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Resolution onAdvocacy onBehalf of theUninsured

Resolution onAdvocacy onBehalf of theUninsured

Copyright © 2002 by the Office of the General Assemblyof the Presbyterian Church (U.S.A.)

Published 2002 byThe Advisory Committee on Social Witness Policy

www.pcusa.org/acswp

and

Health Ministries USA, National Ministries Divisionwww.pcusa.org/health/usa

of the General Assembly Council, Presbyterian Church (U.S.A.)

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Forward ..................................................................................................1

Rationale ................................................................................................3

Introduction ..................................................................................3

Biblical and Theological Reflection ..........................................8

Trends Affecting the Uninsured ................................................10

The Challenges ............................................................................20

Endnotes ......................................................................................24

Recommendations......................................................................................25

Appendix IThe Challenge to Presbyterians ....................................................................27

Appendix IIHealth Care Access Resolution or House Concurrent Resolution 99 ..........31

Resolution on Advocacy on Behalf of the UninsuredContents

The Advisory Committeeon Social Witness Policy(ACSWP) was asked by the211th General Assembly(1999) to develop a resolutionthat addresses the need foradvocacy on behalf ofuninsured persons, especiallythose with low income orfixed income. In adopting theResolution on Advocacy onBehalf of the Uninsured, the 214thGeneral Assembly (2002) recognizedthat the church must provide notmerely a moral whisper ofconscience, but a chorus of voicesraised in a call for immediate action.

Historic inadequacies in ourhealth care system and thedistribution of services through thatsystem leave millions without themeans to obtain even the most basichealth care for themselves and theirfamilies. While continuingescalation of health care costs affectsall of us, the effect on the mostvulnerable is devastating.Individuals on fixed incomesbecome at greater risk. People (andtheir families) who have lost jobsand benefits due to the economicdownturn are at risk. Individualswithout private coverage or who donot qualify for governmentsubsidized insurance are at greaterrisk than before because the numberof health care providers willing togive treatment to medically indigentpeople is decreasing at an alarmingrate. Rising co-payments and

deductibles, combined with stricterpre-authorizations andreimbursement caps, are affectinghealth care access for middle-income persons.

The resolution that follows offersa biblical and theological rationalein light of the current situation forchurch involvement advocating onbehalf of uninsured persons. It alsoprovides the framework for acongregational plan to advocate forhealth care access for all, as well as acopy of legislation currently beforeCongress and calling for basic accessto health care for all. Several trendsaffecting the uninsured are thenexplored followed by anexamination of the challenges aheadas Presbyterians seek to beresponsible in both their public andprivate lives in the quest offurthering God’s intention of health(shalom) for the earth and itspeople. The final section presentsthe recommendations approved bythe 214th General Assembly as itmet June 15-22, 2002, in Columbus,Ohio. In addition, Appendix I, “The

1 Resolution on Advocacy on Behalf of the Uninsured

Forward

Forward 2

Challenge to Presbyterians from the214th General Assembly: AdequateHealth Care for Everyone” offersconcrete ways for individuals andtheir congregations to respond inadvocacy for the uninsured. Itprovides the framework for acongregational plan to advocate forhealth care access for all. Appendix II,“Health Care Access Resolution”(House Concurrent Resolution 99),provides a copy of legislationcurrently before Congress andcalling for basic access to health carefor all.

A small resolution team,appointed by the ACSWP andchaired by Margaret P. Elliott, mettogether as a group for study and thedevelopment of the resolution for thecommittee. Along with its chair, thegroup included the following: PeggyS. Barnett, Alfred B. Johnson, RobertVan Kemper, Sue Donovan Mooney,and William H. Thomas. Doug Graceserved as staff from the PresbyterianWashington Office and Belinda M.Curry served as staff from theACSWP.

In exercise of its responsibility towitness to the Lordship of JesusChrist in every dimension of life, the214th General Assembly (2002) of thePresbyterian Church (U.S.A.) hasapproved this resolution. It is presentfor the guidance and edification ofthe whole Christian church and thesociety to which it ministers. It willdetermine procedures and programfor the programmatic divisions and

staff of the General Assembly. It isrecommended for consideration andstudy by other governing bodies(sessions, presbyteries, and synods).It is commended to the free Christianconscience of all congregations andthe members of the PresbyterianChurch (U.S.A.) for prayerful study,dialogue, and action.

At the time of this printing,House Concurrent Resolution 99 isbefore Congress (See Appendix II).With 96 Congressional co-signers,the Resolution has not yet beenbrought to a vote. The call toPresbyterians from the 214thGeneral Assembly to provide healthcare for everyone is our challenge.

Peter A. SulyokCoordinator

Advisory Committee onSocial Witness Policy

Patricia K. GleichAssociate

Health Ministries USANational Ministries Division


Rationale

This resolution withrecommendations is in response tothe following referral: 1999 Referral:25.037. Response to RecommendationDirecting ACSWP to DevelopResolution Addressing Need forAdvocacy on Behalf of UninsuredPersons, Especially with Low Incomes,with Necessary Funding, forPresentation to the 213th GeneralAssembly (2001)—From the AdvisoryCommittee on Social Witness Policy(Minutes, 1999, Part I, pp. 41, 308).

Introduction

Of all forms of inequality, injustice inhealth care is the most shocking andinhumane

—The Reverend Dr. Martin Luther King Jr.

Almost a half-century ago,President Eisenhower referred to the“Military-Industrial Complex” as apowerful force to be reckoned within the future of American society.The United States’ interests in globalgeopolitics have dominated globalaffairs since the end of World War II.Since then, our nation has beeninvolved in conflicts in SoutheastAsia, in the Middle East, in LatinAmerica, and in Africa. Not so longago, we sent military forces into theformer Yugoslavia; now, in the wakeof the events of September 11, 2001,we have become engaged in fightingagainst terrorists in Afghanistan.The pursuit of war abroad and

wealth at home have been higherpriorities than global welfare andhealth.

Today, many of us have learnedfirsthand that the “Medical-Insurance Complex” has emerged asan even more powerful force inAmerican life. Everyone knowssomeone who has complainedbitterly, “I would quit this jobtomorrow—but I can’t afford to. Mychild’s pre-existing medicalcondition would not be covered if Itook the better-paying job that I havebeen offered in another company.”Despite the provisions of HIPAA(the Health Insurance Portabilityand Accountability Act of 1996),millions of Americans feel that theyare “indentured” workers, trappedin their employer-based healthinsurance plans.

In the United States today, theability to have health depends morethan ever on having healthinsurance. Among the some 285million people living in our country,more than 40 million have no healthinsurance and countless millionsmore are underinsured.2 Only theUnited States among theindustrialized nations of the worldfails to offer its citizens some form ofuniversal health care. Instead,Americans depend on a voluntarysystem of health-care policies paid(or co-paid) by employers, by one ormore government agencies, orthrough the purchase of privateinsurance. At one time or another inour lives, almost every American is

Introduction 4

at risk of facing a health crisis notcovered adequately or not coveredat all. Sometimes, the only solutionto a medical crisis is to find a way tostrip one’s assets, declarebankruptcy, and become indigent sothat government will provide thesafety net that one’s employer-basedinsurance plan failed to offer.

