The $1 Million Price Tag: Health Care Exclusion and Federal Policy

Health care in the U.S. is inundated with bureaucratic and administrative logjams and snafus, as well as intentional efforts to deny people the care they need. A recent article is illustrative of how myopic policies and procedures serve to deflect attention from core health care needs and further impede access to care in the U.S. According to an article by Scott Rothschild, posted on June 19, 2008, Kansas spent around $1 million dollars enforcing a federal mandate intended to prevent undocumented migrants from receiving Medicaid benefits through documentation requirements for eligibility. As a result, 20,000 eligible Kansans lost health insurance and only one undocumented person was identified during this state enactment of a 2006 ancillary federal directive.

Moreover, according to a 2007 report, from the Center on Budget and Policy Priorities, black children showed the greatest enrollment decline for benefits in Kansas during this enforcement period; hence, this measure is particularly problematic in terms of its pronounced effect on a specific racial/ethnic group. And, according to Unequal Health Outcomes in the United States, a 2008 report to the U.N. Committee on the Elimination of Racial Discrimination, “[r]ecent data shows that the new law actually has the biggest impact on poor U.S. citizens, especially African Americans. This group lacks documentation of their citizenship and the financial means to afford the application process.” This then illustrates how structural inequalities in our health care system (read the Kansas flub here) lead to racial and ethnic disparities in health outcomes in the U.S.

In the midst of renewed vigor in the debates regarding health care in the U.S., fuelled by primary races and caucuses over the past months, this story highlights the need to look beyond rhetoric and political smoke screens and demand true policy changes that will give all people access to their right to health care. We must stay focused and demand that our political leaders enact legislation that truly addresses the right to health care and universal access in the U.S. The citizenship documentation policy also highlights the readily accepted paradigm in the U.S. that it is legitimate to exclude people from access to health care, as this federal directive was attempting to do just that – and, unfortunately, succeeded in excluding hundreds of thousands of low-income people across the nation. Yet, a human right to health means that eligibility is not a consideration for accessing heath care. All people have the right to health care because they are human beings and not based on income or one’s documentation or status.

In essence, health care should neither be a privilege nor a commodity to be traded and regulated by private insurance companies. Moreover, it is not a system that we can afford to inundate with administrative mazes or xenophobic and racist mandates that not only fail do address the core issues in health care reform but, quite literally, further alienate people from access to care and grossly misappropriate funding. We all have a fundamental right to health care in the U.S.; and, we have the right to demand better of our federal government than a health care directive that intentionally seeks to exclude people from health care – for the price tag of $1 million in Kansas alone.

Public Housing Crisis of the Gulf Coast

There are some things in life, in my opinion, that shouldn’t even be thought about twice. Like breathing, for example, we don’t think about it, it just happens naturally. Speaking of things coming naturally, it seems it would only be natural for people to be taken care of by their government after such catastrophic disasters as Hurricanes Katrina and Rita. I never realized how terrible of a situation survivors are really in until I began my internship here at NESRI. But how could I? I must say the national media has done a superb job of keeping the crisis facing hurricane survivors (both those who are still displaced and those who have returned to the Gulf Coast) under wraps. After all, news of Paris Hilton and other celebrities is far more exciting than the devastation facing our fellow Americans, including the doubling of New Orleans’ homeless population since the storms.

The housing crisis affecting New Orleans (and the greater Gulf Coast region) just doesn’t make any sense to me. In fact, the entire mistreatment of New Orleans residents at the hands of their government is completely ridiculous. You see, it’s quite simple actually: pre-Katrina, New Orleans had a significant poor, African-American population. By demolishing the four major public housing developments in which a large majority of those residents resided and making the replacement mixed-income housing extraordinarily expensive and out of reach for the majority of the former tenants, the government, in partnership with private sector forces, has made it near impossible for countless hurricane survivors to return home. I never would have thought people would be treated like this, at least not in the United States! Where everyone is always treated equally in the eyes of God! I mean come on, this is supposed to be the greatest country in the world; land of the free and home of the brave, right? But I guess not for poor people – they seem to have no rights, are not recognized by their government, and quite frankly, appear to be invisible to everyone else.

