Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
Rev. Dr. Martin Luther King Jr.
From September 28–October 3, 2020, poor and dispossessed people will be coming together to demand their right to health and health care. People who are uninsured and underinsured, homeless, low-wage and essential workers, health care professionals, clergy and others will join in “Medicaid Marches” that are being organized in multiple states, including California, Kansas, Maine, Massachusetts, North Carolina, Pennsylvania, Vermont, Wisconsin and nearly half a dozen more.
Organized by the Nonviolent Medicaid Army, these marches center the health care needs of the poor and dispossessed, both in response to the pandemic and years of injustice in health care for the poor. Although Medicaid is the only public health care option for poor and low-income people, it is under constant and intensifying attacks. Interventions around drug testing, work requirements and time limits are making it harder for people to enroll or access their benefits. Now, the Supreme Court vacancy means that the future of the Affordable Care Act is on the line, with millions of people’s lives in the balance.
Medicaid is not beyond our means. Just one military contract could pay the initial costs to expand Medicaid in the 14 states that have refused to do so under the Affordable Care Act. As we have seen in this pandemic, resources are readily available when crises break out. In fact, the wealthy have been able to increase their wealth out of this moment, making their lives even more secure.
What is really at stake in the battle for health care is to what extent our society and government can and will can be held accountable to and prioritize the least of these, rather than the wealthy and powerful. This is not a question of charity or goodwill, but of economic and moral necessity.
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Although the U.S. accounts for only 4 percent of the global population, it also accounts for 20 percent of global deaths from the novel coronavirus. While this is due in part to failures in political leadership to address the pandemic in a timely and responsible way, it is also a reflection of a health care system that was already failing millions of people. A January 2020 study found that, while the U.S. spends more on health care as a share of the economy than other rich countries, it has the lowest life expectancy, highest chronic disease burden, highest suicide rates and the highest rate of avoidable deaths among those countries.
These failures translate into devastating health inequities. Mortality rates among Black infants and maternal mortality rates among Black women are disproportionately high and Indigenous people have a life expectancy that is 5½ years lower than the national average. At least 250,000 people die every year from poverty and inequality.
No one should have to bury their child in America because they don’t have health insurance.
Callie Greer, Alabama Poor People’s Campaign
In 2018, there were 87 million people who were uninsured or underinsured, therefore without adequate access to health care. During the pandemic, close to 12 million people lost their employer-sponsored health care when they lost their jobs. Those who are most at risk of losing their health care are poor and low-income people: they usually do not have access to health coverage through their work and if living in states where Medicaid was not expanded, many also fall into a coverage gap where private insurance is too expensive, but their income is above the cutoff for financial assistance.
These gaps and holes in our health care system have a death measurement. Based on a 2013 study, the Center for American Progress found that 12,000 lives could have been saved through Medicaid expansion alone. Rather than securing health care as a human right, approximately 22,000–27,000 die every year from being uninsured.
Indeed, despite our great wealth, this nation is not able to secure our public’s health. During this pandemic, Black and Indigenous people have experienced higher death rates than any other racial or ethnic group, while income has emerged to be a main predictor for contracting the virus. Of the 200,000 who have died from the coronavirus, 40,000 are Black, 39,000 are Latinx, 7,000 are Asian, 1600 are Indigenous and 94,000 are white.
“I worry about you every day.”
Mother’s Day card from Denita Jones’ 16 year old daughter. Denita is a single mom and essential worker in Texas
Health care is not only inaccessible and unequal, it is also increasingly unaffordable. A new study by West Health and Gallup show that half of U.S. adults are worried that a major health event in their household could lead to bankruptcy. The survey found that, because people living in low-income households were four times more likely to carry long-term debt than those living in higher-income households, many of them were avoiding treatment in fear of the costs of health care. Claire Chadwick, an essential worker who contracted COVID-19 at her workplace, could not afford to be hospitalized and was never treated for her symptoms. She still suffers from shortness of breath and may have long-term health consequences that will continue to be beyond her ability to pay. Claire is a member of the Nonviolent Medicaid Army and organizing around health care in Kansas.