The numbers involved in theranks of the insured are related toeconomic prosperity. Employer-based coverage increased from 1995to 1999 as individuals moved tobetter jobsduring theunprecedentedeconomicboom.Conversely,during theearliereconomicdownturn in1989–1990, twomillionAmericans losttheir health coverage. The recenteconomic decline in 2001 suggeststhat additional millions ofAmericans again are at risk ofbecoming uninsured. When U.S.firms cut costs by moving jobs toother less-developed countries, theynot only create more unemploymentat home, they also eliminatesubstantial health-care costs fromtheir corporate balance sheets. Andwhen U.S. employers hireundocumented immigrant workers,they sometimes try to avoid paying

benefits, including medicalinsurance and even mandatedFederal Insurance Contributions Act(FICA) taxes.

America spends about $1 trillioneach year on health-related matters,representing about 14 percent of itsGross Domestic Product. This is 40percent more than any otherindustrialized country in the world.Yet our health indicators (e.g., lifeexpectancy, infant mortality, heartdisease, cancers) often trail farbehind those of other countries.

Medicalcare inAmerica maybe better thanever. Newdrugs, newtreatments,and newdiagnostictools haveimprovedtreatment of awide range of

physical and mental conditions. Thehigher costs associated with thesenew medical technologies haveelevated the problem of uninsuranceinto a national crisis. As a result, theNational Academy ofScience/Institute of Medicine’s“Committee on the Consequences ofUninsurance” recentlycommissioned a series of six reportson the causes and consequences oflacking health insurance. The firstreport, published under the titleCoverage Matters: Insurance and

Among the some 285 millionpeople living in our country,more than 40 million haveno health insurance andcountless millions more areunderinsured.


Health Care (Washington, DC:National Academy Press, 2001),examines why health insurancematters, considers the dynamics ofhealth insurance coverage, anddescribes who goes without healthinsurance in our society.

Employer-based health insurancecovers only about 66 percent ofAmericans under age 65, eitherthrough their jobs or through thoseof their parents or a spouse.Individually purchased policies andgovernmental insurance programsprovide coverage to another 17percent of the under-65 population.This leaves about 17 percent of theunder-65 population withoutinsurance through the year. Forpersons over 65, even Medicare doesnot cover all medical expenses. Asthese expenses increase, somepersons living on fixed incomes find

that they cannot afford neededmedical care even with Medicarecoverage. Also, because some seniorcitizens often fail to understandcompletely the benefits availablethrough Medicare, they may nottake full advantage of the coveragepaid for by their own and others’taxes (FICA).

Uninsurance fallsdisproportionately upon the poor,especially those working forminimum wages in small businessesthat often do not offer health-careplans to their workers. Two-thirds ofall uninsured persons are membersof families who earn less than 200percent of the Federal Poverty Level(FPL). The following table shows thegeneral guidelines used by theDepartment of Health and HumanServices to determine if a householdfalls below the FPL:

2001 Federal Poverty GuidelinesAnnual Income

Household size 48 Contiguous States and DC Alaska Hawaii

1 $ 8,590 $10,730 $ 9,890

2 $11,610 $14,510 $13,360

3 $14,630 $18,290 $16,830

4 $17,650 $22,070 $20,300

5 $20,670 $25,850 $23,770

6 $23,690 $29,630 $27,240

7 $26,710 $33,410 $30,710

8 $29,730 $37,190 $34,180

for each additional person, add

$ 3,020 $ 3,780 $ 3,470

SOURCE: http://aspe.os.dhhs.gov/poverty/poverty.htm

Introduction 6

These working poorare precisely themembers of Americansociety least able toafford to buy privatehealth insurance at thesame time that they areineligible for mostgovernmentalinsurance programs.

The findings inCoverage Matters:Insurance and HealthCare provide a generalprofile of theuninsured:

■ Work Status: Eightout of ten uninsured people aremembers of families with at leastone wage earner, and six out ofevery ten uninsured people arewage earners themselves.

■ Income and Poverty: Two-thirdsof all uninsured persons aremembers oflower-incomefamilies (earningless than 200percent of FPL).One-third of allmembers oflower-incomefamilies areuninsured.

EducationalAttainment: Morethan one-quarter ofall uninsured adults have not earneda high school diploma. Almost fourof every ten adults who have not

graduated from high school areuninsured.

■ Job Characteristics: There aregreater numbers of uninsuredblue-collar workers thanuninsured white-collar workers.Members of families with a

primary wageearner who isblue collar aremore likely to beuninsured thanare members offamilies with awhite-collarworker.

■ EmployerCharacteristics:Wage earners insmaller-sized

firms, in lower-waged firms, innon-unionized firms, and in non-manufacturing employment

America spends about$1 trillion each yearon health relatedmatters — yet over40 million are withouthealth insurance


sectors are more likely to gowithout coverage.

■ Age: Three-quarters of theuninsured are adults (ages 18–64years), while one-quarter of theuninsured are children.Compared with other age groups,young adults are the most likelyto go without coverage.

■ Marital Status: There are moreunmarried than married adultsamong the ranks of theuninsured. Unmarried personsare much more likely than arethose who are married to beuninsured.

■ Family Composition: More thanhalf of all uninsured persons aremembers of families that include

children. Individuals in familieswithout children are more likelyto go without coverage than thosein families that include children.

■ Race and Ethnicity: AfricanAmericans are twice as likely, andHispanics three times as likely, aswhites to be uninsured. Morethan one-third of all Hispanicsunder age 65 are uninsured.Almost one-third of all AmericanIndians and Alaska Natives areuninsured, a rate almost as highas that for Hispanics.

■ Gender: More men than womenare uninsured, percentage-wisemen are more likely than womento be uninsured.

Biblical and Theological Reflection 8

Biblical and TheologicalReflection

“There is no one to upholdyour cause, no medicine foryour wound, no healing foryou” (Jer. 30:13, NRSV).

God’s intention of health(shalom), for the earth and itspeople, and Jesus’ promise ofabundant life(health, healing,and restoration towholeness in body,mind, and spirit)are centraldimensions of thefaith we professand the vocation towhich we arecalled asChristians. It leadsthe list in the order of servicethrough which we participate inGod’s activity through the church’slife for others by

(a) healing and reconciling andbinding up wounds,

(b) ministering to the . . . poorand sick, the lonely, and thepowerless,

(c) engaging in the struggle tofree people from sin, fear,oppression, hunger, andinjustice,

(d) giving of itself and itssubstance to . . . those whosuffer,

(e) sharing with Christ in theestablishing of his just,peaceable, and loving rulein the world (Book of Order,G-3.0300c(3)(a)–(e)).

The health of a society ismeasured in an important way bythe quality of its concern and care forthe health of its people. Howprovisions are made for children in

the dawn of life,the elderly in thetwilight of life,and the sick,needy, and thosewithhandicappingconditions in theshadow of life areclear indices ofthe moralcharacter and

commitment of a nation. At theminimum, credible commitment tohealth includes a safe environment;adequate food, shelter, clothing, andemployment or income; andconvenient access to quality,affordable, preventive and curativehealth services (Life Abundant: Values,Choices and Health Care: TheResponsibility and Role of thePresbyterian Church (U.S.A.), 200thGeneral Assembly (1998)).

Aconsistent and persistent part ofGod’s revelation is the Creator’sconcern for the wholeness and wellbeing of human beings and ourcommunities. The general vision ofGod’s shalom is revealed to usthrough many prophetic declarations.

