Coverage? Getting There. Access? Not Yet

Pamela Merritt

The promise of universal health care coverage appears to be within America's grasp. But health care reform must address barriers to access beyond coverage to be truly universal.

Universal health care is one of the top policy issues in this historic election year. Like many voters, I've been reading each candidate's plan and the many critiques of those plans. One thing is for certain, for every article written in support of a universal health care plan there is an article written denouncing it. Debates swirl over coverage and mandates and how it will all ultimately get funded.

Mike Huckabee, who is still campaigning for the Republican nomination, believes that the current system is irrevocably broken but he opposes federally mandated universal coverage. Senator John McCain, Huckabee's opponent and the presumptive nominee of the Republican Party, opposes federally mandated universal health care coverage. Both candidates for the Democratic nomination, Senator Clinton and Senator Obama, support universal health care with the difference being in the details.

The payoff to these debates may be health care coverage for all Americans and the assumption is that health care coverage for all equals universal access to quality medical care. Most experts agree that proactive and preventative medical care is the ideal prescription for a long and healthy life. Early detection of certain cancers can mean the difference between survival and death while the prevention and early treatment of heart disease would save millions of lives. Prevention of sexually transmitted diseases and infections through education and treatment programs would work to support the reproductive health of thousands.

However, the assumption that universal coverage will result in universal access is flawed. Many Americans face barriers to accessing medical care that go beyond coverage.

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Socio-economic barriers bar access to quality health care. Some women must battle against inadequate childcare or a lack of child care options that hinder their ability to make medical appointments. Securing reliable transportation to and from medical facilities is a very real challenge that often requires elaborate planning to overcome and may result in financial hardship or debt.

I know a single mother who spent several days trying to secure child care for her son so that she could go to a doctor's appointment after school. The closest medical facility was only open Monday through Friday and her daycare closed at 5 o'clock in the evening. Since she couldn't afford a taxi cab and the bus would take too long the woman had to ask a relative for a ride. She was forced to reschedule her appointment several times when either her child care provider or transportation fell through. As a result, the woman missed her monthly appointment.

Lesbian, gay, bisexual and transgender Americans also experience barriers to accessing health care. From the medical forms required to check in for an appointment to the language used during that appointment, there are factors at play that discourage patients from seeking medical care.

LGBT individuals often face homophobia when coming out to their medical care provider. Heterosexist assumptions create the false perception that lesbians and bisexual women are not at risk for sexually transmitted infections. Many medical providers lack any basic knowledge about the lives of LGBT Americans and that lack of knowledge stands in that way of quality healthcare while putting patients at risk.

I am reminded of the documentary Southern Comfort directed by Kate Davis, which followed the last year in the life of a female to male transgender person who was dying from cervical cancer. Robert Eads lived in rural Georgia and could not find a doctor willing to treat him for cervical cancer because he was transgender. The film follows Eads through his last year of life while his family and friends struggle with the possibility that his death was preventable but for transphobia.

Many Americans and immigrants face a language barrier when seeking medical care. Hospitals and clinics struggle to fill the need for translators while patients face risks stemming from miscommunication over symptoms or a misunderstanding about the proper dosage of medication. The denial or delay of medical care due to a language barrier is discrimination (Title VI of the 1964 Civil Rights Act) and medical facilities that receive Medicaid or Medicare must provide language assistance to patients that demonstrate limited proficiency in English. But with demand for translators higher than the supply many patients are not provided one and many doctors have not received training in how to work with a translator.

The promise of universal health care coverage and the access it could provide appears to be within America's grasp. People wouldn't be debating the details they didn't believe in that promise, but universal health care must address barriers to access beyond coverage to be truly universal. In order to insure universal access to health care those barriers will need to be discussed at the policy table too.

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