This financial stress predates the pandemic. In 2016, more than one-third of adults living in poor and low-income households surveyed by the Kaiser Family Foundation reported that they struggled to make their insurance payments; another 70 percent reported cutting back on basic household necessities, including food, in order to pay their medical bills. In 2017, the number one cause of personal bankruptcy was medical debt.
Co-founder of Put People First! PA and lead organizer of the Nonviolent Medicaid Army, Nijmie Dzurinko, described this crisis of affordability in 2018: “People are choosing between paying for medications and paying for utilities. They are stretching out medications, choosing between buying food and getting health care for their kids. This makes life very hard, when you need to choose between one need or another need, when they’re really all needs. People are saying they are forced to stay in relationships because of insurance, because otherwise they won’t have benefits. It’s also a real question for workers, who are constantly bargaining away their other rights for their health care.”
We are only as secure as those with the least health care access among us.
Rev. Dr. Liz Theoharis
For these reasons and more, health care was a unifying concern among voters in the 2020 primaries, more so than in previous years. In 2012, 18 percent of voters said health care was the most important issue facing the country. By 2020, 40 percent of Super Tuesday voters listed health care as the most important issue in deciding their vote, including in Iowa, Alabama, California, Colorado, North Carolina and Virginia. It remained the most important issue to voters in the Arizona, Florida, Illinois, Mississippi, Missouri, and South Carolina contests. By the time the national lockdown was in place, 69 percent of registered voters polled by the Washington D.C. paper, The Hill, said they support Medicare for All, including 46 percent of Republican respondents.
While the pandemic offered an opportunity to reorient our health care system to meet these growing concerns, what lawmakers passed in the CARES Act has fallen far short. The CARES Act provides for free testing for COVID-19, but not treatment or vaccines. It does not incentivize the expansion of Medicaid or secure safety measures and standards for essential workers. It even fails to prevent hospitals from being closed in the pandemic, which means that some dozen hospitals have been shuttered in the worst public health crisis this country has seen in decades.
The CARES Act also leaves the door wide open for pandemic profiteering. Second-quarter earnings for some of the largest health insurance companies were double this year than they were a year ago. Big pharma is looking at lucrative opportunities in terms of new tests, treatments and vaccines. And, the country’s billionaires have added $845 billion to their wealth since March.
There is a relationship between the government’s failure to provide health care for the most vulnerable among us and this wealth bonanza. As Rev. Dr. Liz Theoharis wrote earlier this year, these are “the costs of having a two-tiered, privatized health system — where those who can pay get care, while millions suffer and die in close proximity to some of the best medical resources in the world.”
You only get what you’re organized to take.
National Union of the Homeless
One week after this year’s election, the Supreme Court will hear a challenge to the Affordable Care Act. With all of its flaws, the ACA has narrowed the coverage gap by 20 million people since it was implemented. The politics around the Supreme Court appointment are about their lives, their families and whether this government will take a stand for the poor and dispossessed.
This is not a fight that we can concede. As the Poor People’s Campaign showed in its report on the voting potential of poor and low-income Americans, health is among the two main concerns of more than one-quarter of the electorate. The right to health and health care touches on every issue facing the poor, from job insecurity, homelessness, hunger, pollution, debt, war and more; it connects different segments of the poor to each other, from non-unionized low-wage workers to unionized workers across sectors and families and households of every size, gender, sexual orientation, ability, age and documentation status; and it connects the poor with people who may not be poor today, but who are deeply concerned about their health and health care in every region of the country. It also connects the struggle for health care in this country with the struggles of poor people around the world, especially when questions are raised about funding for war and funding for our basic needs here at home.
Rev. Dr. Martin Luther King Jr., predicted that a “nonviolent army of the poor” would be a new and unsettling force that could lift the load of poverty in this country. In the interview below, organizers describe how this army is rising up through the Medicaid Marches this week. Drawing on the Poor People’s Jubilee Platform, they are calling for the immediate expansion of Medicaid in every state, protecting and securing Medicare and implementing a universal single-payer health care system. They are calling for ending medical debt and investing this nation’s abundant resources into a public health care infrastructure that can ensure accessible and quality health care to everyone in this country.