At the minimum, crediblecommitment to healthincludes convenientaccess to quality,affordable, preventive andcurative health services


Time and time again, we hear that thehealing ministry of our Lord is notreserved for the wealthy few, but isintended for all of God’s people. Forinstance, in Isaiah, the Lordproclaimed,

I will rejoice in Jerusalem, anddelight in my people; no moreshall the sound of weeping beheard in it, or the cry of distress.No more shall there be in it aninfant that lives but a few days, oran old person who does not liveout a lifetime; for one who dies ata hundred years will be considereda youth, and one who falls short ofa hundred will be consideredaccursed . . . for like the days of atree shall the days of my people be,and my chosen shall long enjoythe work of their hands

— Isa. 65:19–20, 22b, NRSV

Health care is a responsibility ofboth our public and private lives.Our love for God is reflected in ourlove for neighbor and in respect ofourselves. Jesus makes clear that astandard for judging all peoples hasto do with how the least are doingin that community (Matt. 25:31–46).

Since John Calvin’s hospitalministry in seventeenth-centuryGeneva, the Reformed tradition hasexpressed God’s love throughministries of education and healthcare. This witness to God’s concernhas included individual andinstitutional responsibilities. Attimes, we have advocated andimplemented this witness. Just apartial list of health-related actionsof the Presbyterian Church (U.S.A.)demonstrates our continuingadvocacy during the past fourdecades:

1960 — The Relation of Christian Faith to Health

1971 — Toward a National Public Policy for the Organization and Delivery ofHealth Services

1976 — Health Care: Perspectives on the Church’s Responsibility

1978 — Health Ministries and the Church

1983 — The Report of the Task Force on New Directions in Health Ministries to theDivisions of International and Medical Benevolence Foundation

1986 — The Report of the Health Ministries Evaluation Team of the ProgramAgency Board

1988 — Life Abundant: Values, Choices and Health Care

1991 — Resolution on Christian Responsibility and a National Medical Plan.

In the ever-changing personal,national, and international world ofhealth care, our church continues toadvocate for and implement

examples of “covenant access toquality, affordable, preventive andcurative health services.”

Trends Affecting the Uninsured 10

Trends Affecting theUninsured

Political Economic Trends

To be without health insurance inthis country means to be withoutaccess to medical care. But healthis not a luxury, nor should it bethe sole possession of a privilegedfew. We are all created b’tzelemelohim—in the image of God—andthis makes each human life asprecious as the next. By “pricingout” a portion of this country’spopulation from health-carecoverage, we mock the image ofGod and destroy the vessels ofGod’s work

— Rabbi Alexander Schindler,Past President, Union of

American HebrewCongregations

The “Medical InsuranceComplex” is a powerful andinfluential political voice throughoutAmerican society. Pharmaceuticalcompanies, insurancecorporations, biotechnologyfirms, hospital systems,professional medical and legalorganizations—the list ofspecial interests seemsendless—have easy access tolaw makers. No major newsmagazine or newspaperappears without full-pageadvertisements for medicinesand health insuranceproducts. In fact, more moneymay be spent each year on

advertising, legal fees, and lobbyingthan on research and developmentof new drugs.

In contrast, persons withouthealth insurance rarely have theopportunity to tell their stories totheir elected representatives in local,state, and federal governments. Indebates about universal health care,those on the margins need advocatesto transform injustice into justice. Toanswer Jesus’ call for justice,advocacy is the first step needed tobegin the uncertain journey for a justhealth-care system.

Among industrialized nations,health care in the United States isdistinctive for its voluntary, profit-oriented features. No wonder that, inrecent years, foreign drug companieshave been buying controllinginterests in several U.S.pharmaceutical firms. Thisconsolidation has not reduced thecost of drugs or medical services—asdemonstrated by the recentcontroversies between the U.S. andCanadian governments and


Switzerland-based Bayer over theanti-anthrax drug Cipro.

The cost of health care continuesto rise at a rapid rate, much higherthan the general rise in the cost ofliving. For instance, the ConsumerPrice Index for All Urban (CPI-U)consumers went from 134.8 inJanuary 1991 to 175.8 in January2001. The Medical Care componentof the CPI-U went from 171.2 to267.4 in the same ten-year period.The Prescription Drugs and MedicalSupplies subcomponent of the CPI-U rose even more over the ten-yearperiod, from 191.1 to 292.4, and theHospital and Related Servicesleaped duringthe same periodfrom 188.8 to327.9. Accordingto Acs andSablehaus (1995),“Increased healthcare spendingwas spreadbetweenhouseholds,government, and business, withfamilies absorbing 30 percent of theincrease through direct out-of-pocket spending. Governmentaccounted for 40 percent of theincrease through higher budgetaryoutlays, primarily for Medicare andMedicaid. Businesses accounted forthe remaining 30 percent ofincreased spending through non-wage compensation costs of labor.”3

The profits of companies in thehealth-care sector continue to

outstrip the performance of thestock market in general. The S&P500 Index went from 343 in January1991 to 1366 in January 2001—thegreatest period of growth in thestock market’s history. During thesame time, the adjusted stock priceof one of the large drug companies(Eli Lilly, maker of the widelyprescribed anti-depressant drugProzac) jumped from $19.23 to$92.10. Another major drug maker(Schering Plough, maker ofBenadryl) leaped from an adjustedstock price of $4.50 to $49.76 in thesame ten-year period.

By the early 1990s, thecomplexities ofthe health-caresystem in theUnited Stateswere obvious toall observers.Phrases like “co-pays,” “denial ofcoverage,”“preexistingconditions,”

“exclusions,” “managed care,”“medigap,” “network and out-of-network,” and “safety net” becamepart of the American language. Inrecent years, they have been joinedby acronyms like HMOs, PPOs,HCFA (recently renamed to CMA,Center for Medicare & MedicaidServices), CHIP, and COBRA. Often,these complexities lead to inequities,especially when knowledge of thehealth-care system is not shareduniformly among persons of diverse

The profits of companiesin the health-care sectorcontinue to outstrip theperformance of the stockmarket in general.


age cohorts, ethnic and linguisticgroups, and socioeconomic classes.

According to Bernard T. FerrariM.D., J. D., a senior partner atMcKinsey & Co., “the cost structureof managed care is roughly 85percent medical and 15 percentoverhead” (Managed Care, available athttp://www.managedcaremag.com/archives19910/9910.consolidate.html). In contrast, federally guaranteedprograms such as Medicare spendless on overhead (about 2 percent)and more on patients’ health. Theincrease in the number of healthadministrators is more than twice theincrease in the number of physiciansin recent years.

In the campaigns for the 1992elections, the problems of rising costsand inequities of coverage madeuniversal access to health care anational issue. The ClintonAdministration made its health plana showpiece, but intensive lobbyingby many special interests led to itsrejection by Congress. In theaftermath of this rejection, Congresscut federal funding for Medicaid,with negative impacts on poor andimmigrant populations, and has triedto privatize and “individualize”Medicare. During the decade of the1990s, the consolidation of thehealth-care industry has resulted inthe disappearance of many formerlynonprofit (often church-related)community health-care systems. Thechanges during the 1990s wereaccompanied by a steady increase inthe numbers of persons without

health-care insurance. The impact onindividuals and their families hasbeen costly beyond measure. It isestimated that nearly half of themore than one million Americanswho filed for personal bankruptcy in1999 made this difficult decision atleast in part because of debtsassociated with catastrophic healthproblems. Health-care expendituresnow constitute almost one-seventh(14 percent) of our country’s grossnational product. Health-care costsnow exceed $1 trillion, and (even inthe midst of a national recession,mergers, downsizings, and layoffs)health-care companies continue tobe among the most profitablecompanies in the country (NationalCoalition for Healthcare, “HealthCare Facts: How Much Do WeSpend?” www.nchc.org/know/spending.html).


