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The Right to Good Healthcare and Good Health
 

The Right to Good Healthcare and Good Health

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Report on health and human rights is based on research at Uplift International, a health and human rights NGO based in Seattle, Washington. Research used in presentation for 2009 National Academy of ...

Report on health and human rights is based on research at Uplift International, a health and human rights NGO based in Seattle, Washington. Research used in presentation for 2009 National Academy of Public Administration\'s Social Equity and Leadership Conference at Rutgers University - Newark.

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    The Right to Good Healthcare and Good Health The Right to Good Healthcare and Good Health Document Transcript

    • T h e Rig h t t o G o o d H e alt hcare a n d G o o d H e alt h—Wh ere Is O ur Bailo u t Pla n? By: Marissa Beach, MPA Candidate, December 2009, University of Washington, Seattle Prepared for: Social Equity and Leadership Conference, Rutgers University – Newark, New Jersey Page 1 of 38
    • EXECUTIVE SUMMARY This report analyzes state universal health care legislation through an international human rights lens. It addresses some of the complexities of healthcare reform based on the author’s summer 2008 research at Uplift International, a Seattle-based nonprofit working in health and human rights1. In sum, the report (a) addresses existing health disparities in Washington State, focusing on King County, despite progressive legislation; (b) addresses different actors in society and their actions for change; and (c) poses critical questions. This report concludes the following: ! A variety of factors influence and affect national, state, and regional health disparities (e.g. race, racism, income, socioeconomic position, poverty, geographic residence, and more); ! The majority of Americans with insurance (64%, data from 2005-2006) attain it through their employer, thus, limited insurance for the unemployed, homeless, and other vulnerable populations; ! Vulnerable populations such as children and the mentally ill, among other vulnerable populations, face greater obstacles to achieving good health and attaining sufficient healthcare to cover their needs—and their human rights; ! Nationally, 16% of the total U.S. population is uninsured, while individual states range from 8 to 20 percent;1 ! Many state universal healthcare bills introduced annually are stalled in the political process or remain at the committee level with an unclear or unknown status; and ! For universal healthcare bills accessible at the time of this research, legislation has been introduced in at least 14 states. 1 www.upliftinternational.org Page 2 of 38
    • 1 TABLE OF CONTENTS 1 TABLE OF CONTENTS ...................................................................................................................... 3 2 PURPOSE OF REPORT ....................................................................................................................... 4 3 METHODOLOGY ................................................................................................................................ 4 4 BACKGROUND ................................................................................................................................... 4 5 INTRODUCTION ................................................................................................................................. 5 6 U.S. HEALTHCARE AND RIGHT TO HEALTH .............................................................................. 5 6.1 U.S. Insurance ................................................................................................................................ 6 6.2 Hunger in the United States............................................................................................................ 7 7 STATE’S ROLE IN HEALTHCARE INITIATIVES AND POLICIES IN UNIVERSAL HEALTH CARE............................................................................................................................................................ 7 7.1 Seattle, Washington........................................................................................................................ 8 8 CHILDREN’S HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 1990s ..................... 10 8.1 Diseases ........................................................................................................................................ 10 8.2 Violence and Delinquent Behavior............................................................................................... 11 8.3 Sexual Behaviors, STDs, and Unwanted Pregnancies.................................................................. 11 8.4 Poverty.......................................................................................................................................... 12 8.5 Youth’s Security: Sexual, Racial Harassment and Rape.............................................................. 12 8.6 Uninsured in King County (1991-1998)....................................................................................... 12 9 CHILDREN AND YOUTH HEALTH IN KING COUNTY - 21ST CENTURY................................ 13 9.1.1 CHILDREN’S ORAL HEALTH .......................................................................................... 14 9.2 Legislation for Children in Washington ....................................................................................... 14 9.3 Hunger in Washington.................................................................................................................. 15 10 PUBLIC HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 2008 ............................ 16 10.1 Uninsured in King County – Seattle, Washington.................................................................... 16 10.2 California .................................................................................................................................. 17 10.3 Maine ........................................................................................................................................ 17 10.4 Vermont .................................................................................................................................... 19 10.5 Massachusetts ........................................................................................................................... 19 10.6 California .................................................................................................................................. 20 10.7 Building Coalitions for Women’s Health & Human Rights ..................................................... 21 10.8 South Carolina .......................................................................................................................... 21 10.9 Florida....................................................................................................................................... 22 10.9.1 Coalitions in South Carolina and Florida......................................................................... 22 11 CONCLUSION................................................................................................................................ 23 12 WORKS CITED .............................................................................................................................. 34 Page 3 of 38
