Health is an exceptionally expensive resource in the United States, “though it should not be,” political scientist Jamila Michener told the House Rules Committee on Oct. 13.
Her testimony about the relationship between poverty and health care was given during the “Ending Hunger in America: Family Budgets and Food Insecurity” roundtable convened by James McGovern (D-Massachusetts) committee chairman.
Michener is an associate professor of government in the College of Arts and Sciences and co-director of the Cornell Center for Health Equity. Her research focuses on poverty, racial inequality and public policy – especially, she told the committee, the ways public policies interact with the larger economy to shape (and often constrain) civic and material well-being of low-income families.
In her testimony, she drew on interviews she conducted for her book, “Fragmented Democracy: Medicaid, Federalism and Unequal Politics,” to describe the experiences and voices of Americans who are living in or near poverty, shouldering sometimes devastating health cost burdens, and struggling to feed their families.
“My research speaks to the circumstances of Americans living in or near poverty, who are disproportionately people of color, and who must navigate the U.S. health care system in a context of economic instability and insecurity,” she said.
Citing studies showing the ways in which low-income families are made more financially precarious when they pursue their health care needs, Michener said that approximately one in three chronically ill people report being unable to afford food, medications or both.
“Food insecurity makes people sick,” Michener told the committee, pointing to evidence that links food insecurity to common and preventable chronic conditions, including obesity, hypertension and Type 2 diabetes.
Michener highlighted a number of changes that could help alleviate medical debt-based poverty, such as continuous eligibility for Medicaid, robust and continual funding for local health institutions and improved coordination between public benefits programs focused on health – like Medicaid – and those focused on nutrition, like WIC and SNAP.
In response to a question from Rep. Deborah Ross (D-North Carolina) about differences between rural and urban communities, Michener cited her developing research on the non-emergency medical transport benefit (NEMT) – which is especially important to rural residents, and likely underutilized. Michener is investigating explanations for the dramatic differences in the use of the NEMT as well as exploring the unique barriers around transportation to medical care and medical services that exist in rural areas.
McGovern gave Michener the last word to close the meeting.
“Fundamentally, what we’re grappling with here today are questions of power,” she said, describing how people in poverty have to fight not only for their basic existence but for their “human dignity to be recognized as having value and importance... When people who have power don’t understand the nature of these circumstances and experiences, they can make policies that are harmful or oppose policies that are helpful.”
Michener told the committee that her research into how people try to channel their political voice and engage in civic and political movements has shown that taking action against injustices is “really hard when you face all of these very difficult decisions and these cumulative disadvantages... the power of people who ought to be able to have an influence over processes so that we don't get these kinds of outcomes is weaker than it ought to be” – making our democracy as a whole weaker.