The Pros and Cons of Obamacare

There is a criticism of Barack Obama that I hear levied against him, not primarily from white people or Republicans, but from black people, that I take some issue with. It is the claim that President Obama has not done, or has not tried to do, anything for black people. Some will point out that he has championed immigration reform for Hispanics and gay marriage for gay people, but nothing for us. Those who say so however probably have not considered this point within the context of health care in the African-American community. Some conservative critics of the healthcare overhaul have criticized the reform as a 100% solution to a 10% problem. And they’re right, in a way. It had been widely reported at the beginning of the healthcare debate and before that there were 46 million Americans without health insurance in this country. Really though it was never that bad; 10 million Americans without health insurance are people making above $75,000 a year who did not want insurance. 14 million were eligible for state sponsored care and never enrolled, while 6 million were eligible for insurance through their employer but never took advantage of it (another 5 million are undocumented immigrants, another 5 million are legal immigrants who are not insured for various reasons) thus leaving about 6 million Americans without reasonable access to health insurance. Too big a number to be sure, but a relatively small percentage of the American population. Yet of that 6 million, most are black Americans, making what might be thought of as a 10% problem for the rest of America a 100% problem for us. In seeking to expand healthcare coverage for all Americans, President Obama was not simply doing something for the country at large; he was doing something for the black community.

Yet and still there are serious concerns to be had about the new legislation as it unfolds, as well as things to be grateful for. The number one positive thing which the Affordable Care Act (its legal name) does is expand coverage to millions of Americans who did not have it previously (assuming the unfortunate glitches with the website are eventually worked out). As noted, in the black community that is a particularly big deal. Medicaid expansion, subsidies available to lower income Americans, and coverage mandates for children and young adults up to the age of 26 as well as for people with pre-existing conditions will help secure the healthcare of millions, including those who are economically and physically the most vulnerable among us. This is a victory for the health of the black community, and for all those who were unable to afford care.

For the black middle class however, and for working class black families and others making more than a relatively modest income (above $43,000 a year for individuals and above $92,000 a year for a family of four, though keeping in mind too that for many making less than these levels but still doing relatively well the subsidies available to them are smaller) there is an increased economic burden resulting from the law that needs to be acknowledged. One of the reasons for passing the ACA to begin with was to help control rising premiums, costs that have been straining the budgets of many American families, and black families are no exception. But for most people in this income range, premiums are not only still too high but are still getting higher, especially for those who don’t receive employer based coverage. (A study by the Manhattan Institute has shown that average premiums on the individual market have risen 99% for men since the implementation of the law.) Particularly as minimum coverage requirements are applied to insurance plans on the individual market, and as insurance companies seek to recoup monies spent on guaranteeing coverage for those with preexisting conditions by passing costs on to other consumers, it seems that what we can expect is for middle class premiums generally to continue to rise even as subsidies and Medicaid increase affordability and access to care for poor and for many working class African Americans.

One might say that this is a fair trade off, and maybe it is. But we shouldn’t be quick to give up on making things easier for the middle class. After all, the prosperity of this nation and certainly the future success of the black community are built upon having a thriving middle class, and insuring affordable health coverage for the middle class is a necessary part of that process. To that end there are many more reforms to be considered, from defensive medicine reform, to expanding competition across state lines, to encouraging Health Savings Accounts, etc.

The point is that, in some important areas, we have made progress. But make no mistake: the effort to fix the healthcare system continues.

African First Ladies Unite to Improve the Health of Women and Children

A coalition of African First Ladies, in collaboration with the United Nations Office for Partnerships and the African Union Commission to the United States, will hold a summit in Los Angeles, California, April 2-4 with American business leaders and foreign assistance agencies to improve health care for women and children in Africa.

Nearly 20 First Ladies from African nations are planning to gather for the health summit, co-sponsored by the Los Angeles-based nonprofit US Doctors for Africa, with support from the Cameroon-based organization of African First Ladies, African Synergy, and the group of 54 nations comprising the African Union who are responsible for organizing the second in a series of African First Lady Health Summits dating back to 2009. The Los Angeles Intercontinental Hotel will be the summit headquarters for the event.

