African American Community Health Forum
Health interconnections

By Jonathan Gramling

Part 2 of 2

Earlier this year, the State of Black Madison Coalition, an association of African American non-profits and service clubs, issued The State of Black Madison
2008: Before the Tipping Point, which detailed the issues that needed to be addressed by the African American community — and the Madison community as a
whole — in order for African Americans to enjoy a quality of life on a par with other Madisonians. One of the subsections dealt with health.
On November 15, the African American Health Network sponsored the African American Health Network to respond to the challenges laid forth in the State of
Black Madison. Approximately 50 people gathered at Golda’s Club on Madison’s far west side to discuss the report’s findings and explore other health topics.
One of the biggest factors that influence health disparities is access to healthcare. As the director of the Wisconsin Well Women program, Gale Johnson keeps
abreast of people’s access to the healthcare system. “It’s not true at all that everyone has access to healthcare,” Johnson said. “You have your screening
programs. You have different education programs. But when you look at a comprehensive healthcare package in terms of education, prevention, diagnosis
services and if you should need surgery, it isn’t available to everyone. Medication is a big issue in the African American community. We know there are some
medications that can be very costly, especially things that you may have to take for the rest of your life. That’s a big issue. Everyone does not have access.”
One of the major access points to healthcare is through employer-provided health insurance. Johnson is concerned that the number of the uninsured will go up
as companies continue to slice their workforce. “With the GM plant and other plants closing, I would agree that we may see the disparity in access increase,”
Johnson said. “It is my understanding that General Motors employees had health insurance even after they retired. We know those are good packages. So yes, I
think we are going to see as more people lose their jobs and plants close, we are going to see more and more people who are going to be in need of other
benefits, healthcare from somewhere else.”
Dr. Joseph West, the events keynote speaker, is also seeing the impact of the rise in the uninsured as employers scale back their workforces. Although West has a
Harvard medical degree, he has chosen to give beck to the inner-city communities of Chicago where he grew up by practicing medicine at a community
hospital. “The Wall Street Journal has done an interesting series the past couple of weeks on how — it’s not a matter of race and class — if you take a corporation
like Circuit City that is cutting 25,000 jobs, at least half of them had healthcare,” West said. “Now they don’t and so now, they fall into the uninsured. General
Motors is laying off people. So all of these people who have lost their job, 1.4 million this year, 240,000 last month [and 550,000 in November] the majority are
now part of the uninsured. They need safety-net hospitals.”
As the number of uninsured goes up, the number of people accessing West’s hospital goes up, oftentimes by private hospitals referring the uninsured to West’s
hospital. It’s not like they can afford it.
“They need safety-net facilities and community hospitals but we don’t reimburse those facilities at the same rate,” West said. “They don’t have the level of capital
and resources that is needed. And you have very wealthy hospitals who want to stay profitable. An example is on any given day, this one particular hospital has
356 days worth of cash on hand. At the hospital I work at, we have three-tenths of one days worth of cash on hand on any given day. Right now, our state is
behind $4 billion in terms of paying its bills. The toll roads got paid. The contractors got paid. The last to get paid are education and healthcare. I never
understand that where in our country, the two things that actually make up the fabric of our well-being are almost the last two things to receive consideration in
almost every state budget, the first thing to get cut and the very last thing to get supported. It’s hard to go to work when you are sick. It’s a hard for a child to
graduate from school when they can’t read. But they are the very first things we find in our budgets to cut. And they are the very last things when things get tight
that we want to pay.”
One of the state of Wisconsin’s most innovative programs to provide access to healthcare has been to establish BadgerCare Plus, a Medicaid-funded program
that insures low-income families with dependent children. And those who are 65 years and older can rely upon Medicare. But that leaves a large gap in the
medical safety net. “It seems to be that where you really have an issue with folks are uninsured, for sure, are men and women who are in their middle years who
don’t have young children, so they are not eligible for Medicaid or the Wisconsin medical assistance program,” Johnson said. “They are too young for Medicare,
so they don’t have those benefits. If we really take a look at the numbers, we are going to find that it will be a lot of young adults and adults in their middle years
who just don’t have anything.”
The state of Wisconsin had plans to expand health insurance coverage to many in these ranks through BadgerCare Plus for Childless Adults. But with the state
facing a possible $5.5 billion deficit, it appears that the program may be delayed. While the program will be instituted in Milwaukee County in January 2009,
plans to expand it statewide have been delayed due to the economy.
And in the end, if the number of the uninsured begins to swell, it is everyone else who ends up paying for it one way or the other as people begin to use the
emergency room as their primary source for healthcare. “If you are unemployed, that’s more people who will be looking elsewhere for health,” Johnson said. “If
you have to pay for health insurance out of your pocket, it can get to be very expensive. It could be the difference between your groceries and … and paying out
$600 per month to pay your health insurance premium. It’s not so much a luxury as it is you have to make some hard choices because it is expensive if you pay
for it out of pocket yourself.”