    • 2 PURPOSE OF REPORT The purpose of this report is to provide researchers and health professionals, specifically Uplift International—a non profit based in Seattle, Washington working in health and human rights— with a broad overview of the right to healthcare and health in the United States. Uplift International and other health advocacy organizations could use this report to advocate for health and healthcare reform at all legislative levels. 3 METHODOLOGY The author’s research took place during the summer (June to August) of 2008 as a Research Assistant for Uplift International. Sources for this research come from a combination of online legislative databases, academic journals, and health statistics. For research on the 2005 Seattle Right to Healthcare ballot initiative, the author interviewed 10 Seattle city policymakers and executive directors of health nonprofits, and 75 residents of Seattle to gage their awareness of the ballot. The ‘street interviews’ took place in various neighborhoods in Seattle, Washington at different hours of the day on five separate days total. Survey questions gauged knowledge and opinions on health and human rights and awareness of the 2005 Seattle Right to Healthcare ballot initiative. One survey drawback was not asking residents their 2005 residency status, which would likely influence their awareness of the ballot initiative. 4 BACKGROUND The Health Insurance Portability and Accountability Act (HIPPA) in 1996 created the first federal standards for health insurance. Post September 11, 2001 policies increased state public spending on public health preparedness, a shift in available federal funds for terrorism and bio- terrorism, which gave U.S. federal agencies the power to both intervene and coordinate a national agenda for public health. At the same time, the shift often gave U.S. federal agencies the power to disregard basic human rights.1 One such area of undermined human rights is the lack of a national single health care policy and law entity, in such that contradicting policies, state and federal laws exist and public opinion becomes a blur.2 There is a need to: “Bridge gaps between different policy-making authorities between conflicting paradigms, legal doctrines, and public policies that coexist only because they have never had to be reconciled.”3 Even when laws and policies are in place to guarantee certain rights or to implement new poverty reduction programs related to health, they do not necessarily lead to the “right to health.” For example, one of the goals of The International Conference on Population and Page 4 of 38
    • Development held in Cairo, Egypt in 1994, was to “empower women to become ‘full and equal members of society,’” but reduced the ‘problem’ to behaviors (i.e. impoverished women perceived as not capable of putting on female condoms nor capable of telling their partners to wear condoms).4 5 INTRODUCTION Several international human rights documents address the right to health and healthcare. According to the Universal Declaration of Human Rights (UDHR), “Everyone has the right to a standard of adequate for the health and well-being of himself and his family…” The Second Bill of Rights for Americans guarantees “the Right to adequate medical care and the opportunity to achieve and enjoy good health.”5 According to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), women need access to health care services, facilities, and education to “help to ensure the health and well-being of families.”6 However, even though many countries have not ratified the international human rights documents, some states and cities have introduced legislation based on international human rights documents. For example, in 1998, San Francisco became the first city in the United States to adopt CEDAW. But how are such documents enforced? Who plays the role of the watchdog and who is/are the decision-maker(s)? What actions have states, cities, counties—and everyday citizens and activists taken? Across the country, coalitions have been built, partnerships established, and legislation introduced. Seattle, Washington is one such place, although it is not alone. In addition, hundreds—if not, thousands—of bills introduced each year in the U.S. Congress are related to health and healthcare. State-run programs greatly depend on federal resources and federal officials to renew programs and funding. Because state and city governments are often bound to limited federal resources, the decision-making power often falls at the national level. 6 U.S. HEALTHCARE AND RIGHT TO HEALTH At least 25 organizations, agencies, and federal programs nationwide work on policies and/or jointly with states to develop policies for the hungry. Such policies are aimed at vulnerable populations, such as those whose income falls below the Federal Poverty Level (FPL) and children, and the cross-population of the two categories. U.S. national health programs that state programs model and/or implement vary in size and scope. A few examples are: The National School Lunch Program (1946); the Temporary Assistance for Needy Families (1996); and the State Children’s Health Insurance Program (1997). In Washington State, school meals, the Basic Food Program and Apple Health provide thousands of families with basic food and health insurance needs. In addition, since 2004, the Children’s Alliance—a children’s health advocacy organization in Seattle, Washington— Page 5 of 38
    • advocated for at least 25 legislative bills that were approved that restored previously cut funding for nutrition programs with the goal of insuring all children by 2010. Despite these programs and legislation, access to healthcare has long been an issue for vulnerable populations. There are appalling racial disparities in the United States and a gap between what citizens want (and need) and what state and local governments have provided. For example, HIV-AIDS efforts during the 1990s focused on helping decrease the number of white gay men with AIDS, meanwhile women—especially minority women—and issues such as domestic violence were largely underfunded and given less attention, if not, outright ignored.7 The term “right to health” is rarely seen both in national and state bills and in the language of ordinary citizens as testimonies to human rights organizations. Instead, the language “right to healthcare” and “universal healthcare” have been frequently used by various actors to address access to health services and health disparities. Cities and states have also introduced numerous bills on universal healthcare (see Appendix 1). Nonetheless, “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” as stated in Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESC), as a component of universal healthcare has been largely ignored. According to a member of the Healthy Washington Coalition—a coalition advocating for healthcare reform in Washington State—language including human rights such as the “right to healthcare” or the “right to health” does not move people because they “are afraid of losing what they have…They’re frightened of healthcare.” 8 6.1 U.S. Insurance U.S. Health Insurance Coverage 2005-2006 Although 16% (approximately 47 million Americans) of the total U.S. population is uninsured (2005), state uninsured rates range from 8% to 20%.9 In addition, countless Americans are underinsured, facing high out- Individual Employ er of-pocket health care expenses and stress due 64% 6% to unexpected unemployment and thus health Medicaid insurance loss, especially in times of economic 15% downturns. Medicare Ot her Public 14% 1% One factor that influences public health is politics. Public officials determine what to fund and what to cut. Each year, bills are introduced Page 6 of 38
    • and assigned to committees that are often left untouched, forgotten, or unknown depending on the state’s legislative database. If the bills are sent to committees, only by contacting the individual state governments or reading state and local newspapers could one find out about specific committee tasks, a tedious task for researchers and state legislators seeking comparative data. Politics is one reason that legislation is not guaranteed to continue from one year to the next. In response, many nonprofits and alliances through out several states are advocating for health care reform with varying degrees of success. Regardless, however, the majority of Americans are willing to pay more taxes to provide every American health insurance, especially children, according to a 2007 New York Times survey.10 6.2 Hunger in the United States An average family in the United States receives $400 less in benefits per year due to the 1996 cuts. In addition, that same year Congress denied food stamps to legal immigrants but later restored legislation to many, albeit not all of these individuals. Unlike national myths, more than 98% of food stamp benefits go to eligible households compared to 15% of taxpayers that underpay their taxes, according to an Internal Revenue Service report. The majority of Americans (75%) despite a tight budget year say that the Food Stamp Program should be protected from administration or Congress’ cuts. Nationwide, 11 million people (3.8% of the U.S. population) experience “very low food security,” where at least one family member goes hungry at times due to lack of money for food. Hispanic, African American and Native American households have much higher rates of hunger. In 2007, Congress froze the value at $134 of the standard deduction for food stamp recipients to subtract from their income to reflect non-food items, a barrier that remains in effect today.11 To keep pace with inflation, this amount should have been $184 fiscal year 2007 and $205 fiscal year 2012. 7 STATE’S ROLE IN HEALTHCARE INITIATIVES AND POLICIES IN UNIVERSAL HEALTH CARE States play three basic roles in the health care industry: regulator, purchaser, and provider.12 States set different qualifications for federal-funded health programs, such as policies to run Medicaid Programs within federal guidelines. Income eligibility for states in 2005 for Medicaid ranged from below 40% Federal Poverty Level (FPL) to over 110% FPL. States purchase federal healthcare through Medicaid, State Children’s Health Insurance Page 7 of 38
