United States: how Trump lit the fuse - Amnesty International Australia

A black American is two and a half times more likely than a white person to die from a police blunder. Sad coincidence: the death rate of black people from Coronavirus is more than twice as high as that of white people. The injustice is first, once again, racial. According to the CDC, the hospitalization rate for coronavirus among Native Americans and Black Americans is five times higher than that of whites. That of Hispanics, four times greater. Black Americans, who account for 13% of the population, represent 23% of deaths, since March 2020. This ratio is “a simple and obvious measure of social inequalities, in a state like the mine where African-Americans also represent half of prison inmates, recalls T. Marie King, anti-racism activist from Birmingham, Alabama, a state facing an upsurge in the number of people affected by Covid-19. We can incriminate their poor health, their pre-existing pathologies to explain their mortality. But it is also an opportunity to wonder why they combine these handicaps. Diabetes, obesity and cardiovascular diseases are wreaking havoc in the ghettos, which are called food deserts, devoid of supermarkets, and whose businesses are sometimes limited to a simple gas station.

Indispensable and… negligible workers

The hygiene of life is singled out, in a country quick to blame the personal shortcomings of the poorest. But those who belong to an American minority also suffer from the very nature of their jobs, which are low-skilled and incompatible with telecommuting. At the supermarket checkout, in building maintenance, at the wheel of delivery trucks, they find themselves in contact with the public, which partly explains their contamination rate twice as high as that of whites. “In times of epidemic, they are essential workers. An official term which in reality means negligible,” quips Tiffany Greene, a professor of public health sciences at the University of Wisconsin-Madison, noting that they are more likely to work for employers who do not respect the rules of sanitary protection. “Are you going to complain if this is one of the few jobs possible, or if you are an undocumented immigrant employed in a slaughterhouse that does not provide masks or protection to workers crowded along cutting lines? she remarks. “It’s the best way to be reported to the immigration police.”

In New York, Queens, Nuna Kim is one of the pediatricians at a major clinic in Flushing Meadows, the city's largest Chinatown. Asian. They received the bad news from China early on, which gave them time to prepare. In addition, wearing a mask is, for them, a usual practice as soon as there is any doubt about one's state of health or about a risk of contagion. "These precautions made it possible to stem the epidemic in the district, but vigilance remains complete. A significant portion of the positive cases come from the medical center's 15% non-Asian patients, mostly Hispanic immigrants. In the neighboring district of Corona near La Guardia airport, a "little Mexico", crowded with new arrivals from South America, the rate of positives exceeds... 67% of the population. Doctors see this as the obvious consequence social inequalities: a job on the front line of Covid-19 and squalid housing conditions. "Three-bedroom apartments, accommodating three families with children: these are real incubators of the disease", laments Nuna Kim.

Lack of papers, the millions of illegal immigrants have no choice but to use the emergency services of hospitals. Certainly they are welcomed, but at a high price, reserved for the uninsured and risk prosecution until the hospital establishes absolute insolvency. Although some hospitals and dispensaries offer staggered payment plans, compatible with patient income, money remains the main obstacle to access to care for illegal immigrants.

A legal stigma

Legal immigrants fare little better, especially because of a 1995 law, signed by Democratic President Bill Clinton, as a concession to the Republican and populist Congress of the day. The text prohibited immigrants, for five years after their arrival in the United States, from applying for any social assistance and from registering for public insurance, whether it is Medicaid, reserved for the most deprived, or Medicare. , for the elderly and the disabled. In anticipation of his re-election campaign, Donald Trump has added an additional restriction: any foreigner requesting the benefit of a public program, such as these insurances or Food stamps (food stamps for the poorest), must be considered a charge for society (Public Charge). And as such, is denied permanent resident status, the famous green card. Announced in August 2019, these new regulations took effect on February 24, 2020, less than three weeks before the March 13 announcement of the national state of emergency due to Covid-19.

Admittedly, under pressure from public health agencies, Trump hastily added an amendment excluding from the settlement public insurance coverage for COVID-related testing and care for immigrants. Maria, a Mexican immigrant from Queens awaiting her papers, was rushed to intensive care and underwent a tracheostomy after being infected with the virus. "The hospital provided me with exceptional two-month care from public Medicaid insurance," she recalls. "But if it had been another illness or an accident , I might be ruined or without hope of a residence permit here.” The exception granted to Coronavirus patients has not dispelled the fears of immigrants. “The Public charge regulations have clearly deterred patients from coming for consultation. We immediately noticed it in our waiting rooms, despite the exceptions, linked to Covid-19, remembers Nuna Kim. Even low-income foreign pregnant women, who are legally entitled to Medicaid coverage for two months, have called us to cancel all their appointments and registration files.” The mistakes of the Trump administration do not stop there.

