Universal Coverage – A Call for Action

Bob Edgar
“Universal Coverage – A Call for Action”
National Coalition on Health Care Leadership Summit
The Carter Center, Atlanta, Georgia
January 26, 2000

The National Council of Churches has recently celebrated the start of its 50th year of life, an event which led us both to examine our roots and to project our goals for the future. As we look at where we have been, there are several issues which have been matters of great concern for us from the start – and among those is health care. One of our earliest Policy Statements calls for the “conservation of human resources from erosion through lack of access to adequate health services, education, housing and employment opportunities.” Perhaps we would word our thoughts differently now, but our concern is just as great as it was then.

For part of my career, I served in the U.S. House of Representatives, representing a district on the edge of Philadelphia. In each of the fourteen years I was there, the first bill introduced in each Congress was legislation by Rep. John Dingell calling for National Health Insurance. Never in those years – nor in any year since – has that legislation or any other designed to provide universal coverage received really serious attention. During my years in Congress we also struggled repeatedly to enact legislation to create the Child Health Assurance Program, but the best we could do in most years was to make minute changes in existing programs so that a few more mothers and children could have access to Medicaid. [See attached chronology of major health care legislation that became law between 1975-1988.]

Consequently, my involvement in this issue from the public policy standpoint has been considerable; but so has my interest in it as a member of the religious community.

The issue of health care, and particularly universal access, has been high on the agenda of the National Council of Churches since its birth. We and our member communions supported the creation of Medicare and Medicaid. We worked with Sen. Kennedy in the 1970s in a failed effort to achieve health care for all people in the U.S. and we have supported health initiatives in every Administration since that of President Truman.

For many years we were counseled and guided in our health care advocacy by the late Dr. Arthur Flemming, a former President of the NCC and Secretary of Health, Education and Welfare in the Eisenhower Administration.

Early in 1990s our Child Advocacy Office did a survey of local churches and published a study showing the extent to which congregations are involved in providing health care services and assistance to people who need it, especially children. The findings were both amazing and alarming – amazing because churches are doing so much, and alarming because what they are able to do is so little compared to the ever-increasing need. And yet there is an expectation both in the society and within government that the churches should, can and will take on more and more responsibility for meeting the unmet needs of the less-affluent members of society.

The National Council of Churches has participated in every national effort that has been made since our founding to widen the health care safety net and knit up the holes in it, so that every person who needs and wants health care coverage can have it.

One major effort was through the Interreligious Health Care Access Campaign in the mid-1990s. Now we are engaged in trying to promote access in the states to the Child Health Insurance Program, approved by Congress a couple of years ago but still not widely utilized.

Of course, we have been part of the National Coalition on Health Care from its early days, where we appreciate having the opportunity to work with representatives of labor, industry, health care providers, consumers, and other religious partners to increase access to quality, affordable health care. And we are part of the Interreligious Health Care Working Group in Washington and the U2K program operated by the Universal Health Care Access Network and the Gray Panthers, which is working to raise public awareness of the health care crisis in the nation in this election year.

From the earliest days of the Church, healing has been a ministry in which religious people have engaged. Jesus was a healer, as were many of his followers. Through the centuries Christians have been constrained to show forth the love of God not only by preaching but also by healing. Society has frequently been served by the churches in meeting health needs.

Churches and religious organizations have sponsored, supported, educated, and employed vast numbers of persons engaged in health professions. Extensive health services have been developed and maintained by churches in this nation and abroad. Through all their activities in the field of health, churches have aided people more fully to render service to God and their fellows and have expressed the Christian faith in love. The major portion of the health care system, however, is not now administered or financed by church-related institutions.

Therefore, as the NCC’s governing body said in a 1971 statement which it recently reaffirmed,

…the churches’ concern for health for all people must express itself in efforts to see that communities, states and the nation provide cooperatively, through governmental and non-governmental programs, an effective system of health care. In matters of health, the rights and well-being of one group in society cannot be secured without securing them for all.’

We believe that it is a national disgrace that over 44 million people in this country are without access to health care. They are not abstract numbers to us. We know these people. They are: our adult, employed children; members of our churches; colleagues at our work places; part-time and seasonal workers; neighbors; veterans; children. In times of crisis, they are served in the emergency rooms of hospitals and institutions operated by religious groups; and, because they are uninsured, the cost of providing them with the limited care they get is passed on to those who are more fortunate.

In addition to those who have no insurance and are not eligible for Medicare and Medicaid, we are acutely aware of the problem of the under-insured who have some coverage but cannot afford the co-payments for the care they need and those who have to choose between eating and buying their medicine because Medicare does not cover their prescription drugs.