Ted Alemayhu, founder of US Doctors for Africa, praised the dedication of the African First Ladies to improve health care and infrastructure in support of Every Woman Every Child, an unprecedented global movement spearheaded by United Nations Secretary-General Ban Ki-moon, that aims to save the lives of 16 million women and children by 2015.

“I applaud your vision, fortitude, and tireless efforts to improve access to quality healthcare for women and children,” Alemayhu said. “We look forward to welcoming you, building stronger partnerships, and mobilizing more resources to reach your objectives.”

Forty-three African first ladies have been invited to the summit, and participation so far is anticipated by at least 15 nations: Angola, Cameroon, Congo-Brazzaville, Gabon, Ghana, Guinea, Mozambique, Namibia, Niger, Nigeria, Senegal, Sierra Leone, South Sudan, and Swaziland; including the First Lady of Haiti who is also expected to attend.

US Representative Karen Bass, of California’s 37th District, Ranking Member of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations, will welcome the group to Los Angeles. Additionally, prominent women leaders will gather for a special breakfast entitled `Ladies First: Healthy Country, Healthy Citizens’ hosted by Marcia L. Dyson’s `Women’s Global Initiative’ and featuring actresses and advocates Tichina Arnold and Tatyana Ali on day two of the conference. The closing gala awards address will be given by Desiree Rogers, Chief Executive Officer of Johnson Publishing, a lifestyle company inspired by the African-American experience and the home of Ebony and Jet magazines, and Fashion Fair cosmetics.

Corporate sponsors include Unither Virology and Procter & Gamble. Nonprofit sponsors include Santa Monica-based emergency response group International Medical Corps and Jhpiego, a health organization affiliated with Johns Hopkins University.

The reigning Miss USA, Nana Meriwether, will also join the summit to use the influence of her title to raise awareness about health care in Africa. Having roots in South Africa, Meriwether co-founded The Meriwether Foundation, which supports four African nations with HIV/AIDS programs.

More details and information about the summit and registration can be found at www.africanfirstladiessummit.org. Follow us on Twitter @1stLadiesAfrica and `Like’ our Facebook Page First Ladies of Africa Health Summit for up-to-date information prior to the summit.

From 500 To 1: The Death Of The African-American Owned Hospital

The health of nations is more important than the wealth of nations. – Will Durant

The idea that someone else will care for you, your family, or your community better than you seems to be the purveying attitude of African America in almost every facet of our strategy today. This is of course assuming you believe we have an institutional strategy of our own to begin with. Instead of building and competing for power and control we seem content on waiting for others to share their spoils with us because it is the “right” thing to do only to be “shocked” when others idea of right and our idea of right do not acquiesce.

The history of African America and health has always been a precarious one. A people descended from the medical genius, Imhotep, known as the “father of medicine” who performed the earliest known surgery to the inspiring story of Dr. Ben Carson in present times. Healing sanctuaries and temples to the goddess Sekhmet are known to be the earliest “hospitals” to date. Fast forward a few thousand years to America and African Americans in Detroit alone owned and operated 18 hospitals of their own between 1917 to 1991. The confines within their own hospitals and medical ecosystem would seemingly be the only place where safety existed. From colonial times to present time, as noted in Medical Apartheid by Harriet Washington, when African Americans went outside of their own medical ecosystem we were and are subject to some of the most brutal medical experiments and abuses known in medical history. In an interview with Democracy Now, Ms. Washington is quoted giving examples of these abuses from past to present, “James Marion Sims was a very important surgeon from Alabama, and all of his medical experimentation took place with slaves. He took the skulls of young children, young black children — only black children — and he opened their heads and moved around the bones of the skull to see what would happen. He bought, or otherwise acquired, a group of black women who he housed in a laboratory, and over the period of five years and approximately forty surgeries on one slave alone, he sought to cure a devastating complication of childbirth called vesicovaginal fistula.” Ironically, as it were, Dr. Sims would go on to become president of the American Medical Association. Ms. Washington then goes on to present times stating “It’s black boys who have been singled out for these very dangerous experiments, such as a fenfluramine experiment that took place right here in New York City between 1992 and 1997. A lot of the abuse in African Americans has dissipated, but that kind of research is being conducted in Africa, where the people are in the same situation. They don’t have rights. They don’t have access to medical care otherwise, and Africa is being treated as a laboratory for the West by Western researchers.” Despite this obvious and consistent pattern of behavior we continue to seek to dismantle our own medical ecosystem.

