21st Century Poverty Chapter 5: Healthcare and Wellbeing

Health and wellbeing are foundational to the success and continued growth of our communities and our nation. In our current system, it is all but impossible to receive medical services without health insurance and avoid medical debt. Both research and personal stories teach us that without health insurance, people are less likely to receive medical care. Understanding who has and who lacks access to affordable health insurance is a key part of understanding the intersection of healthcare and 21st century poverty. But there is still more to the story, because even with insurance health outcomes vary by income level, race, and gender. Health and poverty both intersect and influence each other. High medical costs can cause any family or individual to experience poverty with one diagnosis, while low-income communities experience disproportionate health disparities.

Seeing the connection between health and poverty cannot simply be an academic exercise for us; this issue has real life consequences. In the United States, life expectancy in the lowest-income neighborhoods is 10 years shorter than in the richest neighborhoods.1 Black men have the shortest life expectancy (72.5 years) compared to other groups.2 Additionally, infant mortality is significantly higher for Black, American Indian, and Alaska Native infants compared to white infants.3

Some of these disparities stem from the fact that in our current reality, healthcare is primarily obtained through an employer. For many possible reasons, this may not always benefit an individual or family: an employer may not offer employer-sponsored coverage, a worker might not be eligible, or someone could be experiencing a period of unemployment.4 Most uninsured people have at least one working member of their family, despite the common belief that employment should be the key factor in determining one’s access to healthcare. Moreover, because of the connection between health insurance coverage and work, some ascribe the same incorrect beliefs about work and poverty to health and poverty. The reality is more complicated. In some situations when a worker is offered employer-sponsored healthcare, or an individual qualifies for subsidies in the marketplace, insurance costs can still be prohibitive.

The passage of the Affordable Care Act (ACA) in 2010 allowed states to expand Medicaid for adults who previously earned too much income to qualify but were still struggling financially, established health insurance exchanges with subsidies for individuals and families to purchase their own health insurance, and more. This resulted in a significant decrease in uninsured people in our nation, from 44 million in 2013 to less than 28 million as of the end of 2016.4 Unfortunately, much of this success is being rolled back as President Trump and Congressional Republicans work to dismantle the legislation. In the last quarter of 2017, the uninsured rate began rising again, adding 3.2 million people. Healthcare is a human right, and it is both a personal and political fault that millions of our sisters and brothers lack access to necessary, life-giving care in the 21st century.