Somebody has been hurting our people for far too long and we will not be silent anymore!
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Shailly Gupta Barnes: Some of you have been working around health care for a long time. Where did the idea of the Nonviolent Medicaid Army come from and what do the Medicaid Marches look like on the ground?
Nijmie Dzurinko, Put People First! PA: The whole concept of the Medicaid marches started with the Vermont Workers’ Center and the marches they’ve done over the years. The concept of the Nonviolent Medicaid Army started with Put People First, but it started to cohere a few months ago, after the pandemic. It’s a response to the conditions we are facing, where millions of people are applying for unemployment, have lost their health care, are about to be evicted and these racist police killings are continuing to happen. The Nonviolent Medicaid Army speaks to the connections between all of these attacks on the poor and the need to unite around our need for health care.
Avery Book, Vermont Workers’ Center: Health care is really siloed into a million little issue areas: there’s care for senior citizens, care for people with disabilities, care for immigrants, care for poor people and all these sorts of things that divide up our class.
Having this framework of a Nonviolent Medicaid Army of the Poor means that we’re all getting into step with the long-term vision on a local level, without the usual ways that the policy and foundation worlds keep us divided from each other. It was a real breakthrough when we envisioned a universal struggle around health care. We all want health care as a human right, but that looks different in these different places. Kansas is fighting for Medicaid expansion. In Vermont, we have COVID demands and the all-time demand for universal health care and public control of hospitals. It’s clear that in a system where all the small, rural hospitals are on the verge of closing that we need to treat health care like the public good it is.
Savina Martin, Massachusetts Chapter of the National Union of the Homeless: In Massachusetts, we are organizing mainly around Methadone Mile. We call it Methadone Mile, but now it’s Methadone 2.5 mile. The encampment has grown because of the neglect of the state government that has been turning the other way for years. We’re literally dying every day: from hunger, homelessness, a lack of good treatment around this virus. What we’re asking for is treatment on demand. This is why we’re talking about Medicaid expansion and on and on. This what we’re fighting around.
Anthony Prince, California Chapter of the National Union of the Homeless: In California, there are a lot of ways that poor people can’t access the health care they’re entitled to, especially the homeless. Every year, you have to reapply to be on MediCal, so homeless Service Providers will sign people up for MediCal, but because there’s no attention paid to the re-enrollment process, those people will be dropped. And in the forms to enroll or access your benefits, you can list a shelter, but you can’t list a street as your location of care. This puts homeless people who aren’t in the shelter system out of being able to get treatment, unless they go into the shelters. And providers aren’t obligated to accept MediCal. So you can qualify for MediCal, you can be enrolled in it, but still never get any care.
Kate Kanelstein, Vermont Workers’ Center: In Vermont, we want to organize in places that have been completely abandoned and where people are not being asked to join in anything. Our main march is in a small town, Bellows Falls, which is an area known as “the rust belt.” It has been dis-invested in, in terms of hospitals, schools, and other infrastructure. In this small town of 3000 people, 300 people came out in a march around the uprisings. These are the folks who we want to tap into: folks who are going to be foreclosed and who are facing evictions, who have maybe already been kicked off of unemployment and are struggling in this crisis.
Shailly: Why is it that we spend more on health care than any other country in the world, but guaranteeing health care is not a national priority?
Sergio Hurtado, COSECHA: Immigrants and especially undocumented immigrants have a lot of questions around: Why don’t we have health care? How can we get it? Why are we so left out?
When we say, “profit over people,” in truth, there’s no incentive for the most powerful and wealthy interests to maintain the well-being of people. Immigration is really a source of cheap labor and a correction to the costs of labor in times of crisis. It’s not a coincidence that when this country enters an economic crisis, deportations go up to control labor.
