California women of color need universal health coverage

in summary

Women of color in California experience some of the worst social inequalities, especially when it comes to health care. A UC Davis student argues that universal coverage would help eliminate inequalities that lead to higher infant mortality rates and pregnancy-related deaths.

Guest comment written by

Indira D’Souza

Indira D’Souza is an undergraduate student at UC Davis and winner of the 2023 UC Davis Center for Poverty and Inequality Research Black History Month Student Essay Contest.

Addressing racial and economic inequality in California requires policies that improve the material conditions of those groups in our society who face the greatest difficulties. One such group are women of color, and such a policy would introduce universal health insurance.

The experiences of women of color are deeply racist and tied to the institutional legacy of American slavery, Jim Crow, and discriminatory welfare policies that limit their access to welfare and lock them up at higher rates.

Women of Color are also subject to disparities when it comes to health care. For example, infant mortality rates are highest among African American women across all educational levels. As the number of pregnancy-related deaths in the US increases annually, it is low-income minority women who face the highest maternal mortality rates.

Racial and gender-based health inequalities require bold, creative strategies aimed at improving women’s socioeconomic status relative to men. Medicaid already covers 50% of births in the US, but Medicare only covers those over 65 and can be expanded to the state level to ensure all births in California are covered by health insurance.

Accordingly, Californians need a system of universal health coverage through a single payer like Medicare for All.

Universal health coverage countries, such as Canada and the UK, have significantly lower maternal mortality rates than the US, at 6.5 and 8.6 deaths per 100,000, respectively, compared to the US’s 17.4. Universal health coverage would improve the health of infants and pregnant people by providing free pre- and post-natal maternity care to all Californians.

Because a majority of maternal deaths occur in the postpartum period, the Medicare-for-all system could include incentives for the training and licensing of midwives and home-calling programs, two evidence-based methods of improving outcomes for the pregnant person and child. Home visits are essential to assess social determinants of family health, such as housing and access to food, and to provide psychological support to new parents.

While the Affordable Care Act narrowed the gender health disparity by requiring insurance plans to include contraception and prohibiting sex discrimination in insurance premiums, Medicare for All builds on the expansion of the ACA and Medicaid to provide quality care regardless of socioeconomic status.

Echoing Senator Elizabeth Warren’s plan to provide universal coverage at the federal level, an ideal path for California might begin with a public option. Under the Warren Plan, children and families earning less than 200% of the federal poverty line would be automatically put into the public option with no premiums or cost-sharing, and adults over 50 could elect Medicare, significantly reducing uninsurance rates.

Continuing Warren’s public option proposal, individuals with employer-based insurance could elect the public plan, with mandatory employer contributions and significant reductions in premiums (capped at 5% of earnings) and co-payments (capped at 10%). The public option would ensure greater bargaining power with pharmaceutical companies (thereby helping to drive down drug prices), pay providers more to incentivize participation, and cover benefits such as prescription drugs, dental care and vision.

Ultimately, Medicare for All would save money thanks to reduced administrative and provider costs compared to private insurance. Over a five-year period, Warren’s transition plan ensures that premiums and co-payments are reduced to zero. This would create a state-level healthcare system paid for by a single payer and, like Bernie Sander’s proposal, funded by wealth, capital gains and income taxes directed at the wealthiest Californians and Silicon Valley companies. Private plans, whose costs to workers have steadily increased while covering fewer benefits, would be phased out in favor of the state health plan.

Shifting from a public option to single-payer health insurance would provide access to health care for vulnerable communities, increase competition, reduce costs and drug prices, and reduce health inequalities for pregnant women.

Most importantly, it would help reduce inequalities in access to health care that low-income women of color face. As such, Medicare for All would be an important step in reducing racial and socioeconomic inequalities across California.

Indira D’Souza is the winner of the 2023 UC Davis Center for Poverty and Inequality Research Black History Month Student Essay Contest, from which this commentary was adapted.

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