@DimoriaeTTV Be on the ranting account more I like it 👀

— David Dominguez Fri Jun 11 22:18:59 +0000 2021

Hack on Obamacare

As the pandemic hits the United States with full force, the White House continues its legal offensive against the famous Affordable Care Act (ACA), aka “Obamacare” program , a subsidized private insurance scheme set up by its predecessor to provide coverage to millions of the uninsured. The US government has therefore asked the Supreme Court to repeal it purely and simply. If the Court were to declare the ACA unconstitutional, Trump and his allies in the Senate would have no alternative plan. However, the country had 32 million unemployment compensation claims in August, and 10 million Americans could find themselves without insurance by the end of the year, after losing the coverage provided by their employers.

Despite all its flaws, despite its rates sometimes exceeding $2,000 a month, with huge deductibles for families, despite its confusing jungle of options and its lack of ambition, the ACA has managed to reduce the number from uninsured to 27 million individuals. Ironically, elected Republicans have for 10 years condemned this program to shame, and voted in Congress some 80 motions demanding its repeal, describing the law, however moderate, as a stranglehold of the State on medicine, and a first step towards the socialization of health in the United States. Donald Trump, for his part, devoid of convictions on the subject, was content to take up the watchword of his party. But by depicting Obamacare as "a disaster", since his first campaign meetings, the president was above all seeking to destroy one of the major buildings of his predecessor, without offering an alternative solution. As for his most passionate supporters, uninformed and motivated above all by their hatred of the former president, they seem unaware that they belong to the social category that would suffer the most from a repeal of this health insurance.

51% of Americans still say they are in favor of this insurance. Trump is aware of the political risks. Hampered by a Democratic majority in the House of Representatives, the President chose the so-called “thousand stab wounds” tactic, a sabotage of the system by regulatory means intended to aggravate its problems, in order to render it inoperative or, failing that, to more and more unpopular: he first cut the budget for promoting registrations on ACA and then abolished, in 2017, the subsidies intended for the insured. The ultimate and most dangerous attack, launched by 20 Republican states, led by Texas, consists in declaring unconstitutional the obligation to take out insurance as well as the famous tax penalty imposed on defaulters. If the Supreme Court rules in their favor in September, against the request of 17 states in favor of maintaining the law, Trump will be able to wave his trophy in front of the crowd in red caps of his supporters. But he is also exposing his electorate to a health disaster, as the second wave of the Coronavirus overwhelms the rural areas he is counting on for the November 3 elections.

Also read: Open letter before the US elections, human rights are threatened

Health in the line of sight

The disaster has already begun for the most vulnerable. One of the most important provisions of the law concerns Americans with incomes barely above the poverty level, but considered too high to obtain public Medicaid insurance. To close this gap, Obamacare has thus extended the Medicaid program for people with incomes up to 138% of the poverty level ($16,000). However, 13 states, for reasons of pure ideology, have been relentless since 2013 in depriving their population of this advantage which above all serves black or Hispanic middle-class families. Three in ten Texas residents are uninsured for this reason. And the number of uninsured in states that have refused 'Medicaid expansion' is twice as high there as elsewhere, according to a Center for Health survey. Families USA analysis.

Trump sees in this stubbornness of the governors, the confirmation of Republican support for his re-election. But the first cracks appear, as the epidemic, and unemployment, win its favorite states, and their white and republican citizens. Surprise: Oklahoma, where 65% of voters voted for Trump in 2016, is now opting to expand Medicaid to 200,000 uncovered adults. Missouri, a quintessentially pro-Trump state, was also forced to take the same action following a referendum in August. The governor of Wyoming resigns himself in turn to derogating from the dogma.

It's no surprise that Joe Biden puts public health at the forefront of his campaign, right after the fight against racial inequalities, which concern two-thirds of Americans. According to a recent poll by the Journal of the American Medical Association, 49% of voters on all sides consider the Democrat to be better able to solve the health problem, while only 34% trust Trump in this area.

The combination of the epidemic, the carelessness of Donald Trump, and the Black Lives Matter demonstrations has accelerated the shift to the left of opinion. Joe Biden already has free rein to launch major reforms. There is still no question of creating a full-fledged social security, a “medicare for all” which would force 160 million Americans today insured by their employers to come under the thumb of the state.

But the candidate intends to perk up Obamacare, and add to it measures that Obama had abandoned in 2012 under pressure from the Republicans: Americans would thus have the right to subscribe to a "public option", in other words to obtain, through premiums calculated on their income, the insurance already available to federal civil servants and elected members of Congress. Between the ages of 55 and 65, they could also obtain Medicare as voluntary insured. Finally, all those under 21 would be entitled to completely free healthcare, thus avoiding co-payments equivalent to the full price of a consultation. medicine in France. As for Trump, his harangues on the so-called “Obamacare disaster” will no longer hide the emptiness of his initiatives since the start of the epidemic, nor the appetite for renewal of American opinion.

Correspondence in Washington by Philippe Coste, for La Chronique magazine