Our healthcare debate is evolving on a daily basis. Politicians are keeping the new American Health Care Act (AHCA) bill shut behind closed doors, and many of their constituents are suddenly changing their stance and showing support for the Affordable Care Act (ACA, or “Obamacare”).
There is a lot of drama and mystery surrounding the new healthcare bill, but it has been made apparent that their new approach to healthcare will leave out an oft-forgotten demographic of America: the poor. With strong cuts to Medicare and Medicaid programs, as well as more freedom to the “free-market” insurance companies, there is little doubt that the poor will again be left floundering with little to no access to affordable healthcare. Their health — the health of over 45 million people below the poverty line — could potentially be on the chopping block if the new AHCA is allowed to pass.
But what is often overlooked — or at least ignored — by the politicians in DC, is the harsh reality of poverty. It has devastating effects on families and communities, and it is essentially an inescapable cycle. Additionally, poverty creates its own unique health concerns. Let’s look at the damning evidence of the effects of poverty, and consider how important it is to the discussion of accessible healthcare in the United States.
There’s a common idea in our American culture that anyone can overcome their state in life if they simply “pull themselves up by their bootstraps” and work hard. Yet anyone that has lived in the cycle of poverty is most likely aware of how absurd that idea truly is. As one MIT researcher explained to the Atlantic in April, 2017, it takes almost 20 years of “nothing going wrong” to overcome poverty.
Peter Temin, author of The Vanishing Middle Class: Prejudice and Power in the Dual Economy, explained to the Atlantic just how difficult breaking the cycle of poverty can be; and just how divisive our nation truly is in terms of economic status:
“He [Temin] focuses on how the construction of class and race, and racial prejudice, have created a system that keeps members of the lower classes precisely where they are. He writes that the upper class of FTE [finance, technology, and electronics] workers, who make up just one-fifth of the population, has strategically pushed for policies—such as relatively low minimum wages and business-friendly deregulation—to bolster the economic success of some groups and not others, largely along racial lines. ‘The choices made in the United States include keeping the low-wage sector quiet by mass incarceration, housing segregation and disenfranchisement,’ Temin writes.”
Education seems to be one of the biggest keys to breaking out of the poverty cycle, but access and funding to education for many minority groups in the United States is continually lacking. Plus, the cost of higher education (and subsequently the accrual of debt through student loans) is becoming astronomical — even for those living in the middle-class income bracket. Besides access to education, racial tension between minority communities and the police has led to a booming private and public prison system, yet another inescapable cycle in the form of mass incarceration.
The Poverty Health Crisis
But it’s not just a lack of education that keep many struggling below the poverty line. Health and financial state often have a similar cyclical effect on each other. For one, the continuous stress from lack of money takes its own toll on the body due to severe toxic stress. Prolonged exposure to stress can cause a series of problems to the body, including neurological conditions, digestive issues, and cardiovascular illnesses. It also makes sufferers more susceptible to mental illness and addiction. Some researchers have even wondered if poverty is itself a disease.
As it turns out, the majority of people that make less than $36,000 a year are most likely working 40 or more hours per week, have little to no access to a gym or park, and are living in dangerous areas. This means they often lack the time and ability to exercise, consume or cook healthy foods, or invest in their personal health. The stress they are experiencing is exacerbated by their unhealthy habits.
However, changing those habits are no easy task. Common financial advice columns suggest cutting out avocado toast or a weekly coffees to help save up, but this assumes a lot about the financial habits of the poor. They are not spending money on frugal things, but instead are often strapped for money due to bills, rent, and necessities. Choosing a cheap and fast meal and avoiding the gym often works better with their busy schedules. If a single mother of two is presented with the option of cooking a $10 meal that might take an hour to make or going through the local fast-food line to get a dollar burger for her kids, which do you think she will take? In these cases, the blame should not be placed on the individuals forced to decide between an unachievable option and a reasonable one.
Aside from financial stress that creates problems, and the unhealthy decisions that exuberate a decline in personal health, the poor are also faced with a healthcare system that is severely lacking, even in its current state.
Despite having government or employer-funded health care, most people can’t afford the medications or treatments they need, even after insurance covers its portion. In an increasingly common occurrence, people are turning to charity and online crowdfunding sites (like GoFundMe) to cover their medical expenses. Additionally, people living in poverty rarely have access to medical care in the first place, and they might prolong treatment of serious conditions in an attempt to save money for their families. This in turn increases their risk for deadly health problems and chronic illnesses.
This is extremely apparent in rural areas, where doctors offices are few and far between, and only 64 percent of residents are covered by private insurance companies. Many of these areas are in states that didn’t extend funding to Medicaid when the ACA went into effect, as they are predominantly Republican supporting. Additionally, these rural areas are commonly located in food deserts, meaning access to fresh produce is nearly impossible.
Through pushes from the ACA as well as through technological advancements, some of these areas are showing improvement by building better programs specifically for the poor. Yet, even those could be forfeit if the ACA is repealed and replaced by the AHCA, as cuts to Medicare and Medicaid funding would result in the closure of hundreds of low-income hospitals and facilities. Republicans may have found support from voters in these areas, but taking away their already scant-access to healthcare could be devastating.
Healthcare Reform with the Poor in Mind
If Republicans succeed in repealing and replacing the ACA with the AHCA, over 23 million people will see a loss in their insurance within a decade. The effects could be overwhelmingly damaging, but it’s also important to acknowledge how damaging our system is currently.
Those living below the poverty line are certainly suffering the most in terms of access and cost of healthcare services. If policymakers want to improve the health of the country, they will need to focus on this group first and foremost. This can be done by providing funding to health clinics in rural areas, expanding Medicare and Medicaid funding, and increasing funding for public education in minority-heavy areas.
Making these sorts of reforms might be a tall order, but until the health needs of the poor are strictly addressed, our nation will continue to suffer. Overall health will decline, health care costs will skyrocket for everyone, and the continuing economic divide between the two classes will grow. Already on this path, America is ceasing to be a country “for the people.”
About the author:
Katie McBeth is a researcher hailing from Boise, ID. She enjoys reading teen novels, eating mac ‘n cheese, and seeing the world through her camera lens. Her love for reading is only trumped by her love for cats, of which she has three. She also has a dog, and he helps keep her grounded. You can follow her animal and writing adventures on Instagram or Twitter: @ktmcbeth.