How the Senate's Obamacare repeal bill would wallop the urban poor, and especially those who rely on Medicaid and public hospitals

By Dr. Mary T. Bassett and Stanley Brezenoff

Dr. Mary Bassett

Dr. Mary Bassett

This op-ed was originally published in the New York Daily News.

If there was any hope that Senate Republicans could bring some sanity into the national discussion around the future of our health care system, such hope completely vanished on Thursday. Like the House's health care bill, the Senate's proposal is nothing less than an all-out attack on public health and our public hospital system, and its consequences will be devastating for New York City and the country.

As the Senate prepares to vote on the bill next week, it's imperative to understand what is at stake if the federal government guts funding for public health insurance — as it is poised to do.

The Senate is proposing to save money by slashing Medicaid, the health insurance program for the poor established in 1965. Under its bill, cuts to Medicaid would be even harsher than those proposed by the House — which axes $880 billion to Medicaid over 10 years. Even worse, these efforts would push millions of Americans to the uninsured rolls.

Adding to this concern is the President's budget, which targets Medicaid with a proposed cut of $610 billion. His budget would also cut $5.8 billion from the Children's Health Insurance Program over two years.

Taken together, these policy proposals threaten a death blow to public hospital systems across the country, including our NYC Health + Hospitals. More profoundly, both the House and the Senate's bills would destroy a national commitment made 52 years ago to provide health care to the elderly and low-income Americans.

Read more.

Showing up for LGBTQ communities

By Jesse Chipps, HIV Planning Council Administrator, Public Health - Seattle & King County

Jesse Chips

Jesse Chips

June is National Lesbian, Gay, Bisexual and Transgender (LGBT) Pride Month, and each year at this time hundreds of King County employees, department directors and public officials march together in Seattle’s Pride Parade. Rainbow tinsel laden vehicles, bubble machines, and matching t-shirts pull the group together as One King County.

Same sex marriage became legal in Washington State on December 6, 2012, at midnight.  While couples who had waited for decades to marry could have waited another few hours until the King County Recorder’s Office opened the next morning, King County Executive Dow Constantine began issuing licenses, personally, at 12:01am.  

Jane Abbott Lighty and Pete-e Petersen are the first to receive their marriage license, and a hug, from Executive Constantine.

Jane Abbott Lighty and Pete-e Petersen are the first to receive their marriage license, and a hug, from Executive Constantine.

One of the county’s core values is to be “fair and just” in all we do in order to achieve equitable opportunities for all people and communities.  This language was passed into law in 2010 by a unanimous vote of the County Council. The ordinance reflects the values if those who live and work here.

King County is by no means perfect in our efforts to be fair and just, but there is a concerted effort to consider all actions – large and small – through this “equity” lens.  Individual departments and the county as a whole are not afraid to take on issues of inequity, whether they are related to race, gender identity, immigration status, income level or ethnicity. For example:

  • We changed the gender questions on intake forms at our STD clinic to reflect a wider spectrum of gender identity.
  • The County began reaching out to LGBTQ entrepreneurs for inclusion in the County’s directory of small businesses, and tracks the number and size of contracts awarded to these businesses.  
  • Gender neutral bathrooms were identified and publicized in County buildings.

This dedication to equity for the LGBTQ community extends to our public health efforts as well. Seattle & King County’s HIV/STD Program has worked with scores of community-based agencies, community leaders and the Washington state Department of Health on HIV since the 1980s.  We’re thrilled that King County is among the first counties in the country to reach the World Health Organization’s goal of having 90% of all people with HIV know their status, 90% of those diagnosed be on treatment, and 90% of those on treatment be virally suppressed.

HIV is just one of many conditions that disproportionately affect LGBTQ people.  In King County, lesbian, gay, and bisexual-identified people are also significantly more likely to smoke tobacco than those who identify as heterosexual. But we only know about this health inequity because Washington State has collected sexual orientation data on the Behavioral Risk Factor Surveillance System (BRFSS) every year since 2003. The Centers for Disease Control (CDC) did not create its own sexual orientation and transgender identity questions for BRFSS until 2016, and those questions are optional. Many states do not ask these questions, or do not do it consistently. A 2014 study by the Fenway Institute showed that between 1995 and 2012, 27 states asked about sexual orientation at least once in BRFSS, and in 2009 13 states and Washington D.C. did so.  But collecting information about sexual orientation in health surveys is critically important to understand how LGBTQ may be experiencing health inequities.