How can it be that the United States is the only developed nation in the world that does not have a national commitment to universal health care for all its people? How can we fail to know that what hurts our neighbor hurts us? How can we possibly accept the fact that – in a period which by all economic measurements is a golden time in our nation’s history – the number of people without health care protection is increasing rapidly even though unemployment is at an all-time low?

We used to think that if a person got a job, that person’s family would have health insurance automatically. Now we know better. That person’s family may lose its access to Medicaid and be less well cared for as a result of being employed in a job that does not provide any health care benefits or that covers only the worker but not the family. Employers are providing less health care coverage in this affluent period, not more. Employment is no guarantee of protection.

The National Council of Churches and its member communions hold it to be immoral that any person goes without health care coverage. Our commitment is to nothing less than universal access to high-quality and affordable health care, equitably distributed throughout the country so that people can reach help when they need it, and administered in ways that treat patients with dignity and do not increase the burden on them with excessive bureaucratic demands.

We are grateful for the opportunity to be involved in this effort with the National Coalition on Health Care and commit ourselves to full partnership with the Coalition as it works to advance the cause of quality health care for all.

MAJOR HEALTH CARE LEGISLATION ENACTED BETWEEN 1975 AND 1988

1975
No major legislation.

1976
Passed Health Manpower legislation providing funds to ease the shortage of doctors in rural and inner-city areas.

1977
Passed Medicare Fraud and Abuse legislation.

1978
Passed the Pregnancy Disability Act, barring discrimination in hiring or promotion against women who are pregnant.

1979
Passed legislation providing funds for special psychological counseling and drug and alcohol programs for Vietnam veterans.
[NOTE: The House passed the child Health Assurance Program to upgrade Medicaid health screening and treatment for needy children, but it was stifled in the Senate Finance Committee by Sen. Long on the grounds that enacting it would interfere with his efforts to develop a National Health Insurance plan.]

1980
Expanded Community Mental Health Centers, targeting the bulk of funds to under-served groups such as the elderly, severely disturbed children and adolescents, and the chronically mentally ill.

1981
As part of a budget reconciliation package, required Medicare recipients to pay a greater share of the cost of their care.

Combined 19 health care programs into four block grants to the states and cut funding.

Ended special funds to medical schools to increase the number of doctors in special needs areas.

Provided new funding for Vietnam veterans affected by Agent Orange.

1982
Put caps on Medicare payments to hospitals and doctors. Authorized Medicare for hospice services and revised payment methods to facilitate Medicare enrollments in HMOs.

1983
As part of a Social Security bill, fixed the payment rates for Medicare reimbursements to hospitals for treatment of over 400 conditions.

1984
Made generic drugs available to consumers.

Required states to broaden Medicaid coverage for pregnant women and young children.

Established national computer network to ease logistical problems of organ transplant surgery by matching donors and those needing transplants.

1985
Further liberalized Medicaid coverage for low-income pregnant women.

1986
Required that hospitals participating in Medicare provide emergency services for people in urgent need of care regardless of ability to pay.

Required states to provide Medicaid prenatal and post-partum care to low-income two-parent families in which the primary wage-earner is unemployed. Two-parent families would not have otherwise been covered in states (most of them) that linked eligibility for Medicaid to being on welfare, since two-parent families could not be on AFDC unless the father was handicapped.

Permitted states to provide Medicaid to the disabled, pregnant women, and children up to age 5 who are poor but not on welfare.

Required employers of 20 or more who offer group health plans to allow laid-off workers and others who would lose coverage (widows and former spouses) through death or divorce to continue coverage at the group rate.

Prohibited TV advertising of chewing tobacco and snuff.

1987
Made all pregnant women and their children in families up to 185% of the poverty line eligible for Medicaid.

1988
Passed a Catastrophic Health Insurance bill advocated by President Reagan (later repealed) to protect seniors from huge medical bills related to serious illnesses that exceeded their entitlements under Medicare. This legislation covered outpatient prescription drugs and eliminated the spousal impoverishment requirement for Medicaid nursing home care. The legislation also required states to extend limited Medicaid to all elderly people, pregnant women and infants with incomes below the poverty line.

The cost of the program was to be borne by beneficiaries through premiums, which led to its repeal a couple of years later.

In other legislation, Congress provided the first federal funds to battle AIDS.

As part of the 1988 welfare overhaul, allowed families leaving welfare to keep Medicaid for one year. Made generic drugs available to consumers.