    • Program (SCHIP), and/or provide state employees with health insurance. In addition, states often use federal funds for other health services such as Title V; Women, Infants, and Children (WIC) programs; AIDS treatment, and so forth. Of all state spending, 72% is spent on Medicaid (see Appendix 2). At the time of this research, at least 14 states2 have introduced legislation of universal healthcare to attempt to address health inequities and insurance coverage.13 Previously, other states that introduced universal right to healthcare legislation did not become law due to various factors. Most bills have died at the state committee levels (see Appendix 1). The following is an explanation of the major universal health care reforms across different states. 7.1 Seattle, Washington In 2003, King County Executive Ron Sims created a Health Advisory Task Force (HATF) with the mission to: “Recommend an innovative and achievable set of strategies to improve the quality of health care while moderating costs in the Puget Sound market.”14 In December 2004, Sims created a public-private partnership to that lead to The Puget Sound Alliance.15 Alliance members included: King County, Starbucks, Washington Mutual, the State of Washington, Group Health Cooperative, the City of Seattle, and Recreational Equipment Inc. (REI); and later joined by Virginia Mason Medical Center, Seattle Surgery Center, Regency BlueShield, Community Health Plan of Washington and the Hope Heart Institute.16 The Puget Sound Alliance categorized patients only to include “employees and their families,”17 thus excluding numerous vulnerable populations such as the uninsured unemployed, homeless, and immigrants afraid to seek care to their citizenship status. Among HATF’s key outcomes were to implement strategies to “reduce the increase of total health care expenditures” by mitigating “increases in personal costs/financial responsibility for health care benefits for King County employees.18 In its 2005 final report, HATF concluded: ! Medical professional lacked infrastructure elements, such as “state-of-the-art tools, a common measurement system for data collection and analysis, an organized forum, and regional leadership”;19 2 California, Delaware, Hawaii, Iowa, Illinois, Kansas, Maryland, Minnesota, Missouri, New Mexico, North Carolina, New York, Ohio, and Rhode Island. Page 8 of 38
    • ! High quality health care performance should be rewarded instead of the current state and national system of not rewarding high quality performance and not punishing low-quality performance; ! “All the local players in the health care system (patients, providers, purchasers, and plans) are unhappy and searching for solutions;20 ! A region-wide partnership was needed with specific components that included: giving patients more information to make informed health-related decisions and financial incentives for consumers and health professionals, and others. It is worth noting that the Task Force did not include any human rights advocacy group, but rather, was made up with public and private sector members. Although many members came from the health arena, there were virtually no health nonprofit organizations that formed part of the alliance, despite that the Alliance became a nonprofit itself. Although the Alliance was originally formed partially as a result of HATF’s recommendations, it has nothing to do with legislative health care reform, according to one member who requested anonymity. Instead, it aligns incentives and uses a market-based approach. The Alliance currently has 170 organizations and avoids partisan politics despite the fact that politics has everything to do with changing market-based incentives. “It’s important to help people understand that right now [2008] so many decisions are being made in total darkness,” the same member said. “Why is it we’re willing to tolerate an arcane approach to health care?” In 2005, Seattle voters passed a right to healthcare ballot measure by a majority (69% yes, 31% no) to tell the City Council: “Every person in the U.S. should have an equal right to quality health care.”21 Although the “right to healthcare” ballot measure gave residents a “unified voice in advising the City of Seattle to take concerted action,”22 healthcare disparities cannot be changed over night—nor seemingly over a couple of years. The ballot told the City to “take the necessary steps to help realize this right for Seattle residents and others.”23 This included but wasn’t limited to: ! “Ask Washington State representatives and senators in the U.S. Congress to adopt legislation that provides universal access to quality health care; ! “Ask the Washington State legislators to support our efforts and work toward this goal; Page 9 of 38
    • ! “Support education of the public about this issue and support advocacy on this issue; ! “Research ways that the City Council can improve health care access for the uninsured; ! “Compile data and publish an annual report on local health care indicators including information on access to health care; ! “Convene a panel of experts to prepare a report and make recommendations to the City about specific steps the City and Seattle private employers could take to improve insurance coverage for Seattle residents.”24 After street surveys of 74 Seattle residents in various neighborhoods, the author found that just 9.5% knew about the 2005 ballot, despite that the large majority (approximately 88%) agreed that health is a human right. This survey shows a lack of or little use of communication regarding important health care rights, a method that would go beyond publishing the document online. 8CHILDREN’S HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 1990s In order to properly address health in the 21st century for residents of King County, it is appropriate to provide an overview of children’s health in the 1990s. Children and youth of King County in the 1990s faced a variety of health problems: chronic diseases, substance and alcohol abuse, firearm and handgun ownership in households, poverty, sexual transmitted diseases, and sexual harassment and rape both at school and outside of school, among other issues. These behaviors and environments put children at risk for mental and physical abuse and thus affect children’s health status. 8.1 Diseases During the 1990s, children faced increasing rates of asthma, obesity, and accidental poisoning mostly due to illicit drug overdose, while infant mortality and smoking during pregnancy dramatically decreased among teenage mothers.! Between 1987 to 1996, child (ages 1-14) asthma rates increased by 22%, according to Public Health Watch data. In addition, according to the Center for Disease Control (CDC), childhood asthma hospitalization admissions increased 53% (from 505 to 772) between 1987-1998 in King County." By 1998, asthma was the leading cause of hospitalization among children in King County. Most cases of hospitalization for asthma were significantly higher for children ages 1-4 Page 10 of 38