Recent economic trends haveworsened the uninsurance crisis.The softening of the U.S. economyhas been seen in the sharp declinesin the stock markets since mid 2000.The Federal Reserve Board ofGovernors has been combating fearsof recession by lowering interestrates throughout 2001. The DiscountRate has been slashed from 6.0percent to just 2.0 percent throughten separate rate cuts, but theeconomy barely seems to respond—especially in the wake of the tragicevents of September 11, 2001. Thenation’s unemployment rate, whichhad reached all time low levelsduring 1999, jumped to 5.4 percentduring October 2001. The laying offof hundreds of thousands ofworkers in the transportationindustry (airlines, hotels,restaurants, travel agencies, etc.)comes on top of earlier layoffs ofsimilar magnitude intelecommunications and other NewEconomy (“dot com”) ventures.Many of these workers have beeneligible for short-term, self-financedcontinuation of their healthinsurance, but when their “COBRA”benefits come to an end millions ofindividuals and their families willhave been added to the roles of theuninsured. The high costs of payingthe premiums (about $2,650 for anindividual and $7,053 for a family)result in fewer than 20 percent ofCOBRA-eligible workers electingthis option. Newly unemployedworkers must choose between food,

rent, and clothing versus healthinsurance; it is hard to be concernedabout the future when today mustbe faced. President Bush’s proposalto make $3 billion in emergency aidavailable to workers laid off in thewake of the events of September 11pales in comparison to the $15billion airline industry aid plan.

Denominational andEcumenical Trends Related tothe Uninsured

Every person has the right toadequate health care. This rightflows from the sanctity of humanlife and the dignity that belongs toall persons, who are made in theimage of God. . . . Our call forhealth care reform is rooted in thebiblical call to heal the sick and toserve “the least of these,” thepriorities of justice and theprinciple of the common good. Theexisting patterns of health care inthe United Sates do no meet theminimal standard of social justiceand the common good.

—Resolution on Health CareReform, U.S. Catholic Bishops


Everyone has the right to astandard of living adequate for thehealth and well-being of himselfand of his family, including food,clothing, housing and medical careand necessary social services, andthe right to security in the event ofunemployment, sickness,disability, widowhood, old age orother lack of livelihood incircumstances beyond his control.

—The Universal Declaration ofHuman Rights Article 25 (1))

Following its 1988 statement onLife Abundant: Values, Choices andHealth Care (Minutes, 1988, Part I, pp.517–47), the PC(USA) continued tobe an advocate for the personsmarginalized in the national debateon health uninsurance. TheResolution on Christian Responsibilityand a National Medical Plan (Minutes,1991, Part I, pp. 810–20) appearedjust as the political agenda on healthcare was being established for the1992 national elections. But thePresbyterian church had not been theonly denominational voice crying inthe wilderness for health-care reformduring the 1990s. For example,several other denominations stakedout their national commitments touniversal health care during the 2000political season:

■ The Catholic Health Associationof the United States and theAmerican College of Physicians-American Society of InternalMedicine worked together ontheir own “Campaign 2000” to

develop a national dialogue tomake accessible and affordablehealth care a national priority.

■ The United Methodist Church,through its Program for Healthand Wholeness at the GeneralBoard on Church and Society, alsois dedicated to the proposition thathealth care is a right, even thoughour culture treats it as acommodity to be offered only tothose with resources. According tothe Reverend Jackson Day, theprogram director, “the story of theCanaanite woman reminds us thathealth care must be for all, and wemust find ways to realize that inour society” (Matt.15:21–28).

■ In 1999, the Churchwide Assemblyof the Evangelical LutheranChurch in America (ELCA),approved a resolution to authorizepreparation of a draft of an ELCASocial Statement on Health andEthical Issues in Health Care forpresentation at the 2003Churchwide Assembly. Thisstatement will focus on four points:

•presenting a Lutheran vision ofhealth and health care;

•dealing with the issues of accessto health care and equity inhealth care;

• addressing the mission andministry issues of health careinstitutions related to the ELCA;and

• assessing the role and promise ofELCA congregational healthministries now and for the future.


Most campaigns concerned withthe uninsured and the more generalissue of universal health care areaimed at convincing elected officialsat the federal level to pass legislationto create a more equitable system toreplace the current combination ofemployer-based, government-funded, and private-insuranceplans. Nevertheless, efforts to dealwith the situation exist at all levelsof American society, from specificcommunities to states to the nationat large. We offer three examples todemonstrate the breadth ofecumenical involvement in thesecampaigns:

The Local Level

An example of local initiativescomes from Chicago. In 1999, acoalition of religious, labor, andcommunity organizations launcheda campaign to raise $100 million ayear to provide medical care to thegrowing number of uninsured inthe metropolitan area. Calling itseffort the Gilead Campaign, UnitedPower for Action and Justice(associated with the IndustrialAreas Foundation) hopes that thisnetwork of public and privateorganizations can cut in half thenumber of uninsured in theChicago area. To accomplish thisgoal, $100 million annually will beneeded to provide health-careaccess to 400,000 individuals, whorepresent only half the area’sestimated number of peoplewithout coverage.

The State Level

Several states have takenleadership roles in dealing withhealth issues related to theuninsured. Here we cite two well-known examples, one from the westand the other from the east.

In Oregon, the “Oregon HealthPlan (OHP),” launched throughlegislation passed in 1989, blendsmanaged care and benefitlimitations to provide Medicaid-linked coverage for state residentsaccording to a prioritized list ofservices. As Richard Conviser’s“Brief History of the Oregon HealthPlan and its Features,” points out:“The most immediate result ofOregon’s reform effort was thatmany residents who previously hadno health insurance gained suchcoverage.” (This document isavailable on the Internet atwww.ohppr.state.or.us/docs/pdf/histofplan.pdf). A subsequent studyof “The Uninsured in Oregon 1998”(prepared by the Office for OregonHealth Plan Policy & Research)suggests that the Oregon HealthPlan “has increased access to healthcare for thousands of previouslyuninsured Oregonians. Between1990 and 1996, implementation ofthe OHP, in conjunction with astrong economy and a private-sector commitment to providinghealth insurance coverage, resultedin a reduction in the proportion ofuninsured individuals from 18 to 11percent.” (This report is availableon the Internet at


www.ohppr.state.or.us/docs/pdf/uninsured.pdf).

In Maryland, a coalition of faith-based groups, ranging fromcongregations to denominations,have introduced a “Declaration ofHealth Care Independence” thatcalls for quality, affordable healthcare for all state residents. Speakingon behalf of groups such as theEpiscopal, Lutheran, Methodist, andPresbyterian churches, the BaltimoreJewish council, and the BaltimoreBoard of Rabbis, the ReverendArnold Howard (of theInterdenominational MinisterialAlliance and the Greater BaltimoreClergy Alliance) declared, “Qualityhealth care ought not to be aprivilege for the few but a right foreverybody.”

