining of how health care can contribute to health equity. Hospitals in particular can leverage their role as economic drivers in communities to equalize health and social outcomes for all. The urgent need for innovative opioid intervention presents a fertile proving ground for new ways that hospitals can act to reduce the impact of racial inequity. Inspired by the role hospitals played to achieve desegregation during the Civil Rights era, this essay proposes an integrated approach to use Medicaid expansion to advance health and racial healing in America.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 4: Next Steps in Health Reform , Winter 2018 , pp. 906 - 912
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See, Nash, R. M., “Compliance of Hospitals and Health Agencies with Title VI of the Civil Rights Act,” American Journal of Public Health and the Nation's Health 58, no. 2 (1968): 246–251 (reporting hospital “freedom of choice” arguments and tactics employed to feign civil rights law compliance during HEW inspections only).Google Scholar
Thomson, G.E., “Discrimination in Health Care,” Annals of Internal Medicine 126, no. 11 (1997): 910–912.Google Scholar
Cornely, P.B., “Trend in Racial Integration in Hospitals in the United States,” Journal of the National Medical Association 49, no. 1 (1957): 8.Google Scholar
Reynolds, P.P., “The Federal Government's Use of Title VI and Medicare to Racially Integrate Hospitals in the United States, 1963 through 1967,” American Journal of Public Health 87, no. 11 (1997): 1850–1858.Google Scholar
Simkins v. Moses H. Cone Memorial Hospital, 323 F.2d. 959 (1963) For a full discussion of the case, see, Matthew, D.B., Just Medicine: A Cure for Racial Inequality in American Health Care (New York: NYU Press, 2015).Google Scholar
Reynolds, P.P., “Hospitals and Civil Rights, 1945-1963: The Case of Simkins v Moses H. Cone Memorial Hospital,” Annals of Internal Medicine 126, no. 11 (1997): 898–906.Google Scholar
Reynolds, P.P., “Professional and Hospital Discrimination and the US Court of Appeals Fourth Circuit 1956–1967,” American Journal of Public Health 94, no. 5 (2004): 710–720.Google Scholar
Nash, R.M., “Compliance of Hospitals and Health Agencies with Title VI of the Civil Rights Act,” American Journal of Public Health and the Nation's Health 58, no. 2 (1968): 246–251. (By the close of 1966, 7,160 hospitals agreed to comply with the new federal law; 135 were the subject of administrative proceedings to seek compliance, and 215 of the nation's hospitals decided to stop accepting federal funds rather than to admit non-white patients to their care.)Google Scholar
See, e.g. Glass, A., “Civil Rights March Ends as ‘Bloody Sunday,’ March 7, 1965” (recounting state trooper assault against marchers in Selma, Alabama), Politico, March 7, 2018, available at <https://www.politico.com/story/2018/03/07/this-day-in-politics-march-7-1965-437394> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See, Virginia Museum of History & Culture, Massive Resistance, available at <https://www.virginiahistory.org/collections-and-resources/virginia-history-explorer/civil-rights-movement-virginia/massive> (Last visited October 31, 2018).+(Last+visited+October+31,+2018).>Google Scholar
Reynolds, supra note 8, at 1852.Google Scholar
Bailey, P. et al., “African American Uninsured Rate Dropped By More than a Third under the Affordable Care Act,” Center on Budget and Policy Priorities, June 1, 2017, available at <https://www.cbpp.org/research/health/african-american-uninsured-rate-dropped-by-more-than-a-third-under-affordable-care> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Ortega, A.N. et al., “Insurance Coverage and Well-Child Visits Improved for Youth Under the Affordable Care Act, but Latino Youth Still Lag Behind,” Academic Pediatrics 18, no. 1 (2018):35–42.Google Scholar
Virginia Health Care Foundation, “Profile of the Uninsured” (2018), available at <https://www.vhcf.org/data/profile-ofthe-uninsured/> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Virginia Health Care Foundation Data, available at <https://www.vhcf.org/data/> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
United States Department of Labor, Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, available at <https://www.bls.gov/cps/cpsaat18.htm> (last visited October 31, 2018) (In 2017, hospitals employed more than 7 million people nationally.); see also, United States Department of Labor, Bureau of Labor Statistics, Labor Force Statistics from the Current Population Survey, available at <https://www.bls.gov/cps/cpsaat18.htm> (last visited October 31, 2018)(They employ a significant portion of the population — more than 7 million people in 2017)+(last+visited+October+31,+2018)+(In+2017,+hospitals+employed+more+than+7+million+people+nationally.);+see+also,+United+States+Department+of+Labor,+Bureau+of+Labor+Statistics,+Labor+Force+Statistics+from+the+Current+Population+Survey,+available+at++(last+visited+October+31,+2018)(They+employ+a+significant+portion+of+the+population+—+more+than+7+million+people+in+2017)>Google Scholar