    • through out the late 1980s to mid-1990s and significantly higher for those living where poverty was greatest. Hospital charges more than doubled from 1998-2004. From 1988 to 2004, the average inflation- adjusted hospital charge rose from $6,968 to $17,620. In 2004, the average charge for a hospital visit was $19,328, not adjusting for inflation. 8.2 Violence and Delinquent Behavior The health of youth in King County since 1990 has fluctuated, remained unchanged, or increased depending on the grade level and year.25 Overall, substance and alcohol usage has increased for most grades, ranging from a 1-to-8% increase in alcohol, tobacco, marijuana, and cocaine usage in the last 30 days. In addition, violent and delinquent behavior was not uncommon in the 1990s. In 1998, a quarter (25%) of King County school children in Grade 10 were drunk or high at school; 15% attacked to hurt; 7% had been arrested; 5% had stolen a vehicle; 7% had carried a handgun; and 12% had been suspended. Grade 6 children engaging in the same behaviors ranged from 1% to 21% less, except for intentional violence where 14% had attacked to hurt. Other risky behavior such as not wearing a car seatbelt, bike helmets, and life jackets and motor vehicle crashes were common among youth. The leading causes of death among youth age 10-17 from 1996-1998 was unintentional injury (37%), followed by homicide (14%) and cancer (12%). For young adults age 18-24, unintentional injury was also the leading cause of death (40%), followed by suicide (19%) and homicide (18%). 8.3 Sexual Behaviors, STDs, and Unwanted Pregnancies Although sexually transmitted diseases (STDs) have decreased dramatically overall in the 1990s, youth continued to engage in unsafe sex. Gonorrhea rates for youth ages 15-17 dropped from 412 cases in 1987 to 137 cases in 1997. Rates for Seattle youth and young adults remain significantly higher compared to those living outside Seattle. Chlamydia rates for females ages 15-17 and 18- 24 also decreased dramatically from 1988 to 1997, increasingly slightly in 1994 and 1997 from their previous years, which may be attributed to better detection from improved screening and better access to treatment facilities. For females under age 25, pregnancy, birth, and abortion rates were high during the 1990s. There was an average of 82% of unintended pregnancies from 1993-1997, 55% of which ended in abortion and 27% in live births. Birth rates differ significantly when accounting for neighborhood poverty. In a neighborhood where 20% or more of the residents live in poverty, teenage birth rates were 3 to 10 times higher than neighborhoods where 5% or less live in poverty. Page 11 of 38
    • 8.4 Poverty Poverty affects educational and social outcomes and varies among cities in King County. In addition, there are many racial disparities that exist in King County. Seattle had the highest percentage of school-age children and youth living below the poverty level in both 1989 and 1995, while Mercer Island and Issaquah had the lowest. In 1995, nearly one in five Seattle School district school-age children and youth attending schools lived in households below the FPL. 8.5 Youth’s Security: Sexual, Racial Harassment and Rape Sexual assault and rape were also major problems in the 1990s among youth. For King County public school children Grades 8, 10, or 12, unwanted sexual touching ranged from 13-15%. In Washington State, 18% of Grade 10 students reported unwanted sexual touching in 1995. That same year, rape among public high school students in Seattle ranged from 10-12% with twice as many females reporting as males. Seattle students were more likely to be sexually harassed involving sexual comments at school or on their way to or from school with females accounting for over half of the cases. For example, 53% of female students in Grade 8 and 51% of female students in Grade 10 reported such harassment in 1995. Harassment due to perceived sexual orientation was also a problem; about 8% of Seattle high school students reported such harassment. In 1995, 51% were Latinos and 51% of multiethnic students in Seattle were racially harassed, followed by 48% of whites. Southeast Asians were least likely to report Uninsured in King County, 1998 racial harassment (35%). In a 1998 survey, households with 3% youth age 13 to 17 had high 6% o tin percentages of firearm and gun 83% La ownership; 19% of these households 76% c/ ni te with youth had handguns and 30% pa hi Race / 10% is W had firearms. H Ethnicity 13% l Is c. 1% Pa 2% n/ % of Total 8.6 Uninsured in King n ia Population ia As nd 6% % Uninsured County (1991-1998) -I 9% er er Am m 0% 50% 100% -A Studies show that the uninsured both an ric in King County and nationally in the Af United States tend to have poorer health, die prematurely, have Page 12 of 38
    • decreased access to needed preventative services and face increasing out-of-pocket costs, and thus confront many unmet needs. In 1998, over 50% of uninsured King County residents reported an unmet medical, dental, prescribed drug, or vision care need.”26 Although whites made up the highest percentage of uninsured (76%), they are the only race that has a lower percentage uninsured compared to the percentage of total population. Minorities were disproportionably uninsured in 1998 compared to whites. Similar to national patterns, the majority (77%) of King County adult residents ages 18 to 64 who are insured obtained insurance from their employers or unions in 1998. However, those earning less than $25,000 were less likely to have an employer-sponsored insurance than households earning more than $25,000 (62% versus 82%). The uninsured faced major unmet needs from lack of coverage for prescription drugs, mental health, dental, and eye-glasses for King County residents age 18 and over (ranging from 18 to 40%), which in 1998 was more common than lack of medical insurance. 68% of older adults lacked dental insurance in 1998. In the late 1990s, those who were near the poverty levels earning $15,000-$24,999 had the highest percentage of uninsured (33%) than any other income group, including annual household income ages 18-64 earning less than $15,000 (28%). In 1998, 11% of King County residents (~120,000 people) age 18 to 64 lacked health insurance, compared to 13% for Washington State and 15% for the United States. Those without health insurance living in households with incomes between $15,000 and $24,999 more than doubled from 14% in 1991-1993 to 33% in 1996-1998. In 1995-1997, for this income group, the percentage of uninsured surpassed the lowest income group. Among the different racial groups, Whites, Asians, and non-Hispanic Latinos had lowest percentages of being uninsured, although higher rates of uninsured were found among sub-groups of Asians. When comparing age groups, young adults ages 18-24 had the highest percentage of uninsured (23%), while 8% of children (about 30,000 children) under 17 were uninsured in 1998. Although children living below 200% of the federal poverty level (FPL) qualify for Medicaid, approximately 17% of those who qualified were not enrolled in 1998. 9 CHILDREN AND YOUTH HEALTH IN KING COUNTY - ST 21 CENTURY Infant mortality and smoking during pregnancy in King County as steadily decreased since the late 1980s as the percent of mothers receiving prenatal care in the first trimester has increased dramatically among African Americans, Hispanics, and Native Americans, but nonetheless are still 5-15% lower than white mothers. Page 13 of 38
    • In 2003-2005, the infant mortality rate (deaths per 1,000 live births) in Washington was lower for each race and ethnicity than the U.S. rate.27 In the United States, non-Hispanic Blacks had an infant mortality rate of 14 during 2003-2005. The United States has the second worst newborn mortality rate in the developed world, according to a 2006 report using the “Mothers’ Index.”28 INFANT MORTALITY RATE (DEATHS PER 1,000 BIRTHS) 2003-2005 Washington U.S. Non-Hispanic White 5 6 Non-Hispanic Black 9 14 Hispanic 5 6 Total 6 7 In addition, in the 21st Century, youth have faced depression and eating disorders. In 2004, 14% of 8th graders, 17% of 10th graders, and 16% of 12th graders reported engaging in disordered eating behaviors. Depression is the most common mental health problem. In 2006, 30% of 10th and 12th graders surveyed reported symptoms of depression in the past year. 9.1.1 CHILDREN’S ORAL HEALTH Dental caries or tooth decay is the single most common chronic childhood disease. The disease has increased among WA children since 1994. In 2005, 20% of 2nd and 3rd graders in WA had untreated dental caries and only about 45% had received dental sealants. Nationally, 80% of dental caries in the permanent teeth is concentrated in 25% of the child and adolescent population. Dental caries (tooth decay) has increased among Washington children since 1994. Race and socioeconomic status greatly influence oral health. Children eligible for Free and Reduced Lunch and Head Start of non-white ethnicity in 2005 had higher rates of untreated tooth decay than those not eligible and white children. 9.2 Legislation for Children in Washington At the turn of the 21st Century, in 2002, Washington eliminated the state-funded Children’s Health Program.29 There were numerous administrative barriers for Medicaid eligibility, resulting in 40,000 children who dropped from the Medicaid program, and numerous budget cuts to other vital programs for children. In 2004, Child and Family Services Review (CFSR) scored Washington among the bottom third of all states in the nation meeting CFSR standards. In 2004, an annual client survey of 2nd Harvest Inland Northwest in Spokane found at: Page 14 of 38