Over the last few days, I’ve been blessed to be able to speak with several survivors and find out how they really feel. It’s heartbreaking to hear their stories, and for a lot of them that’s all they need – someone to listen to them. One of the survivors I spoke with, a single mother, expressed to me that every month she’s forced with the decision of feeding her children or paying sky-high rent for a small apartment with a leaky roof and a broken smoke detector. Can you say safety hazard? No one should be forced to live that way. There are many others with similar stories that are just being “kicked to the curb” so to speak and “left fi dead”.

So what happens to these families that are being forced out of their homes (by the way, forced evictions are illegal, but no one seems to care about that)? In President Franklin Roosevelt’s 1941 4 Freedoms Speech, he mentions there are “the simple and basic things [in life] that must never be lost sight of in the turmoil and unbelievable complexity of our modern world.” It seems to me that many of the issues President Roosevelt believed were ‘givens’ for all Americans, are being denied to the survivors of Hurricanes Katrina and Rita. The third freedom – Freedom from Want – simply means “economic understandings which will secure to every nation [but in this case, every survivor of Hurricanes Katrina and Rita] a healthy peace time life for its inhabitants…” If Freedom from Want was being exercised properly, hurricane survivors would not be committing suicide because they want work but can’t find a job anywhere, they would not have to worry about wanting affordable and better health insurance, and they wouldn’t want to return home—because they would already be there.

The National Public Housing Crisis: Root Shock Is Not Just on 125th Street

Last week, the New York Times published a story detailing reactions from long-time community members to the recent leaps in Harlem’s gentrification. Residents are banding together to protest the rapid changes to their neighborhood, changes they fear will force them from homes made newly unaffordable by development – some would say predatory development – and thereby destroy the community they have long called home. The article clearly articulates the mixed feelings of Harlem’s residents who are watching their neighborhood undergo “change that they believe is not intended to benefit them,” but this scenario is not unique to 125th Street – the shift from low income housing to $1 million condominiums is taking place across the nation.

The reactions of Harlem residents could easily have come from Minneapolis, where more than half of the city’s public housing stock was destroyed in 1998 and 1999 – and has still not been fully replaced. In Chicago, public housing demolitions have forced 20,000 residents from their homes. Residents in Atlanta and Los Angeles are steeling themselves for the planned destruction of substantial numbers of public housing units. Tenants in New Orleans, having survived the devastation of Hurricanes Katrina and Rita and the subsequent levee breaches, recently saw 4,800 public housing units demolished which may lead to the displacement of over 20,000 people in a city where the homeless population has already doubled since the hurricanes.

In short, the United States is facing a national public and affordable housing crisis. Through the federal HOPE VI program, public housing is being demolished, without guarantees that tenants will be able to return to their communities. Market conversions of privately owned, HUD subsidized housing have led to the loss an additional 300,000 multi-family units. These problems are only exacerbated by a $6.5 billion shortfall in HUD funding that may lead to the displacements of hundreds of thousands of additional families who rely on HUD’s project-based Section 8 program. Around the country, poor families are facing “root shock” as the communities they have lived in for years and often generations are abruptly uprooted, scattered and destroyed. Our elected officials are disregarding these communities’ right to a decent and affordable place to live in favor of high-profit development projects.

In order to address this crisis, we need to reconsider the assumptions underlying our housing policy. Currently, many government officials think of housing as a commodity and a privilege, seeking approaches that will maximize profits from valuable real estate, managing public housing using strict private sector guidelines, and adopting legislation that penalizes our nation’s poorest families for their economic vulnerability. Although international law recognizes a right to adequate housing, millions of poor families in the United States are spending more than half of their income on rent, living in substandard conditions, and facing homelessness. Until we make a right to housing a basic tenant of our housing policy and recognize it as a human right, community members in Harlem, New Orleans, Chicago and across the nation will be left wondering if gentrification, demolitions, and development will leave them without a community to call home.

Related Articles:
- “U.S. public housing appears to be an endangered resource,” by Charles Hallman, Minnesota Spokesman-Recorder, June 11, 2008.
- “Mixed Feelings as Change Overtakes 125th St.” by Timothy Williams, New York Times, June 13, 2008.

Formaldehyde in FEMA Trailers: After the Flood Comes the Poisoning

Would the U.S. government take victims rendered homeless due to natural disaster and place them in temporary shelters filled with toxic gas for over two years?