Anthony: Unlike political rights, which most people believe they do have across the political spectrum, many people don’t actually believe they have any economic rights, including the right to health care. It is thought of as another commodity that’s available for purchase, that you can either afford or you can’t afford. Even though our country’s founding documents talk about “life, liberty and the pursuit of happiness,” it’s hard to have liberty when you’re diseased and sick.
That’s why I think calling ourselves the “Nonviolent Medicaid Army” has specific significance: We’re raising the issue of the right to health care that we already have under the Medicare and Medicaid programs of 1965. We have to expand people’s awareness to believe, “I do have a right to this,” and then fight for that right and broaden it to include everyone who is currently left out.
We’ve made a real breakthrough around this way of thinking recently in California and Texas, through homeless veterans who are going to the encampments to provide medical services. These are women and men who were medics in the military and have real skills to offer, but because they have access to the Veterans Administration, they also have some concept of the right to health care. They have a better idea that health care is an entitlement, which they have to fight for and defend.
Shailly: Anthony referenced working with veterans and I know that some of you have organized actions against our wars abroad. What is the relationship between health care and foreign policy or militarism?
Nijmie: We spend an obscene amount of money on the military and military bases around the world that could be moved over into health care and basic needs. That’s one way these issues connect, but there are also concrete ways that the military is affecting our health. In Montgomery County in the southeastern part of Pennsylvania, in what is thought to be a well-to-do, mostly white suburb outside of Philadelphia, there is an old military base. It was converted into a drone warfare base. Before its conversion, it was a storage facility for noxious chemicals called PSAS that leached into the ground and poisoned the ground water directly impacting our [PPF-PA] members and their families and their health.
Savina: I was stationed at Fort McClellan, Alabama, which is now closed, because it was built on a contaminated site. It’s in the Choccolocco Hills and there is poisoned ground water there. This was 20–30 years ago. There are veterans today who are still trying to sue Fort McClellan because of the chemical toxicity, burns, respiratory problems, and horrible blisters that they suffered. Veterans have to come home from domestic and international deployment and they still have to fight for health care.
Avery: It’s striking that here in Vermont and other parts of the country we see the National Guard mobilized to put down protests and also to distribute food and set up health care clinics. It’s a very visible representation of where resources go. Where is our corps of health care workers to provide universal health care to everyone? Where is our health care?
Not only is health care underfunded, it is in direct conflict with a system that prioritizes and resources violence. At a time when state violence is being used more than ever to target and divide us, health care has real power to unite us, to unite the poor, around this basic need.
Shailly: What do you hope will come out of these marches?
Nijmie: In a lot of the states [participating in these marches], people are thinking about how to use this activity to build their base. Health care is a rallying point that connects to all the attacks that are facing our class. People can organically see the connections between health care and housing; health care and environmental degradation; health care and mass incarceration, and all of those issues. This is a real vehicle for moral fusion organizing.
With this being organized as the “Nonviolent Medicaid Army” and “Medicaid Marches,” the activity is embedded in a strategy to organize people who are on Medicaid or don’t have it. There is no confusion about who we are organizing: we are organizing poor and dispossessed people. The marches and other tactics are a way to do that concretely.
We’re hoping that out of this activity, the organizing of the poor and dispossessed is strengthened across the country and across the Poor People’s Campaign and more people are in relationship to each other, particularly across the north and the south, and we can build and continue to deepen our political analysis, strategy and base building.
Phil Wider, Put People First! PA: These Medicaid Marches are a moral and organizing revival for folks who are joining this movement, many for the first time, or as Kate said earlier, the “unorganized.” We are trying to use these marches to identify those folks who are coming in our direction. The effort to identify, recruit and absorb some of those elements into our process is really important.
Avery: I think we are in a big “pull back the veil” moment that speaks to how expendable the poor and dispossessed are to the ruling class. Amidst this unprecedented global health and economic crisis, the Democratic Party refuses to take up universal health care. And before the crisis there were 70 million people on Medicaid. We know that the dial is turning towards wanting to plunder every public health care option or program that’s left to maximize the profits that are available in health care. The polarization between the rich and poor will only become more and more pronounced and our fight for health care even more of a rallying cry to unite the poor.
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