There was a brief hope that the federal government was aiming to collect sexual orientation and gender identity information on the Census. Two months ago, the US Census Bureau published, then quickly amended, a document which listed Sexual Orientation and Gender Identity as proposed subjects for the 2020 Census.  The National LGBTQ Task Force responded with, “We’ve been ERASED!”

So, on a national level, questions about orientation are not being asked, and are unlikely to be asked anytime soon.  Getting the U.S. Census to add these questions and national BRFSS to make their questions part of the core questionnaire is a larger challenge, but there are plenty of local challenges that jurisdictions can take on every day. Here are a few: Dedicate resources towards addressing LGBTQ health disparities. Make sure the bathrooms in your office are safe and welcoming for gender non-conforming staff and clients. And, yes, spend a nice, warm Sunday celebrating your LGBTQ community at Pride.

The Zika Fight of 2017

By Chrissie Juliano, Director of the Big Cities Health Coalition

Last year’s high profile infectious disease outbreak of the Zika virus is still fresh in our minds. While official announcements last week told Americans that the outbreak is waning in the U.S., all of the same conditions that created a Zika emergency last year are still present today. And just like then, the consequences of inaction are very real for those at risk, especially pregnant women and their babies. Unlike last year, we are also dealing with an Administration proposing an absurdly large –$1.2 billion – cut to the U.S. Centers for Disease Control and Prevention’s (CDC) budget in a way that would severely hamper its ability to fight, not to mention prevent, disease.

Combining Disciplines, Reducing Stigma: How Long Beach Incorporates Mental Health into Public Health

By Kelly Colopy, MPP, Director, Long Beach Health Department

May is Mental Health Awareness Month, which brings a heightened awareness and opportunity to support the mental and emotional health of those in our communities experiencing a mental illness.  As individuals and families, as well as communities and organizations, we are learning that we all know someone, often close to us, who has experienced some level of mental illness in their lifetime.  Nearly 1 in 5 adults (43 million) in the United States experiences a mental illness each year.  The impacts of mental illness diagnosis vary widely; some have serious impacts on the ability to perform major life activities.  Access to treatment has improved with the passage of the Mental Health Parity and Addiction Equity Act of 2008 and under the Affordable Care Act in 2010, yet more capacity for treatment is needed.  The conversations are increasing at the systems level as we work to grow healthy supportive environments and increase access to mental health resources in our community.  Yet, at an individual and community level, the conversations continue to be difficult.  The stigma, while lessened, still remains.

Four Ways We Are Measuring Affordable Care Act Proposals

By Patty Hayes, Director, Public Health—Seattle & King County

This blog originally appeared in Public Health Insider

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal.

Health Equity and Minority Health in Bexar County and the City of San Antonio

By Vincent R. Nathan, PhD, MPH, San Antonio Metropolitan Health District

Bridging Health Equity Across Communities" is the theme of this April’s U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) National Minority Health Month. Over the past month,  HHS OMH, with their partners, worked to raise awareness about efforts across health, education, justice, housing, transportation and employment sectors to address the factors known as the social determinants of health – environmental, social and economic conditions that impact health.  San Antonio, Texas joins DHHS in celebrating, and more importantly, recognizing the disparities in health among different groups.

Earth Day – A Celebration of Environmentalism and Environmental Justice for All

By Cynthia Harding, MPH, Robert Gilchick, MD, MPH and Angelo J. Bellomo, REHS, QEP, Los Angeles County Department of Public Health

Earth Day, celebrated each year on April 22, commemorates the birth of the modern environmental protection movement.  Started in 1970 during an era when pollution was rampant in our country, Earth Day is credited with bringing the concept of environmental protection into the national political agenda.  The first Earth Day was marked by massive rallies and demonstrations advocating for a healthy and sustainable environment.  In 2017, Earth Day will be marked by a national call to action around science, with a march in Washington DC and other communities throughout the nation.

The Chief Health Strategist Role in Tarrant County, Texas: Building Walkable Streets and Greener Food Carts

By Vinny Taneja, MBBS, MPH, Director of Tarrant County Public Health

Fort Worth and Arlington are both located in Tarrant County, a fast growing community of approximately 2 million individuals living within 902 square miles. Like many large urban communities, neighborhoods vary significantly by culture, race/ethnic background, income, education, green space, housing, crime and many of other social determinants of health.

