Excerpted From: Maya K. Watson, Inaccessible Health Care, 92 UMKC Law Review 393 (Winter 2023) (155 Footnotes) (Full Document)

MayaKWatson.jpegQuality health care is valuable--but only to the extent it is accessible. From 2020 to 2022, I had the privilege of working on a team to launch a medical-legal partnership (“MLP”) in a Chicago suburb with majority Black and Hispanic populations. The MLP provides free legal assistance and inter-professional support to patients of six local medical clinics who face social, structural and/or environmental conditions that prove harmful to their health. Partnering health care providers refer patients to the MLP to address various health-harming legal issues. For example, patients facing imminent threats of eviction, disability-related unemployment, or unsafe dwellings are eligible for referrals to the MLP.

In one sense, patients who are referred to the MLP have effective access to health care insomuch as their connections to primary care physicians created the opportunity for the referral. However, we found that significant access challenges persisted. Some patients could not afford their prescribed medications and revealed that they cut dosages or simply went without necessary treatment. We also met a pregnant client living with a disability who needed to travel to required doctor's appointments, but she faced significant transportation hurdles. The MLP also spoke to individuals whose residential water services had been shut off when they became unable to pay service fees (in many cases, due to COVID-related job loss). Many were forced to choose between paying for water, food, medications, or other necessities. These and other situations highlighted challenges patients faced in accessing health-related services that were critical to sustaining their lives. This Articles will discuss how these obstacles to health care access have thrived in communities of color.

This Article discusses how access to quality health care has remained elusive for large numbers of African descendants in the United States for generations. Black, Hispanic, and Indigenous populations experienced disproportionate rates of illness and mortality as a result of the COVID-19 pandemic due, in part, to disparities in health care access.

Section II of this Article references the role that universal health care has had on global health care access in the countries that have implemented these policies. Access to care within these countries is contrasted with access in the United States. According to the results of an international survey, the United States placed last in many of the polled health care system categories.

The unimpressive state of United States health care, this Article argues, is fueled by governmental failure to address historical and systemic racial health inequities. This failure has made it substantially more difficult for some non-white populations to access health care services. So, in Section III, we narrow our focus on the United States and explain the history of health care segregation in this country and its impact on health care access. We explore how health care segregation yielded a two-tier health care system. In Section IV, this Article discusses Title VI and its limitations. Section V details how efforts towards desegregation have played a critical role in depriving many Black communities of health care access. In Section VI, the Article offers recommendations to address these issues and allow for more equitable access in the United States.

Racial health inequities have been one of the most indelible extensions of systemic racism. To achieve health equity across racial groups and tackle systemic health care inequities, historical and current barriers to access must be addressed.

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The Civil Rights Act of 1964 and the Affordable Care Act were passed with hopes of advancing health equity and access. Both, regrettably, failed to guarantee underrepresented groups long-term access to quality health care and neither adequately redressed generations of racial health inequity.

The United States should follow the lead of its international peers and embrace universal health care. The top performing countries in the 2021 survey with the most successful health care structures have all implemented universal health coverage and successfully reduced barriers and cost for individual patients. While this will not ameliorate all racial health inequities experienced in the United States, it will be a substantial step toward allowing for greater access to health for all population groups.

Relying on the individual fifty states to provide United States' citizens with quality health care has proven to be an inadequate approach. Instead of allowing for equitable healthcare access, this decentralized plan will continue to perpetuate future iterations of past racially discriminatory policies.

It is long overdue for the United States to adopt a universal system. There are various ways that countries have adopted universal health care and the United States can choose from a spectrum of alternatives. The federal government's default method of delegating the administration of health care policy to the states becomes tainted and inextricably linked to the oppressive, racially subjugated systems that have denied Black people access to quality health care for generations.

The federal government is also encouraged to do what Title VI did not do and retroactively address past inequities in access. The federal government must commit--through funding, monitoring and enforcement--to ensuring that communities, like Detroit, that are most affected by the residual impact of redlining, hospital closures and segregation, are infused with quality health facilities with independent, culturally competent providers who advocate for the communities they serve.

Maya K. Watson, J.D., LL.M. is an Assistant Clinical Professor of Law and Director of the Business and Community Law Clinic at Wayne State University Law School.