Id (2016 hospitals purchased $852 billion in goods and services from other businesses.)Google Scholar
Braveman, P. and Gottlieb, L., “The Social Determinants of Health: It's Time to Consider the Causes of the Causes,” Public Health Reports 129, no. 1, suppl. 2 (2014): 19–31.Google Scholar
Lax, Y. et al., “Social Determinants of Health and Hospital Readmission,” Pediatrics 140, no. 5 (2017):e20171427.CrossRefGoogle Scholar
“August 2018 Medicaid & CHIP Enrollment Data Highlights,” available at <https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See, Butler, S. and Diaz, C., “Hospitals and Schools as Hubs for Building Healthy Communities,” Economic Studies Report, Brookings Institution (November 2016).Google Scholar
Deloitte Center for Health Solutions, “Social Determinants of Health: How are Hospitals and Health Systems Investing in and Addressing Social Needs?” (2017), available at <https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-addressing-social-determinants-of-health.pdf> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See, Hostetter, M. and Klein, S., “In Focus: Hospitals Invest in Building Stronger, Healthier Communities,” The Commonwealth Fund: Transforming Care: Reporting on Health System Improvement, available at <http://www.commonwealth-fund.org/publications/newsletters/transforming-care/2016/september/in-focus> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
National Center for Medical Legal Partnerships, available at <http://medical-legalpartnership.org/partnerships/> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See generally, Crawford and Houston, id.Google Scholar
Hartman, M. et al., “National Health Care Spending in 2016: Spending and Enrollment Growth Slow After Initial Coverage Expansions,” Health Affairs 37, no. 1 (2018):150–160.CrossRefGoogle Scholar
Id., Hartman at 157.Google Scholar
American Hospital Association, “Underpayment By Medicare and Medicaid Fact Sheet” (December 2017), available at <https://www.aha.org/system/files/2018-01/medicaremedicaidunderpmt%202017.pdf> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See, Office of the Actuary National Health Statistics Group, National Health Care Spending in 2016, available at <https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE-Presentation-Slides.pdf> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Decreased growth in enrollments and reduced supplemental payments to hospitals also explain decreasing growth in per enrollee payments. See, Hartman, supra note 26, at 157.Google Scholar
See, CMS Healthcare Cost Report Information System, FY2011-FY2015.Google Scholar
Antonisse, L. et al., The Effects of Medicaid Expansion Under the ACA: Findings from a Literature Review, KFF Issue Brief, Kaiser Family Foundation (June 2016), available at <http://kff.org/report-section/the-effects-of-medicaid-expansion-under-the-aca-findings-from-a-literature-review-issue-brief/#endnote_link_191253-92> (last visited October 31, 2018).Google Scholar
Blavin, F., “How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data,” Urban Institute U.S. Health Reform – Monitoring and Impact, available at <http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310> (last visited October 31, 2018). See also, F. Blavin, “Association Between the 2014 Medicaid Expansion and US Hospital Finances,” JAMA 316, no. 14 (2016): 1475-1483 (Between 2011 and 2014, hospitals in the 19 expansion states saw annual Medicaid revenues increase by $3.2 million, and uncompensated care decrease by $2.8 million per year on average).+(last+visited+October+31,+2018).+See+also,+F.+Blavin,+“Association+Between+the+2014+Medicaid+Expansion+and+US+Hospital+Finances,”+JAMA+316,+no.+14+(2016):+1475-1483+(Between+2011+and+2014,+hospitals+in+the+19+expansion+states+saw+annual+Medicaid+revenues+increase+by+$3.2+million,+and+uncompensated+care+decrease+by+$2.8+million+per+year+on+average).>Google Scholar
See, Office of the Actuary National Health Statistics Group, National Health Care Spending in 2016, available at <https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE-Presentation-Slides.pdf> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