The Federal Level

Designed to place universalhealth care on the political agendafor the 2000 elections, the U2Kcampaign had 400 endorsing faith-based and community-basedorganizations. Founded in October1999 by the National Council ofChurches, the Universal Health CareAction Network, and the Gray

Panthers, U2K mobilized theecumenical faith community to backits efforts toward achieving“comprehensive, affordable, quality,and publicly accountable health carefor all.”

All of these advocacy efforts—whether at the local, state, or federallevel—are intended to combineshort-term “fixes” to the presentpiecemeal health-care system with alonger focus on the future creationof a universal national medical plan.In this sense, our denomination hascontinued to labor in the light of thepolicy statements of 1988 and 1991.The 207th General Assembly (1995)approved “Call to Healing andWholeness: A Review of thePresbyterian Church (U.S.A.)’sHealth-Care Policy and Programwith Recommendations” (Minutes,1995, Part I, pp. 35, 459–82). One ofthe recommendations in the 1995resolution required that a“monitoring report” be prepared bythe Advisory Committee on SocialWitness Policy for submission to the211th General Assembly (1999). Oneof the conclusions of this monitoringreport is that “Several entities of theGeneral Assembly have beenactively advocating for health-caredelivery systems for all persons” (p.12). In particular, the church hasbeen a participant in the NationalCoalition on Healthcare and hasworked through the PresbyterianWashington Office with lobbyinggroups such as Families USA andthe Alliance for Health Reform.


Health TrendsWe don’t really want cars—we want transportation.

We don’t really wanttelephones—we want to communicate.

We don’t really want lightbulbs—we want light.4

And we don’t really want healthinsurance—we want health.

The health care system inAmerica is not in the same place as itwas before the terrorist attacks ofSeptember 11, 2001, amid continuingthreats of anthrax and contagiousdiseases. Health care needs are nowentangled in the fiercely partisandebate over theeconomicstimulus packagein the Senate.Democrats arebacking a planthat wouldprovide $9 billionto cover 75percent of thepremiums forthose personswho have losttheir jobs since September 11 and aretrying to keep their privateinsurance. The plan would alsoprovide $5 billion to increase thefederal contribution to Medicaid,and another $3 billion for states thatwant to help unemployed workerswithout coverage and not otherwiseeligible for assistance. TheRepublican position is that the plan

is too costly, is not focusedsufficiently on the neediestAmericans, and runs the risk ofcreating an expensive newentitlement, even though thepremium assistance is limited to justover a year.

With the debates only beginningat this time, we need to be advocateson behalf of vulnerable persons,especially those with low incomesand fixed incomes. The health systemis being directly affected by theeconomic slowdown of 2000–2001,and the situation has worsened sinceSeptember 11, 2001. For example,thousands of workers daily are beinglet go from work. They may havetemporary health insurance in place,

as long as theycan afford to paythe full premiumsas specified underthe ConsolidatedOmnibus BudgetReconciliation Act(COBRA), the1986 lawdesigned toprovide a bridgefor workersbetween jobs. The

COBRA has been used by millions ofworkers, but it has seriouslimitations; for example, it does notapply to persons who work forbusinesses with fewer than twentyemployees. Because persons able toafford the premiums mandated byCOBRA tend to be more affluent,they rarely qualify for other publicprograms aimed at the health of

With the debates onlybeginning at this time,we need to be advocateson behalf of vulnerablepersons, especiallythose with low incomesand fixed incomes.


behavioral health programs, such asthose in the states of Arizona andTennessee, and in the city of Dallas(Texas) have struggled with thedynamics of trying to serve thispopulation under capitated managedcare systems.

The following table5 offers aprofile of the 44.3 million uninsuredpersons by income as a percentage ofthe federal poverty level (FPL)6:

less than 100% FPL 26.1%

100%–150% FPL 16.8%

150%–200% FPL 14.0%

200%–300% FPL 18.3%

300% FPL or more 24.8%

In a CHIP document entitled“Healthy Families: Family HealthInsurance through One Door, March2001—Recommendations forCreating a Unified Health InsuranceProgram for California’s Childrenand Their Parents,” the 100%Campaign (a collaborative ofChildren Now, Children’s DefenseFund, and The Children’s PartnershipInsure the Uninsured Project, withfunding from the CaliforniaEndowment and the CaliforniaWellness Foundation) states:

. . . By submitting a “waiverrequest” to federal officials,California became one of the firststates to develop a plan for usingavailable federal [funds to supportits] State Children’s HealthInsurance Program (SCHIP). . . .But one consequence of thisproactive approach is that

parents and their children. Tocompound the problem, lower-income individuals without childrenare not eligible for coverage underthe CHIP programs and cannotafford the COBRA premiums.

It is urgent to understand thatbeing uninsured is not a status of acertain class of citizens in our society.It is a condition that may affectanyone at any time. For instance, forretired persons with fixed incomes“end of life costs” can be a specialburden. When Medicare funding hasbeen exhausted, caregivers must payfor all services. Depending on theseverity and duration of illness, a longand costly list of hospital and medicalservices may not be covered (e.g.,days beyond the “lifetime” limit forhospital care and oxygen equipmentfor lung and respiratory illness).

Even workers who participate inemployer-based medical insuranceplans may not be covered for certainimportant kinds of health care (e.g.,eye care, dental care, psychiatriccare). As long as health insurancecontinues to be employer based, theuncertainty of employment meansthat access to health-care benefitsmay vary at alarming rates. In thisnational context, the advocacy onbehalf of the uninsured is essential.

Uninsured Americans have poseda challenge for public-sector healthsystems as states attempt to findways to address physical andbehavioral health needs for apopulation that frequently delaysseeking care until a conditionrequires hospitalization. Several


California’s residents now face adaunting add-on-collection ofprograms and policies built overmany decades. And while eachpiece has valuable objectives, thecumulative effect is a maze ofinconsistent, redundant, andinconvenient rules thatdiscourage parents and theirchildren who want and needhealth care. In addition, thefragmented approach to healthcoverage has continued to leavemany working parents uninsured.

The issues of unequal access toquality health care are not onlyvisible among low-income andfixed-income individuals, but alsoappear among the large populationsof immigrants who have come toour nation in recent decades. InNovember 2000, the Henry J. KaiserFamily Foundation funded apublication on “Immigrants’ Accessto Health Care after Welfare Reform:Findings from Focus Groups in FourCities.” Prepared by Peter Feld et al.,the conclusions section of thispublication merit our attention:

Many immigrants arrive in theU.S. to a very different world—faced with challenges in adjustingto a new and complex societywhere systems of health carecoverage and access to servicesmay be very different from theirnative countries. The complexityof the policy environmentcompounds the difficulties facingnew arrivals to this country.Recent policies treating new

immigrants differently from bothcurrent immigrants and citizenscreate additional confusion andcomplexity for immigrants whoneed Medicaid and other publicbenefits. Additional factors suchas language, poverty, country oforigin, discrimination, and type ofemployment also contribute toimmigrants faring poorly inregard to health care coverage andaccess. As policymakers discussthe nation’s growing number ofuninsured and issues of accessand quality, the plight of the non-citizen U. S. population will needto be addressed.