    • ! 56% of clients going to their food bank had worked during the past year; ! Over half of the parents (60%) skipped meals so their children could eat; ! 27% skipped meals at least once a week; and ! Nearly half of their food bank clients were children. Fortunately, the Children’s Alliance advocated for over 30 bills since 2004 to increase funding for children’s programs, restore previous budget cuts with the new Governor, Christine Gregoire, especially programs aimed at foster children, racial disparities in health, and childhood hunger. In 2005, the “Health Care for Every Child” (HB 1441) created comprehensive health coverage program for immigrant children below the FPL not eligible for Medicaid and Washington legislators promised to insure all children by 2010. In addition, in 2005, Washington legislators passed bills to: ! Expand school breakfast to all high-need schools in the state (where at least 40% of students are eligible for free or reduced-price meals); ! Fund the WIC Farmer’s Market Nutrition Program, nutritious foods for low-income families; ! Improve child welfare for allegations of abuse, chronic neglect, and education for coordinators of foster children; ! Fund the Kinsap Care Navigator Program to address disproportionality for children of color. 9.3 Hunger in Washington “Food insecurity of hunger”—households where at least one family member goes hungry at times due to lack of money for food—increased in Washington households from 275,000 in 2003 to 292,000 in 2004. In 2005, 12% of all Washington families, including senior citizens living on fixed incomes, and low-income working families (276,000 households) lived with hunger or the threat of hunger, according to the U.S. Department of Agriculture. Nearly 7.3% (520,401) Washingtonians use their food stamp benefits to buy food, receiving on average $0.93 per meal or $251 to feed a family of three for a month. The average food stamp benefit is less than $1 per person per meal. Nationally, hunger increased slightly from 11.2% (2001-2003) to 11.4% (2002- 2004). In early 2006, the Children’s Alliance found that 26 counties in Washington had high levels (20% or above) of poverty of school-age children; 51,000 of these children were food insecure and 18,820 were hungry.30 That same year, 97,519 children were uninsured and 68,128 (or nearly 70%) of these uninsured children were eligible for publicly funded health programs such as Medicaid, SCHIP, Basic Health, and Children’s Health Program. However, “very low food insecurity” or hunger as previously termed, decreased in the period 2003-2005 when compared Page 15 of 38
    • to 1996-1998 (4.7% compared to 3.9%).31 10 PUBLIC HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 2008 Health disparities and insurance status differences exist depending on income, and thus, place on the FPL, place of residence, and race in King County. Low-income residents often have greater needs that are unmet contributed by a lack of access to services or lack of financial cushion. 10.1 Uninsured in King County – Seattle, Washington King County residents are about as likely to lack health insurance today as they were 10 years ago; however, disparities have increased dramatically.32 In 2000-2004, Hispanics had the highest rate (35.5%) of being uninsured followed by Blacks (21.5%). From 2002 to 2004, uninsurance rates increased in Washington State from 8.4% to 9.8% for a total of 606,000, or almost 1 in 10 Washingtonians uninsured.33 Overall, nearly 140,000 King County residents as of 2008 lack health insurance and another 120,000 (10%) are estimated to be underinsured. About 382,000 King County residents lack dental insurance. In the past 10 years, disparities between African Americans and Whites have increased dramatically as have other minorities compared to Whites. About 29% of American Indians/Alaska Natives and 25% of African Americans lack insurance compared to 11% of Whites. Residents of southern King County are most likely to lack insurance (Tukwila/SeaTac, 27%; Burien/Des Moines, 23%; White Center/Boulevard Park, 20%). In the last decade, the uninsured rate of uninsured in King County among African Americans, people ages 45 to 64, and people with low- and middle-income categories increased. In addition, uninsured residents in the South King County region have also increased. Over four in 10 (43%) of near-poor residents (annual household income between $25,000 to $35,000) in King County lack health insurance, the highest rate of all income groups.34 Almost one in every two (47%) of the working poor lack insurance. About 382,000 of King County residents lack dental insurance. Nearly 65,000 low-income residents are in need of publicly funded mental health services for a serious mental illness yet less than half (43% or 28,000) low-income county residents with Medicaid receive on-going outpatient mental services and only about 500 low-income people without Medicaid receive outpatient mental services. Gum disease is linked to heart disease, stroke and diabetes. The latest data (2001) shows that Page 16 of 38
    • about 382,000 adults lacked dental insurance. 10.2 California Senator Sheila Kuehl introduced SB 840, the California Health Insurance Reliability Act, in February 2005, a bill that would provide all Californians with universal health care. Governor Arnold Schwarzeneggar, however, promised he would veto it35, and then proposed his own universal health care plan that would be financed by state lottery revenues and based on income in relation to the Federal Poverty Level (FPL).36 Kuehl did not support the Governor’s health care proposal and voted it down with her colleagues at the Senate Health Committee, despite the confusing label by media outlets as “universal health care.”37 Although the Governor’s proposal for universal health was not as progressive as the Massachusetts reform, it was neither as conservative as Kuehl espoused it to be. Governor Schwarzeneggar’s proposal would: ! Require all Californians to purchase insurance; ! Help low-income Californians do so by expanding access to public programs such as Medi-Cal and Healthy Families; ! Cover all uninsured children below 300% FPL regardless of residency status; ! Limit individual annual out-of-pocket health expenses to $7,500 and family to $10,000; and ! Create “Healthy Actions Incentives/Reward” programs in the private and public sector to focus on preventative practices and behavioral changes incorporated into health plans.38 The Governor pushed his proposal on the November 2008 California ballot. 10.3 Maine In 2003, Governor John Baldacci of Maine created the Governor’s Office of Health Policy and Finance (GOHPF) and signed into law the Dirigo Health Reform,39 a comprehensive health care Page 17 of 38
    • plan implemented by various state agencies.3 Under Dirigo Health, Governor Baldacci’s goal is to provide all Maine people with access to health care by 2009. The Dirigo Health Agency administers the Dirigo Health plan while GOHPF is responsible overall for the Dirigo Health Reform and is the liaison for the former. The Reform of 2003: ! Created DirigoChoice, which gave businesses with fewer than 50 employees, the self- employed, and individuals monthly payment discounts and deductible reductions and out-of- pocket expenses based on household size and income;40 ! Created the Maine Quality Forum, an independent division of Dirigo Health whose mission is “to advocate for high quality healthcare and help each Maine citizen make informed healthcare choices;”41 ! Includes 100% coverage for prevention services and the Healthy ME Rewards Program; ! Provides two options for plans (see Appendix 3);42 ! Partnered with Anthem Blue Cross and Blue Shield as the providers. Then, in 2007, Governor Baldacci introduced Dirigo 2.0, which made three changes to the above reform. It: 1. Formed a new partnership with Harvard Pilgrim Health Care to replace the previous provider;43 2. Implemented Employer and Individual Shared Responsibility by making health insurance obligatory for all Mainers by July 2008 and January 2009 respectively; and 3. Allowed Dirigo to self-administer. 3 The Bureau of Insurance, the Department of Human Services and the newly created Dirigo Health Agency along with the Governor’s Office of Health Policy and Finance (GOHPF). The last office would be the main coordinator working with all state agencies. Page 18 of 38