See, e.g., Cohen, A., “How White Users Made Heroin a Public-Health Problem,” The Atlantic, August 12, 2015; Here, in my view, is one of the most impactful: Brian Broome for Public-Source, “Amid the Opioid Epidemic, White Means Victim, Black Means Addict,” The Guardian, April 28, 2018, available at <https://www.theguardian.com/us-news/2018/apr/28/opioid-epidemic-selects-white-victim-black-addict> (last visited October 31, 2018); see also, Report of J. Fagan, in United States of America v Alfred Washington and John T. Hummons, No. 1-CR-632 (N.D. of Illinois, Eastern Division), available at <https://www.law.uchicago.edu/files/files/report_of_jeffrey_fagan.pdf> (last visited December 19, 2018).+(last+visited+October+31,+2018);+see+also,+Report+of+J.+Fagan,+in+United+States+of+America+v+Alfred+Washington+and+John+T.+Hummons,+No.+1-CR-632+(N.D.+of+Illinois,+Eastern+Division),+available+at++(last+visited+December+19,+2018).>Google Scholar
CDC News Room, “Emergency Department Data Show Rapid Increases in Opioid Overdoses,” Tuesday, March 6, 2018, available at <https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Kim, B., Nolan, S., and Ti, L., “Addressing the Prescription Opioid Crisis: Potential for Hospital-Based Interventions?” Drug and Alcohol Review 36, no. 2 (2017):149–152, doi: 10.1111/dar.12541.Google Scholar
CDC News Room, supra note 36.Google Scholar
Centers for Disease Control, “Opioid Overdoses Treated in Emergency Departments,” Viral Signs (March 16, 2018), available at <https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
Schorsch, K., “What it Costs Hospitals to Reverse an Opioid Overdose,” Modern Healthcare, February 20, 2018.Google Scholar
Courtwright, D.T., Dark Paradise: A History of Opioid Addiction in America (Cambridge, Massachusetts, and London, England: Harvard University Press, 2001).Google Scholar
Day, H. B., The Opium Habit (New York: Harper & Bothers, 1868), 6–7. See, Civil War Veterans and Opiate Addiction in the Gilded Age, available at <https://journalofthecivilwarera.org/2016/11/civil-war-veterans-opiate-addiction-gilded-age/#_ftn5> (last visited October 31, 2018).Google Scholar
Cooper, A. and Smith, E. L., “Homicide Trends in the United States, 1980-2008” (November 2011, NCJ 236018), available at <https://www.bjs.gov/content/pub/pdf/htus8008.pdf> (last visited October 31, 2018).+(last+visited+October+31,+2018).>Google Scholar
In contrast, D. Courtwright's work estimates the number and ratio of black and white heroin users in treatment peaked around 1970 when just under 6,000 whites and nearly 8,000 blacks entered treatment.Google Scholar
Kerr, P., “Growth in Heroin Use Ending as City Users Turn to Crack,” NY Times, September 13, 1986, see 1986 archives, available at <https://www.nytimes.com/1986/09/13/nyregion/growth-in-heroin-use-ending-as-city-users-turn-to-crack.html> (last visited December 10, 2018).+(last+visited+December+10,+2018).>Google Scholar
Courtwright, D.T., Dark Paradise – A History of Opiate Addiction in America (Harvard University Press, 2001).Google Scholar
Langan, P.A., “Race of Prisoners Admitted to State and Federal Institutions 1926-1986,” U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, NCJ-125618 (May 1991).Google Scholar
Galea, S. and Vlahov, D., “Social Determinants and the Health of Drug Users: Socioeconomic Status, Homelessness, and Incarceration,” Public Health Reports 117, Suppl. 1 (2002): S135–S145.Google Scholar
Betz, M.R. and Jones, L.E., “Wage and Employment Growth in America's Drug Epidemic: Is All Growth Created Equal?” Ohio State University's Institute for Population Research (December 15, 2017).Google Scholar
See generally, id., Betz and Jones (Though the impact is concentrated at the low end of wage distributions and plays a larger role in non-metro counties.)Google Scholar
Id., Betz and Jones.Google Scholar
Diane Wescott, interview (1982).Google Scholar
College Entrance Examination Board, “Equality and Excellence: The Educational Status of Black Americans” (New York, 1985).Google Scholar
Id. College Board.Google Scholar
Leitner, J.B., Hehman, E., Ayduk, O., and Mendoza-Denton, R., “Blacks’ Death Rate Due to Circulatory Diseases is Positively Related to Whites’ Explicit Racial Bias: A Nationwide Investigation Using Project Implicit,” Psychological Science 27, no. 10 (2016): 1299–1311.Google Scholar
Kaiser Family Foundation, “Medicaid's Role in Addressing the Opioid Epidemic,” available at <https://www.kff.org/infographic/medicaids-role-in-addressing-opioid-epidemic/> (last visited October 31, 2018). (last visited October 31, 2018).' href=https://scholar.google.com/scholar?q=Kaiser+Family+Foundation,+“Medicaid's+Role+in+Addressing+the+Opioid+Epidemic,”+available+at++(last+visited+October+31,+2018).>Google Scholar