Clearly, the church and ourthousands of congregations must beeducated about the continuingimportance of the 1991 “Resolutionon Christian Responsibility and aNational Medical Plan.” The need tounderstand the new dynamics ofhealth care in the twenty-firstcentury is even more demanding.Only with help from religiousorganizations, health-careinstitutions, professional medicalorganizations, and even theinsurance industry will the nation’slegislative leadership be willing topursue the goal of establishing aNational Medical Plan. We askcongregations, middle governingbodies, and the denomination toconsider the new context forParagraphs 40.021 and 40.022 of the1991 Resolution, which establish, atthe highest levels of society, the basisfor advocacy for the uninsured.

The Challenges 20

The Challenges

“I came that they may have life,and have it abundantly”

— John 10:10b

Data from the 2000 U.S. Bureau ofCensus estimate that there are 42.6million Americans who areuninsured at any one time, a numberthat has risen by 8 million (20percent) since 1990 (ExecutiveMemorandum June 4, 2001, #750).This is frightening! The word“uninsured”drives terror intous because of theconnotation ofinsecurity andfear. This is hownearly 43 millionof our fellow-citizens areliving—with asense ofinsecurity anduncertainty abouttheir future, their health, and theirwell-being. A catastrophic illnesscould drain the savings of thosewith some resources, but for thepoor, it becomes a traumatic eventbecause of the added inability togain access to quality treatment.

The challenge and the goal of ournation ought to be access to qualityhealth care for everyone within itsborders. We believe that it is themoral responsibility of the state toensure that all its peoples enjoyaccess to quality health care.“Quality” health care should not be

reserved for the privileged. It is aright for all. With the proliferation ofhospitals and the large number ofpracticing doctors, quality care canbe available to the entire community.It is also the Christian responsibilityin keeping with Christ’s threefoldinstructions to Peter, as therepresentative of the Church, that heshould “feed my lambs,” “tend mysheep,” and “feed my sheep” (John21:15–17).

Without proper health care, ournation is losing the benefit of human

resources and theeconomy is beingrobbed ofpotentialcontributors. Weneed to realizethat failure toensure access toquality healthcare for the 42.6millionuninsured canhave a serious

domino effect. Not only are entirefamilies affected negatively, but alsothe entire nation is at risk in theevent of an epidemic. By providingquality health care for theuninsured, we are not justpreserving the life of poorindividuals, we are protecting thehealth of the entire nation.

In pursuing the goal of accessiblehealth care for the uninsured, wecannot discriminate as to whoshould be the recipients of ourservices. We cannot discriminate onthe basis of color, class, race,

We need to realize thatfailure to ensure accessto quality health care forthe 42.6 millionuninsured can have aserious domino effect.


ethnicity, religion, or nationality. Wecannot discriminate on the basis ofthe documented or theundocumented.

The goal must be quality care forall people, irrespective of theirability to pay, their status, or theirplace of origin. As one of the richestnations of the world, blessed withboth medical practitioners andmedical resources, America needs toassure universal health care for all.This is a service that can bedelivered with the resolve of ourpolitical leaders, with the desire forequity, with thesocialconsciousness ofthe corporatesector, with properplanning, and withthe compassion ofcaregivers.

As we seek torealize our goal ofaccessible healthcare for all, one ofour priorities mustbe informing the public of theservices that are available. Publicityand promotion are importantaspects of accessibility. Too manyprograms are underutilized becausemany of the targeted people are notaware of the resources available tothem. We live in a pluralistic societywith a multiplicity of languages, andwith many people not conversant inEnglish. This is indeed a challenge.It is incumbent upon us to developan effective communicationsnetwork so that government

programs available for theuninsured are publicized.

Another important challenge aswe address the issue of accessiblehealthcare for all is the need toremove the threat of penalties andthereby dispel the fear of reprisalfrom some sectors of the community,including the undocumented.Because of the fear of reprisals,many uninsured persons areunwilling to utilize availableservices. For instance, manymembers of the undocumentedimmigrant community believe that

they could bereported to otherarms of thegovernment andultimatelydeported. We needto assure allpersons that therewill not be abetrayal of theirprivacy and thattheir legal statuswill not be

disclosed. Care must be given toensure and maintain a sense ofconfidentiality.

A third challenge is that someindividuals may feel robbed of theirdignity or personal pride if theyutilize services for which they areunable to pay. This loss of dignitycan be worsened if service providersfail to demonstrate respect andsensitivity or deliver inferiorservices because they are aware ofthe circumstances of the recipients.We need to maintain equally

The goal must bequality care for allpeople, irrespectiveof their ability to pay,their status, or theirplace of origin.

The Challenges 22

professional standards of care for theinsured as well as the uninsured.The uninsured must haveconfidence in the quality of the carethey receive from public programs.We cannot allow the mostvulnerable in the community tohesitate to seek treatment becausethey are in doubt and fear of thequality of the care they will receive.Clinics, hospitals, and other health-care providers must serve all peoplefaithfully.

Anotherchallenge toaccessiblehealth care isthe escalatingcost ofprescriptiondrugs andhealth servicesin general.Health careneeds to beaffordable forboth theuninsured andalso theunderinsured.Many people who have insuranceare finding out that their coverage isnot adequate to meet the cost of themedicines they need. Since Medicaredoes not cover prescription drugs,and since the cost ofpharmaceuticals has increaseddramatically in recent years, manyolder adults and others on fixedincomes must choose betweenpaying for food or for medicines—because they cannot afford both.

Individuals in need of health careare already in difficulty. Their healthis in jeopardy. They may be facingdisability or may be aged and on afixed income. Their resources maybe limited and in danger of beingdrained away as they purchasemedicines to maintain their health.Their economic situation isthreatened and the quality of theirlives is diminishing. The issue oftheir mortality is real. It is immoralthat some corporations prey on and

exploit theseindividuals withthe desire forprofit. Thesituation ismade worsewhen thegovernmentbecomes anunwittingaccomplicebecause ofmisplacedpriorities oracquiescence tothe pressure ofinterest groups

so that they fail to subsidize orcontrol the price of drugs.

The country needs to examine thehigh cost of drugs and make themmore affordable for the community.We call to question whether drugsare being sold in accordance withthe cost of production or with theprofit motive at work in ourcapitalist society. Those at risk in thesociety should not have to choosebetween drugs or food, or have to

Those at risk in the societyshould not have to choosebetween drugs or food, orhave to travel to othercountries to purchasedrugs at a lower cost, orask that drugs be re-imported so that they canbecome more affordable.

travel to other countries to purchasedrugs at a lower cost, or ask thatdrugs be re-imported so that theycan become more affordable.

“(Jane Public) is among scores ofolder Americans who have headedacross the border by the busload tobuy cheaper medicines. A drug shetakes to lower cholesterol, Zocor, isjust $60 for a month’s supply inCanada. At home she pays $101”(New Jersey Star-Ledger; Sunday,10/15/00, Page 19, Section: NewsEdition).

“Prescription drugs can cost threeto four times less in Europe andCanada than they cost in the UnitedStates. For example, a 30 day supplyof Claritin, an allergy medication,costs $63 in the United States,compared with $16 in Europe,according to the Life Extension

Foundation, an advocacy group”(New Jersey Star-Ledger, Thursday,7/12/01, page 004).