The answer is a horrifying and resounding, Yes. In the wake of Hurricanes Katrina and Rita, FEMA officials placed survivors of the storms in temporary government-issued trailers. Yet, since early 2006, FEMA officials were made aware of dangerous, noxious fumes in these trailers. Countless survivors complained about the trailers with concerns ranging from nose-bleeds, uncontrollable asthma and increased allergic reactions. In fact, one elderly man in Slidell, Louisiana who repeatedly raised concerns about the habitability of his trailer, was later found dead. His concerns went unanswered. In Texas, after the death of their infant, the parents blamed the toxicity of their FEMA trailer for the child’s death. There was still no official investigation into the habitability of the trailers. For two years, the federal agency refused to conduct investigations and instead chose to convince survivors that all was well. But, all was not well. In a final bow to public pressure, in February 2008 – almost three years since the storms – FEMA and the Center for Disease Control investigated the habitability of the trailers. What was found? Dangerous levels of formaldehyde – a poisonous, human carcinogen used in embalming procedures.

In a 2006 NESRI published an issue brief on the human right to housing of Hurricane survivors. In the brief, Ms. Stephanie Mingo, a former resident of the St. Bernard Housing Project in New Orleans, Louisiana was quoted as saying:

Why pay for a trailer for me when you could pay someone to clean up my unit, so I can come home? Just give me my home back! I have such a big hole in my heart, sometimes I just feel like dying so I won’t have any more problems. They don’t realize how much people are suffering.

Under the auspices of the U.S. Department of Housing and Urban Development (HUD) and the Housing Authority of New Orleans (HANO), Ms. Mingo’s home was bulldozed earlier this year. She will never be able to return home. As the four major public housing complexes were being demolished, thousands of families who had been living in the FEMA trailers were given eviction notices. Where are they to go? No one knows and more disturbing, our government seems not to care.

This awful treatment of Hurricane survivors is not due to lack of resources. As NESRI’s 2006 issue brief notes, the government’s approach after the disaster was to intentionally refuse cost-effective solutions while wasting hundreds of millions of dollars – including the ultimate absurdity of securing cruise ships for flood victims at the price tag of $5,100 a month per person or a total $249 million. Most disturbing, our government refused to acknowledge Hurricane Katrina and Rita survivors as Internally Displaced Persons (IDPs) with protections under the UN Guiding Principles on Internal Displacement. Recognition as an IDP carries certain government protections, including the right to return and the right to safe and habitable housing. Yet, the United States Agency on International Development (USAID) employs the Guiding Principles in its work overseas.

Do we still need to ask why we need human rights – in particular economic and social rights – in the United States?

The destruction of post Katrina and Rita public housing communities, the poisoning of survivors, and the lack of recourse available for these atrocities highlight the widespread violations of Hurricane survivors’ human right to housing and health, as outlined by the Guiding Principles and other international human rights conventions and declarations. This is painful evidence of why we need better human rights protections in the United States. Other abuses include lack of safe emergency shelter and healthy long-term housing for all survivors, as well as arbitrary evictions and restricted access to health care, including the permanent closing of Charity Hospital in New Orleans – the second largest public hospital in the country.

Katrina and Rita survivors need the support of progressive, justice-minded citizens and organizations around the country to assist them in building a national community of concern that pushes for the various pieces of national legislation that will alleviate these violations of basic rights. Additionally, international supporters and activists are also needed to bring the plight facing Katrina and Rita survivors to global attention.

Towards this end, and to create greater visibility around the human right to housing crisis in the Gulf Coast, New Orleans public housing tenant activists, with support from NESRI, have been working with the Zero Evictions Campaign in Padua Italy, which has adopted New Orleans as one of its global sites. We encourage you to let others know about this important international initiative! NESRI, along with local partners, has also invited the UN Advisory Group on Forced Evictions and the UN Special Rapporteur on Housing to make an official visit to the post Katrina and Rita Gulf Coast to witness and report the ongoing abuses and violations taking place.

We need to address the human rights emergency on the ground in the post Katrina and Rita Gulf Coast immediately and promote any short term relief available. But in the long run, those who have been internally displaced, rendered homeless, subjected to poisonous living conditions, and whose livelihoods and communities have been destroyed by the storms and ensuing government action must be protected through long-term programs that ensure decent housing, health and dignity of each family and individual affected by the natural and man-made disasters. These programs must be designed without discrimination, according the same rights and privileges to all survivors. Human rights demand no less, and neither can we.

For more information:

NESRI’s Special Project on Hurricane Katrina

Zero Evictions Campaign

Justice for New Orleans