    • Although Maine’s health reforms do not parallel the health care reforms of Massachusetts, the state at least has taken the initiative to implement new standards for state agencies, to analyze other states’ reforms, and to recognize that access to health care is an ongoing prominent issue. 10.4 Vermont In 2006, both the Vermont House and Senate passed The Health Care Affordability Act that changed the state health care focus from acute illness treatment to chronic disease management; and created Catamount Health to provide comprehensive affordable insurance to the uninsured. Eligibility criteria for Catamount Health is limited to: ! Vermont resident adults; ! Those not eligible for a public health program; ! Those uninsured for at least 12 months; ! Those without access to health insurance through their employer. Catamount Health is part of a broader package of health care reform in Vermont to fulfill Section 902 of Title 2: “By 2009, Vermont has an integrated system of care that provides all Vermonters access to affordable, high quality health care that is financed in a fair and equitable manner.”44 There are exceptions for those who had health insurance but lost it due to loss of employment, divorce, and other reasons.45 In addition, goals set for 2009 and 2011 under House Bill 887 would provide state schools with time to: ! Comply with new nutrition guidelines to promote health; ! Increase access to healthy foods in communities; ! Promote physical exercise and healthy living; and ! For the Vermont Department of Health to make nutrition recommendations on issues such as trans-fat for the entire state. 10.5 Massachusetts In 2006, the Office of Health and Human Services expanded access to health care through reform.46 General funds were allocated in 2007 for education and prevention programs and a MassHealth insurance program to provide universal health care coverage. The state used a combination of individual mandate, subsidies for low income, and public insurance for the Page 19 of 38
    • uninsured to purchase.47 For college students, mandated insurance is nothing new; since September 1989, both part and full-time students by law have purchased insurance.48 Members of the Commonwealth Care— the new insurance program to insure the uninsured—will pay a maximum of $200 per calendar year in co-payments for pharmacy services and $36 for other services.49 The Health Care Reform Law of 2006:50 ! Requires state residents to purchase health insurance or face a fine that began July 2007; ! Imposes a surcharge on employers who do not offer coverage, excluding employers who already do; ! Expands existing public health insurance safety net, including MassHealth (Medicaid and State Children’s Health Insurance Program); ! Expands eligibility for children from 200% of the federal poverty level (FPL) to 300%; ! Provides incentives for residents with healthy behaviors. 51 Some have praised the Health Care Reform, while others such as President Bush immediately began predicting its’ failure.52 Some argue that those who benefit from mandated health insurance are those who previously could not afford expensive procedures or costly premiums (i.e. low-income and/or the poor working class) but now can thanks to health care reforms.53 10.6 California Mayor Gavin Newsom created a Universal Healthcare Council (UHC) in February 2006 to develop a plan to insure the uninsured. The UHC’s recommendations led to the Health Access Program (HAP), an expanded health care safety net—not insurance, albeit the city’s goal is to enroll the uninsured into their programs. Since July 2007, the San Francisco Department of Public Health has operated HAP. HAP (eventually named Healthy San Francisco) is open to uninsured San Francisco residents, regardless of employment or immigration status, or pre-existing medical conditions. As of June 18, 2008, Healthy San Francisco has been serving 23,184 participants from various districts by providing them with a “Medical Home,” one of the 27 San Francisco Department of Health Clinics and San Francisco Community Clinic Consortium Clinics. Page 20 of 38
    • A Medical Home consists of a primary care physician, nurse practitioner, or physician assistant to develop and direct a plan of care for each participant.54 Participants choose a Medical Home and maintain the relationship for 1 year, after which they can choose to change their Medical Home or stay with the same one. Healthy San Francisco medical services emphasize “wellness, preventive care and innovative service delivery,” but exclude vision, dental, infertility and cosmetic services.55 Participants pay depending on their Medical Home and household income. Hospital, urgent, and emergency care are only provided at San Francisco General Hospital. Each Medical Home specializes in a variety of services with multilingual staff. Languages include Mandarin, Russian, Spanish, Tagalog, and many more depending on the district. On January 9, 2007, judges ruled in favor of San Francisco to make businesses provide health care to their employees, a city version of universal health care, challenged by a “local restaurant trade group.”56 City ballots and initiatives are outpacing—if not, competing with—the state government’s role in universal health care as the demand for a systematic change has increased over the years due to the rising health care costs.57 10.7 Building Coalitions for Women’s Health & Human Rights Policies based on patriarchal beliefs or partisan politics instead of statistical data are not uncommon. In a study comparing South Carolina and Florida, racial disparities and limited access to healthcare sparked a coalition of professionals and academics to advocate for women’s reproductive rights.58 In 1996, the Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) further hindered low-income women’s access to health care by giving states incentives to “enact measures to reduce out-of-wedlock childbearing and to promote abstinence-only education.”59 The Act decreased Medicaid responsibilities by eliminating the requirement that recipients be given family planning services. This policy trend is seen at the forefront in South Carolina and Florida. 10.8 South Carolina Although three-quarters of South Carolina state residents believe that sexuality education should emphasize abstinence but should also address contraception and be taught in schools, the State Department of Education prohibits instruction of sexual practices outside of marriage or practices unrelated to reproduction except in the context of disease. Only 38% of schools taught students how to correctly use a condom. Page 21 of 38
    • Data shows that African-American women in South Carolina are disproportionably affected and receive inadequate preventative care, such as clinical breast cancer screening, mammograms, or Pap smears. Breast cancer is the second leading cause of death for women in the state and the mortality rate is nearly double for African American women to that of white women. In addition, abortion rights are gravely threatened both by violence and by lack of access to abortion clinics. In South Carolina, 66% of women live in a county without an abortion provider and any health care provider or health facility can legally deny a woman an abortion for any reason. South Carolina has also increasingly incarcerated pregnant women for drug and alcohol abuse under state child abuse laws, instead of providing treatment (or prevention), an example seen in South Carolina vs. Regina McKnight.60 Luckily, the case was eventually overturned.61 10.9 Florida During the 1990s, Florida was similar in a similar stance on women’s health and human rights. In the entire state, there are only 311 publicly funded family planning clinics. Breast cancer is also the second leading cause of cancer related death for both black and white women, although black women die of breast cancer at a higher rate. Florida has the second highest number of known cases of HIV infection and the third highest number of AIDS cases in the nation. In 1998, Florida sponsored a statewide Abstinence Education Program, and in 2002, the Florida Department of Health launched a statewide abstinence-only-until-marriage campaign called “It's Great to Wait.” However, activists and medical professionals did not wait for state campaigns to change their policies regarding health. 