The above two articles beg thequestion as to why, both in Canadaand Europe, drugs can be obtainedmore cheaply than here in theUnited States where most of themare manufactured. Who is benefitingfrom the high cost of prescriptiondrugs? And why should theuninsured and under-insured be thelosers? The affordability of drugs forthe poor and uninsured in thecountry is being called to question!

For an ultimately healthy society,the United States is being calledupon to provide access to qualityand affordable health care for theuninsured. This access must bewithout discrimination and mustensure the dignity of all people.


Endnotes

1. Federal tax credits would not be ahelpful method to address thehealth needs of the uninsureddue to the fact that many low-income individuals do not file taxreturns anyway. [This endnotecan be found in therecommendations.]

2. Estimating the number ofuninsured persons in the UnitedStates is difficult because the U.S.Bureau of the Census, the federalagency with the primaryresponsibility for gathering thesedata, recently changed the keyquestion in the CurrentPopulation Survey (CPS) used todetermine uninsured status.Before March 2000, the questionasked if someone in a householdwas covered by insurance at anytime during the previous year.After March 2000, the questionwas changed to ask if a person ina household was uninsuredthroughout the previous year.The result of this rewording haslowered by more than a millionthe number of “uninsured”persons reported in officialstatistics. All analysts agree thatat least 40 million persons livingin the U. S. currently areuninsured. Thus, different figuresappear in different reports. Someof the variation is a function ofthe actual change in the numberof uninsured persons in differentsurveys and some of the variation

is a result of the rewording of thequestion.

3. Acs, Gregory and John Sablehaus(1995) “Trends in Out-of-PocketSpending on Health Care,1980–1992,” Monthly LaborReview, Vol. 118, No. 12(December), pp. 35–45.

4. Cox, W. Michael and RichardAlm (1997) “The Economy atLight Speed,” p. 12. Dallas, Texas:Federal Reserve Bank of Dallas,1996 Annual Report.

5. “A look at the uninsured.” MentalHealth Weekly (May 15, 2000) vol.10, i. 20, p. 6 [this articlesummarizes the March 1999Current Population Survey data,as reported by the Alliance forHealth Reform.]

6. The Federal Poverty Level isbased on data gathered by thefederal government but each statesets the percentage of the FPLrequired to be eligible for stateand federal programs within thatstate. Some states use 100 percentof FPL, but others use 125 percent,150 percent, and so forth.

Endnotes 24


Recommendations1. Reaffirm past policy statements

and resolutions related tohealth-care issues [e.g., LifeAbundant: Values, Choices andHealth Care: The Responsibilityand Role of the PresbyterianChurch (U.S.A.), 200th GeneralAssembly 1988; Resolution onChristian Responsibility and aNational Medical Plan, 203rdGeneral Assembly (1991)].

2. Reaffirm the church’scommitment to advocacy for anational medical plan[Resolution on ChristianResponsibility and a NationalMedical Plan, Minutes, 1991, PartI, pp. 810–20].

3. Encourage the church torecognize and sustain the effortsof safety-net organizations,including clinics andpharmacies, dedicated tomeeting the health needs of theuninsured.

4. Reaffirm the church’scommitment to advocacy at alllevels on behalf of low-incomeand fixed-income immigrantpopulations who lack healthinsurance.

5. Encourage presbyteries,sessions, and the members ofcongregations tobeadvocatesforuniversalhealthcare and tosupport advocacy efforts in theirlocal communities to bringpublic and private entitiestogether in this effort.

6. Urge presbyteries, sessions, andthe members of congregations tobe mindful of our church’s healthpolicy statements and toestablish employment practicesto cover all employees (includingpart-time employees).

7. Urge presbyteries, sessions, andthe members of congregations tocelebrate Health Awareness Weekeach year and to give emphasis tothe need for universal health carein our nation.

8. Urge presbyteries and sessions toprovide educational programsand advocacy efforts on behalf ofpersons, especially those withlow incomes and fixed incomes,without medical insurance.

9. Urge the Office of HealthMinistries USA, in consultationwith the PresbyterianWashington Office and otherappropriate entities, to produceadvocacy materials in appropriatelanguages on behalf of medicallyuninsured persons, particularlythose with low incomes and fixedincomes. These advocacymaterials should be ready fordistribution to congregationsbefore the Health AwarenessWeek of 2003.

10.Urge the Rural Ministry Office(Evangelism and ChurchDevelopment) to give specialattention to issues of access toand cost of health care in ruralcommunities, particularly amongpersons with low incomes andfixed incomes.

Recommendations 26

11.Direct the PresbyterianWashington Office to advocatethe following:

a. Urge adequate funding for theChildren’s Health InsuranceProgram (CHIP) so that health-care coverage will be availablefor all children.

b. Urge the expansion of CHIPlegislation to include the parentsor caregivers of children coveredunder its provisions.

c. Oppose federal tax credits as amethod to address the healthneeds of the uninsured.1

d. Urge the expansion ofMedicaid to insure more low-income and fixed-incomepersons, including the recentlyunemployed.

e. Encourage members of theCongress to recognize theimportance of universal healthcare—that is, equal, accessible,affordable, and high-qualityhealth care for all personsresiding in our nation.

12.Encourage the MissionResponsibility ThroughInvestments (MRTI) to reviewhealth policies of thecorporations in which thechurch makes investments andto advocate for universal health-care coverage for employees atall levels.

13.Urge the Advocacy Committeefor Women’s Concerns (ACWC)and the Advocacy Committee forRacial Ethnic Concerns (ACREC)

to advocate on behalf of low-income and fixed-income personswho lack health insurance.

14.Encourage Presbyterian Church(U.S.A.) seminaries, through theCommittee on TheologicalEducation, to deal systematicallywith health-care issues,especially in the context ofcourses focused on social justice,community ministry, andcongregational care, as well as byensuring that all students andtheir dependents have access toaffordable, comprehensivehealth-care coverage.

15.Urge the Board of Pensions(BOP) to make available healthcoverage to all church employees(including part-time (20 hours ormore) employees) so that thechurch can serve as a model toother organizations in the nationfor offering universal health-carecoverage.


Appendix I

The Challenge to Presbyterians from the 214th General Assembly:Adequate Health Care for Everyone

As Presbyterians, we are called topromote justice and equity, toengage in healing and to treat oneanother with compassion. Historicinadequacies in our health caresystem and the distribution ofservices through that system leavemillions without the means toobtain even the most basic healthcare for themselves and theirfamilies. While continuingescalation ofhealth carecosts affects allof us, the affecton the mostvulnerable isdevastating.Individuals onfixed incomesbecome atgreater risk.People (andtheir families) who have lost jobsand benefits due to the economicdownturn are at risk. Individualswithout private coverage or who donot qualify for governmentsubsidized insurance are at greaterrisk than before because thenumbers of health care providerswilling to give treatment tomedically indigent people aredecreasing at an alarming rate.Rising co-payments and deductiblescombined with stricter pre-authorizations and reimbursement

caps are affecting health care accessfor middle-income persons.

Presbyterians and other peopleof faith cannot achieve health carejustice without legislative action.The church must provide notmerely a moral whisper ofconscience, but a chorus of voicesraised in a call for immediateaction. These voices mustovercome the special interest

groups’rationale.These voicesmust speak forthose who feelthey will not beheard. Thesevoices mustemanate fromevery churchand eachcommunity.

