Advancement Project

September 17, 2009

Democrats and Republicans to Create More Healthcare Inequality

Advancement Project aims to set the record straight on policies and laws that make it harder for poor people, People of Color and immigrants to live a decent life free of inequality.

And today is one of those days that we feel compelled to call out both Democrats and Republicans for failing to pursue policies that would lead to greater healthcare equality.

The issue I’m referring to surfaced last week during President Obama’s healthcare reform speech when Republican Congressman Joe Wilson showed incredible disrespect for the office of the president by yelling “You Lie!” during the president’s speech to Congress.

What provoked the outburst? Obama’s claim that undocumented immigrants wouldn’t benefit under the health-care reform bills being considered by Congress.

Apparently, the proposed reform bills in the House and Senate clearly state that undocumented immigrants would not share in the healthcare reform benefits that promise to extend coverage to many of the 46 million uninsured. But what caused Wilson to lose his cool was the fact that the bills under consideration do not require healthcare reform recipients to provide proof of citizenship to participate in the healthcare exchange.

In the aftermath of Wilson’s outburst, however, according to Time and the Wall Street Journal, leading Senate Democrats reversed course, and decided to add a provision that would require proof of citizenship for anyone who would participate in the exchange

It’s troubling that Democrats would seek to mollify Wilson—or the other conservative Republicans who won’t vote for healthcare reform anyway.

But more troubling is the fact that adding a citizenship requirement means that many of the uninsured—who are more often poor and People of Color–will remain uninsured.

There are myriad reasons why many in this country–who would otherwise benefit from healthcare reform—wouldn’t be able to under a citizenship requirement because they won’t have a copy their birth certificate or other required documents and would have a difficult time getting them.

For one, people who are poor have to move more often out of necessity. If they become unemployed–unlike the middle and upper class who can get by with a mix of savings, credit cards and help from other middle and upper class family members—low-income people will face more disruption in their lives. They may have to give up an apartment and move to a room or move in with a relative who is willing to take them in. They are more likely to face an eviction and lose their belongings or live in substandard housing and lose their belongings in a fire. Having less financial instability means you are likely to be able to hold on to a birth certificate—if you were ever issued one in the first place.

If you had a birth certificate and lost it—as I have done—you are less likely to afford the fees needed to replace it and you may be in a job that won’t allow you to spend a day in a government office applying for replacement documents. For the underemployed who are forced to work part time, there are typically no vacation days or personal days to take to deal with government bureaucracy. A lost day means lost wages that some people just can’t afford.

The situations that can cause you to not have a birth certificate are myriad. For instance, in some states like Mississippi, the state didn’t bother to issue birth certificates to rural Black people in the 1930s.

A Government Accountability Office (GAO) reoprt from 2007 proves the point. It showed that proof of citizenship requirements led to declines in medicaid coverage in about half the 44 states that submitted reports on the citizenship requirement to the GAO. And most of those who lost coverage because they failed to provide documents were eligible U.S. citizens.

It is for the above reasons that Advancement Project has opposed bills and laws requiring voters to provide photo-ids and proof of citizenship. We know that that poor people and People of Color disproportionately bear the burden of such laws and are thus more likely to be disenfranchised.

The same is true for the uninsured that would have a harder time getting medical care, if they first had to figure out how to get a birth certificate. Many would just do without health care insurance.

Senators should work quickly to remove the burdensome proof of citizenship requirement from the Baucus bill so that more substantive issues like the fate of the public option can be addressed.

On a related matter, it’s rather unfortunate that the leaders of our two rival political parties seem to agree that undocumented immigrants should not receive health care benefits under the proposed plans. I wouldn’t argue that it’s okay for people to come to America and live and work here without legal permission. But, once here, it does the nation no good to deny them medical care and have folks trying to survive with an undiagnosed major health issue because they don’t have coverage.

For one, such people may show up at a hospital emergency room for care when it’s too late for effective medical treatment and lose their lives simply because they’ve been barred from coverage. Furthermore, if they should have an untreated communicable illness, that would make it more likely that others would be exposed to it, unnecessarily, and get the illness, which is bad for all of us.

If our elected leaders fail to recognize these problems, and move forward with this citizenship requirement, that uncompassionate stance will only create more inequality.

Rushing, is writer-editor for Advancement Project, a national civil rights organization that advocates for racial justice.