Health, Race, and Poverty

Why is life expectancy in the city’s poorest neighborhoods eight years shorter than in its wealthiest neighborhoods? There are a number of reasons why being poor adversely affects health. But the major health problem for poor New Yorkers is getting access to quality medical care.

Many poor New Yorkers, stuck in low-paying jobs, face a situation where either their employers do not offer health insurance or employee contributions for the insurance premium are far too costly. In addition, the number of primary care physicians in poor neighborhoods has dwindled over the years.

To a large degree, to be poor in New York City is to be black or Latino. Besides a link between poverty and race, this helps to explain another connection - between race and health care. Discrimination affects health. Not only does it tend to limit access to quality care; it can affect health through psychological stress.

Health care access
is the problem

And since most poor New Yorkers are likely to be black or Latino, they are also the most likely to be without health coverage, either because their jobs do not offer it or because they cannot afford the premiums. According to the Urban Institute, about 40 percent of black workers and 25 percent of Latino workers in the city have no health insurance, compared to about 16 percent of uninsured white workers. This situation has a devastating effect on communities of color throughout the city.

A recent report by the city’s Health Department revealed that African American and Latino New Yorkers have a higher mortality rate from many diseases. Deaths due to AIDS are six times higher in New York’s poorest neighborhoods than in its wealthiest neighborhoods. Poor New Yorkers are three times more likely to suffer from diabetes, liver disease, and high blood pressure. Children living in poor neighborhoods are three times more likely to be hospitalized with asthma than those living in wealthier neighborhoods.

Medicaid Difficulties

Many African American and Latino patients in New York City depend on Medicaid for health coverage. Yet because of difficulties in the current application and renewal process, large numbers of people who are eligible for Medicaid do not have coverage. If the city and state were to make it easier to get and keep Medicaid benefits, this would help create a more stable patient base in low-income neighborhoods. Doctors would be more willing to set up practices in these areas, knowing that the patients they serve have coverage to pay for their care.

Since the Medicaid Managed Care program began in New York State, CSS has been monitoring enrollees’ experiences in New York City. We do this through periodic surveys where we actually ask people what they understand about managed care, and what their experiences are in getting care. We also hear it regularly through our MCCAP network.

MCCAP Assistance

CSS has operated the New York City Managed Care Consumer Assistance Program – known as MCCAP - since 1998, and currently has a network of 29 community-based organizations that provide people with assistance in figuring out the managed care system. We are currently providing services in 18 languages.

MCCAP not only assists people in getting health coverage; it educates them on how to use their health insurance and it provides one-on-one assistance to help them exercise their rights and resolve problems with their plans. MCCAP’s ultimate goal is to help people learn skills that allow them to get the care they need and to know what to do when they don’t.

Many MCCAP clients are immigrants with low-English proficiency. They often have a hard time understanding our health care system. MCCAP’s approach to providing health care addresses these problems. MCCAP is a decentralized program. Help is provided in clients’ own neighborhoods, in their own languages.

CSS acts as a bridge between MCCAP’s target populations and those public officials who make the decisions that affect health care policies. We provide first hand data on health care disparities and advocate for policy changes that will close those disparities.

If you need help with your managed care plan, call NYC MCCAP at 212-614-5400. Or you can go online at MCCAP’s website: www.nycmccap.org. The site includes a listing and location of all MCCAP agencies.

From the New York Amsterdam News
December 15 - 21, 2005