Congregations and individualscan become the catalysts forchange - once they are aware of theincreasing climate of crisis in ourhealth care system, and, once theyhave become aware of effectivelegislative solutions. They willneed to bring together concernedpeople to create networks of healthcare advocates who will shareinformation, lobby their electedofficials, and add their voices tothe public policy debate alreadybegun.

The church must providenot merely a moral whisperof conscience, but a chorusof voices raised in a call forimmediate action.

Appendix I 28

Where does one begin? Theprocess is very straightforward.

1. Interact with your localcongregation by raising thegeneral awareness to the crisis inhealth care. Be certain to point outthat health car access not onlyaffects the uninsured, but thoseinsured people who are continuingto pay more for health care throughrising co-pays and deductibles,stricter pre-authorizations andreimbursement caps. If you havehealth care providers in yourcongregationthey might bewilling to sharesome of theirownfrustrationswith the healthcare system.Look foropportunitiesto inform themembers ofyourcongregation of the crisis in healthcare. You might:

• Write an article for yourcongregation’s newsletter orbulletin

• Sponsor a study of scriptureswhich call the community offaith to concerns of healing andjustice.

• Request that health care issuesbe the topic of sermon(s).

• Use Moments for Mission inworship.

• Make a presentation to theSession.

• Make a presentation to thehealth/mission/outreach/social concerns committee.

• Make presentations to existingidentity groups in thecongregation.

2. Reach beyond your localcongregation. After gathering afew members of your congregationwho are interested in health carereform, extend your coalition toother Presbyterian congregations

by requestingtime atPresbytery orSynodgatherings andleadershipevents to bothraiseawareness andengage othersin the coalitionyou are

building. Look for allies among other

people of faith. Social justice issuesresonate among reformed traditionfaith groups. Invite theirparticipation. Urge them to educateand enlist others. Make use of yournatural contacts. Find out if anecumenical or interfaithorganization in your state is alreadyinvolved in universal health careadvocacy. Establish contact with thesocial action and advocacy or healthministries staff who serve in

If you have health careproviders in yourcongregation they might bewilling to share some oftheir own frustrations withthe health care system.


coordinating structures in your stateand national offices.

For each person you add toyour coalition, systematicallyidentify the components of his orher “sphere of influence.”

3. Identify and collaborate withexisting organizations working forHealth Care Access. In manystates, groupsare nowworking topull peopletogether forhealthadvocacy.Contact themand find outwhether youcan work with them. They may beable to provide you with materialsand information updates for yourgroup. Find out, also, whetherthere are local contacts ororganizations working in yourlocal community for universalhealth care. If not, form a coalition.

4. Remember the concept of“enlightened self interest.”Health care costs affect everyone,so rule out no one as you buildyour coalition. Brainstorm lists oflocal organizations that have anyreason to be concerned. Manymembers of your congregationalso belong to other organizations,unions, neighborhood groups, etc.Today, employers and health careproviders are beginning to call forreform. Again, make use ofcontacts you already have to build

your coalition of concernedadvocates.

5. Inform and Alert yourcommunity. Look foropportunities to raise theawareness of your entirecommunity. Use data from andillustrations of the crisis in healthcare provided here and from the

resources listedat the end of thissection to planawarenessprograms. Forma speaker’sbureau fromyour coalitionand contact civicand business

organizations (this is a great timeto utilize “sphere of influence”information from your coalitionmembers.)

In many states, groupsare now working to pullpeople together for healthadvocacy.

Appendix I 30

6. Communicate yourexpectations to your electedofficials AND hold themaccountable. For universal healthcare access to be adequately andcomprehensively addressed,legislative action is necessary.Know the names of your electedofficials and take everyopportunity to meet and speakwith them. While many electedofficials take seriously the will oftheir constituents, they do notactively solicit the opinions ofthose who have elected them. Becertain the legislators whorepresent you are aware that youexpect them to work for healthcare access and that you (and yourgroup) will track their voting onlegislation pertaining to this issue.

Additional resources for advocacyefforts on Universal Health CareAccess are available on the HealthMinistries USA website –www.pcusa.org/health/usa . Theseresources include links to thePC(USA) Washington office, to otherorganizations that have joined in theeffort, and to legislative trackingentities. You will also finddownloadable posters and graphicsand an increasing number ofmaterials designed specifically forcongregations by among others, thePresbyterian Health Network (ofPHEWA). Please check the websiteoften as it will change frequently.Printed advocacy materials can beobtained by calling 1.888.728.7228,ext 5550, or by sending an e-mail [email protected].


Appendix II

Health Care Access Resolution Or House Concurrent Resolution99: Directs Congress to enact legislation by October 2004 thatprovides access to comprehensive health care for all Americans.

■ Whereas dollars that could bespent on health care are beingused for administrative costsinstead of patient needs;

■ Whereas the current healthcare system too often puts thebottom line ahead of patientcare and threatens safety netproviders who treat theuninsured and poorly insured;and

■ Whereas any health carereform must ensure that healthcare providers andpractitioners are able toprovide patients with thequality care they need:

The legislation text is as follows:

■ Whereas the United States hasthe most expensive health caresystem in the world in terms ofabsolute costs, per capita costs,and percentage of grossdomestic product (GDP);

■ Whereas despite being first inspending, the World HealthOrganization has ranked theUnited States 37th among allnations in terms of meeting theneeds of its people;

■ Whereas 43 million Americans,including 10 million children,are uninsured;

■ Whereas tens of millions moreAmericans are inadequatelyinsured, including medicarebeneficiaries who lack access toprescription drug coverage andlong term care coverage;

■ Whereas racial, income, andethnic disparities in access tocare threaten communitiesacross the country, particularlycommunities of color;

■ Whereas health care costscontinue to increase,jeopardizing the health securityof working families and smallbusinesses;

Appendix II 32

■ Now, therefore, be it Resolvedby the House of Representatives(the Senate concurring), that theCongress shall enact legislationby October 2004 to guaranteethat every person in the UnitedStates, regardless of income,age, or employment or healthstatus, has access to health carethat —

1. is affordable to individuals andfamilies, businesses andtaxpayers and that removesfinancial barriers to neededcare;

2. is as cost efficient as possible,spending the maximumamount of dollars on directpatient care;

3. provides comprehensivebenefits, including benefits formental health and long termcare services;

4. promotes prevention and earlyintervention;

5. includes parity formental health andother services;

6. eliminates disparitiesin access to qualityhealth care;

7. addresses the needsof people with specialhealth care needs andunderservedpopulations in ruraland urban areas;

8. promotes quality and betterhealth outcomes;

9. addresses the need to haveadequate numbers of qualifiedhealth care caregivers,practitioners, and providers toguarantee timely access toquality care;

10.provides adequate and timelypayments in order toguarantee access toproviders;

11.fosters a strong network ofhealth care facilities,including safety net providers;

12.ensures continuity of coverageand continuity of care;

13.maximizes consumer choice ofhealth care providers andpractitioners; and

14.is easy for patients, providersand practitioners to use andreduces paperwork.

Presbyterian Church (U.S.A.) • 100 Witherspoon Street • Louisville, KY 40202-1396

PDS #68-600-02-004

resolution on advocacy on behalf of the uninsured · 5 resolution on advocacy on behalf of the...

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