A Journey Through the Health Care Safety Net
20 Pages Posted: 21 Oct 2017
Date Written: October 20, 2017
Teaching health law is incredibly rewarding and stimulating, but it is also very challenging. This is partly because there is no coherent body of health law, just as there is no uniform system of health care delivery and financing in the United States. This is also because health law is always evolving. Health law students need an adequate foundation in the patchwork of laws that govern the current system, but they also need to be prepared for the dynamic character of health law and to become familiar with the enduring policy debates that make future change inevitable. This is most vividly illustrated by the uncertainty ushered in by the 2016 elections, which not only made repeal of the ACA a realistic possibility, but renewed momentum for a dramatic rollback of longstanding Medicaid entitlements and funding – a rollback that would strike at the heart of the health care safety net. Professors of health law are, of course, thinking about the legal, policy and human implications of this. But they must also confront the challenge of teaching health law in the midst of this uncertainty. This makes the St. Louis University Law Journal Teaching Issue on Health Law a particularly timely resource.
My contribution to this issue offers one approach to teaching students about the health care safety net, by focusing on a book I have considered a valuable teaching supplement for fifteen years: Mama Might Be Better Off Dead: The Failure of Health Care in Urban America. In this book, investigative journalist Laurie Kaye Abraham chronicles the health care experiences of an economically disadvantaged family in Chicago from May 1989 to April 1990. Abraham takes readers on a journey that touches almost every part of the safety net, revealing myriad challenges the poor face in getting care—from coverage gaps, to bureaucratic impediments to access, to social determinants of health. Abraham also makes a complex and vast subject digestible. Students become so invested in the family’s experiences that it makes them want to devour the technical statutes and regulations governing health care finance and delivery that would otherwise seem tedious or difficult to grasp. This foundation not only helps students better understand the goals and design of various health reforms, including the ACA, it also helps students evaluate whether such reforms are effective at removing access barriers and promoting health. One may wonder how valuable this book is today in light of the significant insurance expansions enacted since the late 1990s. But this Essay shows how the book’s lessons are timeless and its narrative force is as compelling as ever. The book also serves as a powerful cautionary tale in the face of attempts to repeal the ACA and rollback Medicaid – a vivid reminder of what lies ahead if we choose retrenchment.
Keywords: Health Care, Safety Net, ACA, Medicaid
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