116 3rd St SE
Cedar Rapids, Iowa 52401
Obtaining healthcare coverage not easy for all in Iowa
By Tessa Lengeling, IowaWatch.org
Dec. 21, 2014 9:00 pm
Isaiah Newsome likes to play sports and hang out with friends, like any 17-year-old. But most of the time these activities are cut short as his body, stricken with sickle cell anemia since birth, fills with pain.
'It just randomly happens,' said Newsome of Des Moines. 'There's no really preventing it or seeing it coming.'
Obtaining insurance to cover his health care adequately all these years has not been easy, but at least he has had insurance the past year. Other black families in Iowa with low incomes do not, adding to difficulties they face getting health care.
A University of Iowa Public Policy Center study in December 2013 put the problem into perspective, showing that black as well as Latino Iowans do not have the same access to adequate health care that Asian and white Iowans have.
The Public Policy Center went on to say in its report, which used data from a child and family health survey conducted in fall 2010 and spring 2011, that Iowa's blacks and Latinos are more likely to need medical care, even though they are more unlikely than Asian or white Iowans to receive it.
The disparities are a result of varying factors, the Public Policy Center report said, including a lower quality of care in general, higher than normal unmet need for care, poor diets, a higher likelihood to seek care from a hospital emergency room, and fewer safe and supportive neighborhoods.
Social aspects — including someone's poverty level, neighborhood, culture or race — account for 90 percent of what affects health status, the study's authors concluded.
'The causes of health disparity vary, but we need to look beyond health care,' said Dr. Peter Damiano, director of the Iowa Public Policy Center's director and also its health policy research program. 'Iowa needs to be looking at behavior, genetics and environment.'
Disparity is defined as a lack of similarity or equality.
Newsome's mother, Charice Williams, did not have health insurance coverage for herself or her children until she signed up under the Affordable Care Act in 2013.
'Even though I am low-income, I am still over-income for things. Everything goes by your gross income instead of what you really bring home as your net pay,' said Williams, who works part-time for the city of Des Moines so that she can spend time caring for her son.
The Public Policy Center study focused on the several factors that create a disparity, including overall health status; insurance coverage; need and access to care; lifestyle, family, and social environment.
The study pointed out that more than 90 percent of Asian and Pacific Islander and white children in Iowa had an overall health rating of 'excellent' or 'very good.' This compares to a 76 percent health rating in the same categories for black Iowa children and 69 percent for Hispanic children in the state.
LIFESTYLE AFFECTS HEALTH
The Public Policy Center report said 3 percent of Iowa's black children were not covered by health insurance during the 2010-2011 survey. The rate for Iowa's white children was 2 percent.
The rate jumped to 10 percent for Latino children in Iowa, the study showed.
Six of every 10 black children in Iowa were in public insurance programs such as Medicaid or Hawk-i programs at the time of the study. Five of every 10 were Hispanic.
Between one and two of every 10 white Iowa children on average were in the program.
Poverty-based problems are move prevalent for black Iowans — even though they comprised 3.3 percent of the state's population in 2013 — because 35.5 percent were living in poverty in 2012, the most recent figures from the Iowa Data Center show.
That poverty rate was close to triple the 12.7 percent for white Iowans, U.S. Census Bureau estimates show.
'There are small pockets of African Americans secure in their jobs and have health coverage,' said Cynthia Hunafa, of the northwest Des Moines urban neighborhood support organization Creative Visions. 'Then there is a larger segment that isn't secure and finally a huge segment that is scrambling to get things together.'
The lack of insurance drives the trend of going to an emergency room instead of a doctor. But using emergency room care as the only method of maintaining health is a reactive measure, rather than a preventive one.
'We are seeing a better trend now with national health care, but individuals still don't think about going to the hospital or getting adequate care, and that is when we decided to open our own clinic,' said state Rep. Ako Abdul-Samad, D-Des Moines, Creative Visions's founder and executive director.
Damiano said people in certain racial groups, such as Latinos and blacks, also go untreated because they have to work through complicated cultural differences.
'It's not as easy as giving someone a pill and it's done,' he said. 'It's a challenge for providers to assess what the patient needs based on cultural barriers and lack of quality care over long periods of time.'
But while health providers need to be knowledgeable to treat complicated patients, patients also need to be more educated about the health system, sources interviewed by IowaWatch said.
'The underserved are unfamiliar with the health system, which makes it difficult to navigate and gain access,' said Betsy Richey, data management program manager in the Iowa Department of Public Health's Bureau of Communication and Planning.
Iowa was 5.5 percent Latino in 2013, Census Bureau estimates show. Latino Iowans' poverty rate was double that of white Iowans, at 26 percent, in 2012, the most recent figures available from the Iowa Data Center show.
Non-native Iowans tend to have a language barrier with providers. Also, 'beliefs and customs are different, which prevents some cultures from trusting providers or going for medical care,' Joan Jaimes, outreach counselor at Marshalltown Community College, said.
Hospital staffs need to be more culturally competent when dealing with under-served Iowans but do not bear all the blame, Jaimes said. 'The Hispanic culture is less healthy in general, not because of hospitals or doctors, but because of the way we eat and our customs, making us prone to more diseases like diabetes that go untreated.'
Lucia Santillan and Iraima Franqui, of Fort Madison, can tell you about language barriers when getting health care in Iowa. 'I'm used to receiving weird looks from people in the Midwest because of my accent or when I speak Spanish,' Franqui said in Spanish, with Santillan translating as they sat in a Hy-Vee in Burlington this past summer.
Santillan, 27, and Franqui, 43, lived in a homeless shelter as recently as early 2013 but were operating a cleaning business after moving to Iowa almost two years ago.
Franqui said her English is not 100 percent so Santillan translates for her when they go to the Great River Quick Care clinic in Burlington to keep their costs down. They also have gone to hospital emergency rooms for care. 'I prefer to not have insurance because the clinics work with you so well in Iowa to make payments without insurance,' Santillan said.
RESULTS WITH OPPORTUNITIES
Isaiah Newsome hopes things start looking up 2015. He and his mother are to go to the University of Minnesota in January so that Newsome can have a bone marrow transplant. He is to have chemotherapy to wipe out his diseased blood cells, giving new ones a chance to form normally and stop his constant pain.
'One of the issues we find in the community is people of African or Latino dissent are not registered on the bone marrow registry,' Williams said. 'I think it's just a lack of knowledge. And there's a fear of the medical community in the African American community – a fear of the unknown because that preventative care has never been a part of our community, so people are afraid to go to the doctor.'
The family established a Go Fund Me account online and friends have held fundraisers in their name to help with the extreme costs. The transplant is a serious procedure, but the family has high hopes that the pain will cease once they return to their Des Moines home.
Then Newsome will look forward to a new goal: attend college.
This story was produced by Iowa Center for Public Affairs Journalism-IowaWatch.org, a non-profit, online news Website that collaborates with Iowa news organizations to produce explanatory and investigative reporting.
l This story was produced by Iowa Center for Public Affairs Journalism-IowaWatch.org, a non-profit, online news website that collaborates with Iowa news organizations to produce explanatory and investigative reporting.