It is no secret that the health of the African American community has always been in peril. Arguably today, more so than it has ever been in our history in this country. To some, the issues of medicine are a one size fits all prescription for any human anywhere. It is true we all have the same anatomy certainly but historical diet from our ancestry, environment, stress from the Middle Passage, slavery, and socioeconomic burdens that culminated after desegregation have taken its toll and many other factors create unique factors in the African American health dynamic. In fact, every group  based on their historical geography and diet has unique health features in their present health makeup. As such what is conducive to one group will not necessarily work for another. The variables at play do not provide for blanket medical solutions or care. Biological diversity exist in every species be it cats (lions, cheetahs, tigers) or humans. Yet, our desire to ignore these realities for the sake of creating a racial or ancestral Utopia has created a boom in our health risk with no seemingly end in sight. The numbers bear out a bleak picture of African American health today. African American life expectancy is 4.3 years less than the average American and 4.8 years less than European Americans. We currently have the highest age-adjusted death rate among all populations. The infant mortality rate in America for all is 6.8 per 1000 births yet for African America it is 13.2 per 1000 births. Approximately 20 percent of all African Americans are uninsured versus a national average of 15.9 percent. We are going extinct and do not even realize it.

Nathaniel Wesley Jr.’s book “Black Hospitals in America: History, Contributions and Demise” points out that at our apex there were 500 African American owned and controlled hospitals. Today, Howard University in Washington D.C. is the last one standing. In 1983 as Dillard University was selling its hospital Flint-Goodridge their president at the time, Dr. Samuel Dubois Cook stated that its demise was a result of “tragic mismanagement, social change that desegregated hospitals, financial irregularities, the fact that 90 percent of the patients were on Medicare or Medicaid and the loss of broad community support”. It would be hard not to assume that these were the underlying cause of the majority of most African American owned hospitals since as we know fervently believe that our proverbial ice could not possibly be as cold as the ice in other communities.

Rethinking the role of hospitals in general is needed given the rapid rise of healthcare cost but especially so in the African American community where the ability to afford private healthcare is almost impossible given our lack of wealth. While Asian and European America’s median net worth both approach $100,000 the African American median net worth is close to $2,000 and dropping according to the Economic Policy institute. Hospitals in our communities should be fashioned as health and wellness focused on preventive care, nutrition, and alternative medicines more unique to our biology. HBCUs themselves while not all needing to build hospitals should all be investing in community clinics that are connected regionally with an African American owned hospital. The pre-med and business programs should create more courses on the development of these facilities. Its impact on both wealth creation and health improvement would do wonders for African America as a whole.

It could be said that for all the benefits of the Affordable Healthcare Act proposed by President Obama, our longer term interest in building a medical ecosystem focused on the needs and issues that face the African American and African Diaspora community would go much farther in improving our health as a people. After all if health is wealth and wealth is created by ownership then we must once again build and own the ecosystem that is the DNA of our blood, sweat, and tears.

Mr. Foster is the Interim Executive Director of HBCU Endowment Foundation, Founder of the HBCU Chamber of Commerce, sits on the board of directors at the Center for HBCU Media Advocacy, & President of AK, Inc. A former banker & financial analyst who earned his bachelor’s degree in Economics & Finance from Virginia State University as well his master’s degree in Community Development & Urban Planning from Prairie View A&M University. Publishing research on the agriculture economics of food waste, full-time contributor at HBCU Money, and guest contributor for a number of African American media outlets.

The Break: Journey to the Election Part 1 (PODCAST)

Welcome to the first installment of our “Journey to the Election” podcast series, which will run every Friday until Election Day on November 6th. In this episode, listen as the family discusses the Black vote, Obama’s accomplishments in this first term, questions and concerns about Mitt Romney and the state of politics today. Podcast guests include Chris Lehman, Tash Moseley, Leisha Mack, John and Triawna Wood and Brother Malcolm Darrell. Listen up and chime in! Feel free to drop us a line at (323) 455-4219.