10.9.1 Coalitions in South Carolina and Florida The Women’s Health and Human Rights Initiative (WHHRI) of the Mailman School of Public Health of Columbia University in 2003 offered research and organizing assistance for advocacy capacity-building in South Carolina and Florida to “build coalitions of advocates working towards improving the reproductive and overall health care of low-income women.”62 Their work paid off as they partnered with National Advocates for Pregnant Women (NAPW).63 In September 2004, after strategic meetings with South Carolina advocates, 59 health organizations, agencies and university departments formed the “Women’s Health Coalition of South Carolina.” This Coalition has organized letter-writing campaigns; written commentary articles in local newspapers; and is mobilizing around SC Senate Bill 1084, Unborn Victims of Violence Act, a bill that incarcerates persons who commit a violent crime against an unborn Page 22 of 38
    • child; however, unrelated to abortion.64 In Florida, WHHRI partnered with the Bylley Avery Institute, a long-standing health advocacy organization, and hosted the first statewide meeting on women’s health in December 2005. In attendance were about 40 health care providers, legislators, academics, and activists representing 20 organizations from across the state who participated in informational sessions on HIV/AIDS, access to care, an overview of state level reproductive health policy, and more. Similar to South Carolina, after March 2006 the coalition formed the “All Women’s Health: A Florida Partnership for Change.” This advocacy model bridges the traditional gap between activists and health professionals. It allows for coalitions to engage in state-level policies and for policymakers to pay attention to women’s reproductive health and human rights. Many ideas and strategies for this model were taken from the HIV Law Project in New York City from the 1990s, a legal assistance service for low-income HIV positive women who did not qualify for state AIDS-related benefits and services. 11 CONCLUSION In conclusion, the term “universal healthcare” has varied definitions, evident by the diverse characteristics of such plans in various states. Numerous bills have been introduced to both state and house senates but their current statuses overall tend to be unknown as the information is unavailable online. Even when bills are referred to committees, online information is seemingly missing as to the current status of the bills (i.e. implementation stage, waiting period, etc.). Passing universal health care legislation requires joint collaboration both from the house and senate, the political will of politicians, and ballot initiatives or public forums so citizens can have a voice in the political process. It is no easy task to brainstorm a national solution to the U.S. health care problems. Nonetheless, the right to health and healthcare has been a forefront issue of many national, state, and city advocacy organizations. Given the uninsured rates, increasing healthcare costs, and public health budget cut-backs, many Americans, especially vulnerable populations, will continue to face health care burdens. Page 23 of 38
    • APPENDIX 1: State Universal Health Care Bills, page 1 of 4 STATE BILL NAME YEAR SUMMARY AND STATUS Established Alaska Health Care Board & mandatory health insurance. Alaska HB 242 2007 Status: Referred to Committee. California AB 8 & ABx1 2007 Failed in Senate Would establish the California Universal Healthcare System. California SB 840 2007 Status: Passed Senate, In Assembly Established UHC plan task force to study feasibility of adopting one. Connecticut HB 5694 2008 Status: Introduced Would create a non-government run program and cost effective single Delaware SB 177 2007 payer health care system. Status: Referred to Committee Employers pay for 50% premiums for 20hr or more employees Hawaii Prepaid Health Care Act 1974 Status: Passed Established Hawaii Health Commission to develop universal health care. Hawaii HB 2898 2008 Status: Referred to House Committee on Health Would establish the state health authority to propose a plan to provide medical assistance for all citizens of Hawaii. Hawaii SB 2101 2008 Status: Referred to Committee Would establish an agency to operate a single-payer universal healthcare insurance system. Hawaii HB 1598 2008 Status: Referred to Committee Illinois HB 806 2005 Establishes the Covering ALL KIDS Health Insurance Program. Status: Page 25 of 38
    • Signed into law by governor Would create the Health Care for All Illinois Act. Status: Referred to Health Care Availability and Access Committee Illinois HB 311 2007 Hearing Creates a plan of health insurance to provide primary coverage to every resident of Indiana Indiana HB 1680 2007 Status: Referred to House Committee on Public Health Relates to health care reform in Iowa including the Iowa health care coverage exchange Iowa SB 3140 2008 Status: Referred to Senate Human Resources Committee Enacts the Kansas Small Business Health Policy Committee Act Kansas SB 540 2007 Status: Referred to Senate Financial Institutions and Insurance Committee Establishes the health reform fund Kansas SB 541 2008 Status: Referred to Senate Health Care Strategies Committee Establishes the Kansas Health Care Commission, providing health Kansas HB 2001 insurance coverage for all residents of the state Legal research commission to conduct feasibility of UHC Kentucky HCR 79 2007 Status: Posted in committee 2007 Creates a UHC program Maine LR 289 2007 Status: Assigned House Paper number 519 and LD 688 Creates Blue Ribbon Commission on Dirigo Health MAINE Exec Order 30 2005 Status: Passed Maryland HB 1125 2008 Establishes the Maryland Universal Health Care Plan Page 26 of 38
    • Status: Referred to House Committee on Health and Government Operations Would create an Act promoting access to health care (PATH) Massachusetts H 4479 2005 Status: Passed to be engrossed by House - 131 YEAS to 22 NAYS Individual mandate to require those who can afford to maintain health ins through employer, state, or individual market Massachusetts H 4279 2005 Status: Amended substantially in committee (H 4463) Would create a Constitutional Amendment for UHC MN SB 14 2007 Status: Carry-over to Committee Would establish UHC Minnesota HB 1856 2007 Status: Referred to Health and Human Services (carry-over) Would establish the Missouri Universal Health Insurance Act for Missouri residents Missouri HB 1558 2008 Status: PENDING This act would establish the Missouri Universal Health Assurance Program MO SB 1101 2008 Status: Referred Senate Health & Mental Health Committee Plans for UHC system for all Montanans Montana SB 498 2007 Status: DIED in committee New Mexico HB 147,588;SB 225,377 DIED New York AB 7354 2008 Status: Referred to Health Committee North An act to amend the North Carolina constitution to recognize the right to Carolina HB 901 2007 health care Page 27 of 38
    • Status: Carry-over to Committee Directs the Legislative Council to study universal health care for North Dakotans North Dakota SCR 4024 2007 Status: Without recommendation Would establish and operate the Ohio Health Care Plan to provide UHC coverage to all Ohio residents Ohio HB 456 (SB 168) 2007 Status: N/A Would provide health insurance coverage to U.S. permanent resident children and parents Rhode Island SB 2220 2008 Status: Referred to House Committee on Finance Creates Catamount Health Program Vermont H 861 2006 Status: Passed Directs the Joint Legislative Audit and Review Commission to study UHC coverage possibilities for Virginians Virginia HJR 158 2006 Status: HOUSE concurred in SENATE amendments Requests that Congress enact a UHC system Washington HJM 4005 2007 Status: Recommended to Committee to "do pass" Health Care Rights of Conscience Act West Virginia SB 673 2005 Status: Referred to two different Committees Creates the Commission on Health Care Reform West Virginia HB 4021 2006 Status: Passed Creates the Wisconsin Health Plan Wisconsin AB 1140 2006 Status: Introduced January 2007 Page 28 of 38
    • APPENDIX 2: U.S. Health Expenditures Source: Steuerle, C. Eugene and Randall R. Bovjerg. “Health and Budget Reform As Handmaidens,” Health Affairs, Vol. 27, Issue 3, 633-644. Page 29 of 38