More than the ACA: We Can’t Stop Fighting Now

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

This op-ed originally appeared on huffingtonpost.com

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Marking National Public Health Week, “Healthiest Nation 2030,” by Defending the CDC’s Support for Prevention in Local Communities

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This year’s American Public Health Association’s (APHA) National Public Health Week (NPHW) challenges us to think about what the “Healthiest Nation 2030” means. As we focus on this charge, we find ourselves again working to defend huge cuts in public health funding at the Centers for Disease Control and Prevention (CDC) and elsewhere.

Fighting TB in San Jose: New Urgency with Federal Funding at Risk

By Tara Perti, MD, MPH, Assistant Health Officer and Tuberculosis Controller at the Santa Clara County Public Health Department

Tuberculosis (TB) remains an enormous global problem and is one of the top ten causes of death in the world.  As we live in a global community, infectious diseases common in other countries also affect the United States.  In the United States, in 2015, 9,557 patients were diagnosed with TB disease

The ACA Replacement Would Devastate America’s Health

By Leana Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

This blog originally appeared on statnews.com. 

As a physician who has treated patients in the emergency department before and after the Affordable Care Act was instituted, I have seen firsthand how it has transformed the lives of many of my patients. And as the health commissioner for Baltimore city, I have seen how it has safeguarded the lives of more than 40,000 residents in my city, and millions more around the country, who would otherwise be uninsured.

ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities And States At Risk

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This blog was originally posted in Health Affairs.

When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.

Repeal of ACA would imperil a little-known part with a huge impact

By Gretchen Musicant, MPH, BSN,Commissioner,  Minneapolis Health Department

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.

To End HIV/AIDS, Cities like Ours are Leading the Way by Setting Bold Goals

By Anthony Stamper, Denver Department of Environmental Health

This was originally published as an op-ed in The Hill newspaper.

On December 1st, communities across the nation will commemorate World AIDS Day. First memorialized in 1988, World AIDS Day offers the opportunity for people worldwide to unite in the fight against HIV, show support for people living with HIV, and remember those who have died. We know that in the U.S. the number of people living with HIV and AIDS is concentrated in cities, and that cities are also the most ambitious leaders in the fight against the disease. This World AIDS Day, Denver can report some major victories in fighting the disease that policy makers at every level should study carefully.

Live Today: The Big Cities Health Inventory 2.0 – Success and Challenges

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

Today we launch version 2.0 of our Big Cities Health Inventory (BCHI), an online, open access data platform that allows the public health field, media, researchers, the public, and policymakers to look across more than 50 health and socio-demographic indicators from 28 cities – in total more than 17,000 data points. We also have a number of case studies available, highlighting innovative work in our member cities.

November is National Diabetes Month: How We’re Fighting Diabetes in Long Beach, CA

By Kelly Colopy, Director, Long Beach Department of Health & Human Services

November marks National Diabetes Month in America, and it could not be more important for us to seize this chance to educate more Americans about the disease, and help them find out more about what they can do to fight it. More than 29 million U.S. adults have diabetes, and 25% of them don’t know it. Additionally, about 86 million adults—more than a third—have prediabetes, and 90% of them don’t know it. This wave of chronic disease costs money. More than 20% of health care spending is for people with diagnosed diabetes. A 2012 study estimates the total costs of diagnosed diabetes at $245 billion.

Congress Took 233 Days To Respond. Here’s How To Prepare For The Next Zika

By Barbara Ferrer

Dr. Ferrer is a member of the Coalition's Alumni Council, as the Former Director of the Boston Public Health Commission. This blog originally appeared on HealthAffairs.com.

Congress recently passed federal funding for the nation’s response to the Zika virus, and the manner in which they provided those funds exposed a serious flaw in the way our nation handles disease outbreaks. In the time between the White House’s initial request for funding in February and the passage of the bill in September, the outbreak escalated dramatically, nearly unchecked by federal lawmakers. The entire process took a grand total of 233 days, which is simply far too long. It did not need to be this way.

Battling AIDS in Houston Latin-American communities

By Chrissie Juliano, MPP, Director of the Big Cities Health Coalition

This article was originally printed as an op-ed in The Hill newspaper.

October 15 will mark National Latinx AIDS Day across America, which is an opportunity to take stock of the great strides made towards defeating the virus and eliminating the stigma it can create. (The term Latinx serves as a gender-neutral alternative to Latino/Latina).

Science has come a long way since HIV and AIDS became a part of the national consciousness in the early 1980’s, but as experts have learned, if those advances are not shared with everyday people, and if awareness about the disease and how to prevent it does not grow, then disease rates can continue to climb, despite breakthroughs in the laboratory.