Health Care Reform Should Include Addressing Poverty

Nineteen states have yet to adopt the Affordable Care Act's (aka Obamacare) Medicaid expansion. After the failure by House Republicans to pass an Obamacare repeal bill, the American Health Care Act, there is speculation that some, if not all of these states will eventually expand Medicaid eligibility. True, Medicaid got a reprieve from Paul Ryan's attempts to de-federalize and destroy it, but it is not out of the woods yet. On Thursday, March 30th, one of the 17 Republican governors in a Medicaid non-expansion state, Kansas's Sam Brownback, proved that Republican ideology trumps common sense and decency.

Yesterday, Governor Brownback vetoed a Medicaid expansion bill passed by his state's legislature. He provided several reasons for the veto, one of which was that it "prioritizes able-bodied adults above the truly needy." No surprise that Brownback is of the if you don't have a job you don't deserve health insurance school of thought. He's known for his small government, low-taxes brand of conservatism. He's also known for making it
harder for poor people in his state to receive government assistance.

Kansas has suspicion-based drug testing for welfare recipients, job-training and work requirements, and severely limits lifetime welfare benefits. And while there is nothing wrong with requiring welfare recipients to pursue training and work, holding a clock over their heads and treating them like criminals helps no one, and some experts think it can be detrimental to the state's economic growth and increase health care costs.

Not Addressing Poverty Has A Cost

Poverty has many costs, both individual and societal. But that may be a too touchy-feely for conservatives like Governor Brownback. Therefore, we need to address poverty's costs in a way that Brownback and others like him can understand.

According to a
Government Accounting Office (GAO) report, "economic research suggests that poverty can affect economic growth to the extent that it is associated with crime, violence and unrest." States must spend resources to address these issues. We also know that poverty is associated with low educational attainment, which can limit workforce participation. And on the health care side, we know that the poor have higher rates of chronic illnesses and require more health care than the non-poor. You would think that addressing poverty would be a high priority in health care reform, higher even than Medicaid expansion.

Health Care Reform Ignores Poverty As A Cost Driver

In reading his book, "Reinventing American Health Care," I was surprised that Ezekiel Emanuel, one of the architects of Obamacare, never mentioned the study of poverty's impact on health care costs. Dr. Emanuel, President Obama and others working on Obamacare focused on increasing the quality and decreasing the quantity of medical care to control costs. But as someone who works in
Philadelphia, the poorest big city in America with the highest deep poverty rate of any city, you would think that Dr. Emanuel would bring that perspective to health care reform. He didn't.

Maybe Zeke and Obama viewed poverty as a separate, nice to address, but too much for right now while we are dealing with health care reform issue. Or maybe they thought the link between poverty and health care costs might seem logical, but there's not enough empirical evidence to give us a starting point to address it. I don't know what Obama, Zeke and other politicians think about the link between poverty and health care costs, but it seems logical to me that when people have access to lead-free housing, reliable shelter, nutritious food, education and health care, they are healthier and use less medical care. And isn't using less medical care one of the main goals of health care reform?

Addressing Poverty's Impact On Health Care

It is a fact that health care status among the poor improves with access to health care through programs like Medicaid. Increased access may lead to lower health care costs for everyone as fewer people seek expensive emergency room care, but it is too early to tell. But access to health care alone may not be sufficient to lower America's out-of-control health care costs we still need to decrease the need for care.

Some people realize that treating chronically ill poor people requires more than traditional medical care. Access to decent housing and nutritious food may be just as important in addressing the medical needs of the poor as traditional medicine. Recognizing the connection between poverty and health care costs, a
doctor in Hawaii is asking the state to classify homelessness as a medical condition. A bill addressing the issues is under review in the state legislature.


Health insurance and health care access is a step in the right direction for America, but until we address the stench of poverty our health care costs will remain out of control. If conservatives think Medicaid expansion cost too much or is another failed anti-poverty program, they need to study poverty's impact on the economy. But understanding poverty's impact on health care costs and the larger economy is not just a Republican or conservative problem; Democrats had a chance to create programs like Hawaii's and did nothing. Eventually, we'll all figure out that poverty is too expensive to tolerate.

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