    • APPENDIX 3: MAINE’S TWO HEALTH PLANS PLAN 1 PLAN 2 Max. Annual Out-of-Pocket for Individuals $800 - $4,000 $1,600 - $5,600 Max. Annual Out-of-Pocket for Families $1,600 - $8,000 $3,200 - $11,200 Individual Deductible $250 - $1,250 $500 - $1,750 Family Deductible $500 - $2,500 $1,000 - $3,500 Co-payment (CP) $20 network; $20 network; $35 non-network $35 non-network Network Coverage - 80% after deductible for hospital, emergency room - 80% after deductible for hospital, Page 30 of 38
    • services, & professional services; emergency room services, & professional services; - 100% for physician office visits after $20 CP, deductible n/a; routine/ preventative services - 100% for physician office visits after $20 CP, deductible n/a; routine/ preventative services; specialists Non-Network Coverage - 50% after deductible for hospital & professional - 50% after deductible for hospital & services; & routine/preventative services after $35 CP; professional services; routine/ preventative services after $25 CP - 80% after deductible for emergency room services; - 80% after deductible for emergency room services; - 70% after $20 CP for physician office visits - 70% after $35 CP for physician office visits Page 31 of 38
    • 12 WORKS CITED 1 http://www.statehealthfacts.org/comparebar.jsp?ind=125&cat=3&sub=39&yr=1&typ=2 2 Havighurst, Clark C. “American Health Care and The Law—We Need To Talk!” Journal of Health Affairs. Vol 19, Issue 4, 84-106. 2000. http://content.healthaffairs.org/cgi/content/abstract/19/4/84?maxtoshow=&HITS=25&hits=25& RESULTFORMAT=&fulltext=right+to+health&andorexactfulltext=and&searchid=1&FIRSTIN DEX=0&resourcetype=HWCIT 3 Ibid. (p. 86). 4 Ibid. 5 http://www.worldpolicy.org/projects/globalrights/econrights/fdr-econbill.html 6 http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm#article12 7 Gollub, Erica. “Human Rights is a US Problem, Too: The Case of Women and HIV.” American Journal of Public Health. Vol 89, No. 10. Oct 1999. pp. 1479-1482. Accessible at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1508808 8 Interview on June 23, 2008. 9 http://www.statehealthfacts.org/comparebar.jsp?ind=125&cat=3&sub=39&yr=1&typ=2 10 http://www.nytimes.com/2007/03/01/washington/01cnd-poll.html 11 “Food Stamp Erosion in Washington: How Washington Families have lost hundres of dollars in purchasing power.” May 2007. Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm. 12 http://www.kaiseredu.org/tutorials/StateHealth/player.html 13 http://www.ncsl.org/programs/health/universalhealth2007.htm 14 http://www.metrokc.gov/exec/hatf/ Page 34 of 38
    • 15 http://www.pugetsoundhealthalliance.org/ 16 http://www.metrokc.gov/exec/news/2005/0118_PSHealthAlliance.htm 17 “A Collaborative Strategy for Better Care, Healthier People, and Affordable Costs.” King County Health Advisory Task Force Final Report. 30 June 2004. Accesssible at: http://www.metrokc.gov/exec/hatf/ 18 Ibid. 19 Ibid, p. 25 of Report. 20 Ibid, p. 34 of Report. 21 King, Brian. “Seattle Votes for a Right to Health Care.” Monthly Review. 22 Dec. 2005. http://mrzine.monthlyreview.org/king221205.html. 17 July 2008. 22 http://clerk.ci.seattle.wa.us/~scripts/nph- brs.exe?s1=&s2=&s3=&s4=&s5=drago%5Bspon%5D+and+%40dtir%3E%3D20050000+and+ %40dtir%3C20060000&Sect4=AND&l=200&Sect1=IMAGE&Sect2=THESON&Sect3=PLUR ON&Sect5=CBOR1&Sect6=HITOFF&d=CBOR&p=1&u=%2F~public%2Fcbor1.htm&r=12&f =G 23 Ibid. 24 Ibid. " http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4941a1.htm 25 “Healthy Youth in King County.” Public Health Data Watch. Vol. 3, No. 2. Oct. 1999. http://www.metrokc.gov/health/datawatch/dw-adol.pdf 26 “The Uninsured in King County 1991-1998.” Public Health Data Watch. Vol. 4, No. 1. Jan. 2000. http://www.metrokc.gov/health/datawatch/ 27 http://www.statehealthfacts.org/profileind.jsp?ind=48&cat=2&rgn=49 28 Green, Jeff. “U.S. has second worst newborn death rate in modern world, report says.” http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/ 29 “2005 Washington State Legislative Session: Wise Investments in Children and Families.” May 2005. Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm. 30 “Poverty and Food Insecurity Among School-Aged Children in Washington.” Jan. 2006. Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm. Page 35 of 38
    • 31 “Hungry in Washington.” Nov. 2006. Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm. 32 “Public Health King County Access.” 2008. (Beth Rivin’s document emailed to me). 33 “The Uninsured Population in Washington State.” 2004 Washington State Population Survey. Washington State Office of Financial Management. Research Brief No. 31. Feb. 2005. http://www.ofm.wa.gov/healthcare/spg/default.asp 34 “Public Health King County Access.” 2008. (Beth Rivin’s document emailed to me). 35 http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2006/09/05/state/n130430D47.DTL 36 http://igs.berkeley.edu/library/policy_desk/2007/univhealth.html#Topic3a 37 Steinhauer, Jennifer. “California Plan for Health Care Would Cover All.” New York Time. 7 Jan 2007. http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0CE6D61530F93AA35752C0A9 619C8B63 38 http://www.chhs.ca.gov/Pages/HCR.aspx. Click on “Health Care Proposal.” 39 http://www.dirigohealth.maine.gov/ 40 Ibid. 41 http://www.mainequalityforum.gov/ 42 http://www.dirigohealth.maine.gov/ 43 Ibid. Information found at: http://www.dirigohealth.maine.gov/ 44 http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT203.HTM 45 http://hcr.vermont.gov/increase_access/enhance_private_insurance_capacity/uninsured 46 http://www.mass.gov/legis/laws/seslaw06/sl060058.htm 47 http://www.kaiseredu.org/tutorials/StateHealth/player.html 48 http://www.mass.gov/?pageID=eohhs2terminal&L=5&L0=Home&L1=Consumer&L2=Insuran ce+(including+MassHealth)&L3=Additional+Insurance+and+Assistance+Programs&L4=Qualif Page 36 of 38
    • ying+Student+Health+Insurance+Program+(QSHIP)&sid=Eeohhs2&b=terminalcontent&f=dhcf p_consumer_qship_intro&csid=Eeohhs2 49 http://www.mahealthconnector.org/portal/site/connector/template.MAXIMIZE/menuitem.3ef8fb 03b7fa1ae4a7ca7738e6468a0c/?javax.portlet.tpst=2fdfb140904d489c8781176033468a0c_ws_M X&javax.portlet.prp_2fdfb140904d489c8781176033468a0c_viewID=content&javax.portlet.prp_ 2fdfb140904d489c8781176033468a0c_docName=content&javax.portlet.prp_2fdfb140904d489c 8781176033468a0c_folderPath=/About%20Us/Connector%20Programs/Benefits%20and%20Pla n%20Information/&javax.portlet.begCacheTok=com.vignette.cachetoken&javax.portlet.endCac heTok=com.vignette.cachetoken 50 Fahrentold, David. “Mass. Bill Requires Health Coverage: State Set to Use Auto Insurance As a Model.” Washington Post. 5 April 2006: A01. http://www.washingtonpost.com/wp- dyn/content/article/2006/04/04/AR2006040401937.html 51 http://search.cga.state.ct.us/dtsearch_olr.asp?cmd=getdoc&DocId=19452&Index=I%3A%5Czi ndex%5C2006&HitCount=1&hits=1067+&hc=1&req=(number+contains+291)+&Item=0 52 Lee, Christopher. “Massachusetts Begins Universal Health Care.” Washington Post. 1 July 2007: A06. http://www.washingtonpost.com/wp- dyn/content/article/2007/06/30/AR2007063000248.html 53 http://www.npr.org/templates/story/story.php?storyId=91427522&ft=1&f=1007; and http://www.hcfama.org/index.cfm?fuseaction=Page.viewPage&pageId=743&parentID=737&no deID=2; 54 http://www.municode.com/content/4201/14131/HTML/ch014.html 55 Ibid. 56 McKinley, Jesse. “Judges Tell San Francisco It Can Begin Health Plan.” New York Times. 10 January 2008. http://www.nytimes.com/2008/01/10/us/10health.html?_r=1&oref=slogin 57 Davis, Ronald M. “Addressing the Rising Cost of Health Care.” American Medical Association. http://www.ama-assn.org/ama/pub/category/18295.html 58 Please note that all information from the section “Building Coalition” was taken from the following source unless otherwise noted: McGovern, Theresa. “Building Coalitions to Support Women’s Health and Human Rights in the United States: South Carolina and Florida. Reproductive Health Matters. Vol. 15, Issue 29. May 2007. pp 119-129. Accesible at: http://www.rhmjournal.org/article/S0968- 8080(07)29290-0/abstract Page 37 of 38
    • 59 Ibid. p. 119. 60 http://www.drugpolicy.org/law/womenpregnan/whitnervsth_/ 61 “Regina McKnight—Victory at Long Last.” http://advocatesforpregnantwomen.org/blog/2008/05/regina_mcknight_victory_at_lon.php 62 See endnote 3. (p. 3). 63 http://www.advocatesforpregnantwomen.org/ 64 http://www.scstatehouse.net/reports/hupdate/lu2310.htm Page 38 of 38