More than 7 million African Americans are without healthcare coverage. That's the startling statistic the Barack Obama campaign says the next president of the United States must face.
"When there's a lack of coverage, we tend to delay care, and a lack of routine care contributes to poor health," Dr. Byllye Y. Avery, founder of the Black Women's Health Imperative and the Avery Institute for Social Change said on an Oct. 2 conference call with black media.
"When we fail to get healthcare, the survival rate for breast cancer is 77 percent, compared to 90 percent for white women, mostly because [black women] are diagnosed much later, and that's when care becomes expensive," Avery added, noting that obesity (more than four in ten African-Americans are obese,) poor diet and lack of exercise also contribute to increased rates of high blood pressure and heart disease in the black community.
Other risk factors include drug abuse, incarceration and HIV-AIDS.
In the end, however, it is unequal access to healthcare that most threatens the health of America's black population, said Avery, noting that "Without good medical care, you don't get prescription drugs and you have no way to keep your disease in check."
Dr. Charles Franklin, a Maryland internist, agreed that insurance is among the biggest barriers to equality in health outcomes for blacks.
"I've been in family practice for over 30 years in the Silver Spring area in Maryland," Franklin said. "Therefore I've been on the front line. My practice is 60 to 70 percent African-American and 20 percent Hispanic. One of the biggest barriers to finding care and to finding a physician who understands you is a lack of insurance. 20 percent of us and 30 percent of Hispanics don't have insurance."
Franklin said Obama's health care plan, which would offer the uninsured a package of health benefits similar to the one members of Congress enjoy, would "make sure everybody would be included." Avery criticized Sen. John McCain's health plan, which consists of a $2,500 tax credit for individuals (and $5,000 for families) which would go directly to insurers to purchase individual or family policies, and an elimination of the disparity between employer-paid benefits and individually purchased health plans by taxing the former for the first time.
Franklin said that among other problems is the fact that McCain's plan would not prevent insurers from refusing to cover those with "pre-existing conditions," something he said he sees in his practice.
Franklin said that among the biggest threats to African-American health are obesity, diabetes, hypertension and heart disease.
"If you see somebody black over 40 [years of age] they've probably got at least one of these. You can't exclude pre-existing conditions, because everybody's got a pre-existing condition."
Franklin said Obama's health plan would eliminate such exclusions, as well as what Franklin called the "games insurance companies like to play, like letting a person get care, and then sending out a questionnaire. And if the patient doesn't answer the questions [in a certain way,] they refuse to pay."
Franklin recalled an instance in which an insurance company refused to pay to treat a patient's uterine cancer, claiming that her prior yeast infection was a pre-existing condition.
Referring to McCain's four bouts with skin cancer, Avery quipped, "here is a man with a very big pre-existing condition, and if he didn't' have his big, government-run health coverage, he would be out in the cold."
In response, the McCain campaign provided a Sept. 8 memo written by senior policy adviser Douglas Holtz-Eakin which stated, "John McCain believes that no American should be denied access to quality and affordable coverage simply because of a pre-existing condition. As President, John McCain will work with governors to develop a best practice model that states can follow – a Guaranteed Access Plan or GAP – that would reflect the best experience of the states to ensure these patients have access to health coverage." The memo went on to say McCain's plan would include "reasonable limits on premiums, and assistance would be available for Americans below a certain income level."
INSURANCE COMPANIES CRITICIZED
Obama, in his campaign speeches, has talked often about watching his mother tangle with insurance company red tape even as she was dying of cancer.
U.S. Rep. Jesse Jackson Jr. of Illinois, who co-chairs Obama's national campaign, said Obama's plan would help small businesses cover their employees. "Barack wants to reduce costs for African Americans by offering federal reinsurance to insurers to ensure that catastrophic care doesn't make health insurance out of reach for employers." He accused McCain of being "opposed to increased funding to help cover the uninsured and tax credits for businesses to cover uninsured workers."
Both campaigns have faced repeated questions about how they would fund their healthcare agendas given the economic downturn, and the tighter budget the next president will face.
Neera Tanden, an Obama healthcare policy adviser who helped write Hillary Clinton's health plan during the primaries, said Obama would continue to prioritize healthcare, as part of his response to the fiscal crisis.
The non-partisan Kaiser Family Foundation analyzed both the McCain and Obama health plans and estimates that Obama's plan would cost between $50 and $65 billion per year. The McCain campaign disputed that figure, calling the Obama plan “a $179 billion a year employer mandate," according to an Oct. 5 memo from Holtz-Eakin.
"Senator Obama has said that our country can't not afford to do healthcare," Tanden said. "Costs are really burdening families; premiums have doubled over the last eight years under George Bush, making small business and the economy struggle as well. And we have higher [health] costs here than our competitors overseas. Solving the healthcare crisis is critical to solving our economic problems."
The Kaiser Family Foundation concluded that Obama's plan would address minority health disparities by "increasing access to coverage, expanding the capacity of the safety net, requiring collection of racial and ethnic patient data, promoting prevention and public health, implementing patient navigation programs, setting goals for improving health plans and provider performance, and promoting a diverse health workforce."
In addition, Obama's plan "supports research into racial and ethnic disparities in health outcomes," something Rep. Jackson has championed on Capitol Hill, including helping to create an office focused on health disparities at the National Institutes of Health, a federally funded medical research center. According to Kaiser, McCain's plan does not specifically address minority health disparities.
Jackson said Obama's focus on the issue of disparities is one reason African-Americans should go to the polls in large numbers. Added Avery, "Your health is the most important thing you have, and our health is really at stake in this election, and I say vote for your health."