Delivery of Care

Through the lens of disability

U.S. HHS Secretary Xavier Becerra visited Central Falls, held a roundtable about the Affordable Care Act at the Blackstone Valley Community Health Care Neighborhood Health Station, and demonstrated his own peculiar myopia when it come to viewing the world through an equity lens

Photo by Richard Asinof

HHS Sec.Xavier Becerra conducts a meeting in Central Falls at Blackstone Valley Community Health Care center.

By Richard Asinof
Posted 7/19/21
What did not get talked about at the gathering with Secretary Becerra in Central Falls was as important was what got discussed.
When will the R.I. General Assembly conduct an audit of private contractors working for the R.I. Medicaid Office? When will health insurers collect and publish data related to toxic chemicals in our air and water that may be related to chronic diseases? What lessons have been learned from the coronavirus pandemic related to those who are uninsured and under-insured when it comes to accessing health care?
When you are disabled, gaining access to news events is always a challenge. Walking tours are not high on the top of the priority list of coverage So, too, are events where there are no chairs to sit down and participate in a news conference. We have gotten much better in becoming more inclusive when it comes to the lens of racial equity.
The incident with Secretary Becerra in Central Falls, when he challenged my credentials as a reporter, apparently because of the way I looked, shows how far we still need to travel when it comes to honoring and respecting those among us who are uniquely abled.

CENTRAL FALLS – When U.S. Health and Human Services Secretary Xavier Becerra visited the Blackstone Valley Community Health Care neighborhood health station on Friday afternoon, July 16, many of the top poobahs in Rhode Island attended – Sens. Sheldon Whitehouse and Jack Reed, Reps. David Cicilline and Jim Langevin, Gov. Dan McKee, and Central Falls Mayor Maria Rivera.

On the health care side of the ledger, there were: Dr. Nicole Alexander-Scott, director of the R.I. Department of Health; Womazetta Jones, the secretary of the R.I. Executive Office of Health and Human Services; Lindsay Lang, HealthSource RI director; Peter Marino, the president and CEO of Neighborhood Health Plan of Rhode Island; Jane Hayward, CEO of the Rhode Island Health Care Association and co-chair of the Rhode Island Foundation long-term stakeholder group; and Merrill Thomas, president and CEO of Providence Community Health Centers, among others.

On the community side, there was Linda Katz, policy director and co-founder of the Economic Progress Institute, and Channavy Chhay, executive director of The Center of Southeast Asians.

Ray Lavoie, the executive director of the Blackstone Valley Community Health Care, served as emcee of the event, which was slated to be a roundtable discussion about the implementation of the Affordable Care Act, organized by Rep. David Cicilline.

What was not talked about
Sometimes, what does not get talked about is as important as what gets discussed. There was no mention of a few of the biggest elephants and rhinoceroses dominating the health care landscape: the pending merger of Lifespan, Care New England and Brown; the scandal unraveling at Eleanor Slater Hospital; the potential for the accountable entity initiative under the Reinvention of Medicaid to crash and burn; and the way that the approval of the new, high-priced Alzheimer’s drug threatens to bankrupt Medicare. Surprisingly, there was no acknowledgement by Becerra or by members of the Congressional delegation about the location where the gathering was being held – one of the few new buildings constructed in Central Falls in the last 20 years. [See the link below to ConvergenceRI story, “Investing in the bricks and mortar better health care. ”

Visits from federal officials are always, to some degree, about bringing home the bacon. As part of his short visit, which lasted less than an hour, Becerra announced that there would be $102 million in new federal grants forthcoming to support front-line health care workers in Rhode Island and elsewhere, and he urged community health centers to apply.

Becerra also made a big show promoting his sense of inclusiveness – making everyone go around the room and introduce themselves, including all the news media and the numerous aides to elected officials who were attending the gathering.

In turn, Secretary Jones talked about the importance of Gov. Dan McKee intentionally and purposely creating a deputy chief of staff position specific to equity, in order to promote a racial equity lens in engaging community sentiment.

Further, Dr. Alexander-Scott talked about the efforts to develop community-based solutions around health equity zones, but surprisingly shared nothing about the expanded dimensions of the HEZ initiative, which announced its latest expansion on Friday, July 2, including four new HEZs in Warren, Warwick, Blackstone Valley and the 02905 ZIP code in lower South Providence.

Show and tell
The conversation was pretty much a show-and-tell kind of event, a love-fest of mutual admiration, with everyone praising the strength of the Rhode Island Congresssional delegation to get things done. Becerra joined in that parade of praise.

Becerra also heard about all of the ways that Rhode Island was a place of innovation and leadership when it came to health care. As Sen. Sheldon Whitehouse said, “We all know each other; we all trust each other; there are solid working relationships here. If you are looking for cool things to do,” he continued, using an outstretched arm to include everyone gathered around the table, Rhode Island was the place to be. “We have got a lot of capacity to do good things and to measure outcomes.”

Much was made of the capability that Rhode Island had displayed to lower the number of uninsured adults to about 4 percent under the Affordable Care Act. Becerra asked Katz from the Economic Progress Institute to delve a bit deeper into the makeup of the 4 percent that were still uninsured.

Katz told Becerra that the data for the uninsured showed that about half were young men between the ages of 19 and 39. Many of those who were uninsured, Katz continued, may not have been in the country for five years and so may not be eligible. Others, Katz suggested, may be living in what she described as mixed families, with some people who were documented and some people who were not. Many, Katz continued, may be afraid to come forward, because of the toxic conversation around immigration.

Access and affordability
Central Falls Mayor Maria Rivera told her own story about being a single mother but being unable to secure health insurance coverage when she worked for the R.I. Department of Human Services, before the Affordable Care Act became the law.

Another attendee talked about the difficult choices faced by many residents in having to choose between paying for medication and putting food on the table.

Through the lens of disability
What came next was weird. When the news media, most of whom were seated in the back of the room, were invited to ask questions of Secretary Becerra, ConvergenceRI carefully made his way to stand at the edge of the conference tables where the participants were seated, supported by trekking poles, necessary tools of support, given the loss of stability as a result of an auto-immune disease. [For the occasion, ConvergenceRI was wearing a button-down blue Oxford shirt with a bright golden tie, a color combination that Gov. McKee’s press secretary had complimented.]

ConvergenceRI introduced himself, and began to ask a question, only to be interrupted by Secretary Becerra. “Are you a member of the news media?” he asked.

ConvergenceRI was stunned. Secretary Becerra was challenging his media credentials. What was it about my image – a disabled reporter standing with the help of trekking poles – that would make the Secretary ask such an offensive question?

ConvergenceRI quickly explained that he was editor and publisher of the weekly digital news format, which he had been publishing for eight years. If the Secretary had any questions, why not ask any of the members of the Rhode Island congressional delegation, who were are all very familiar with my work, ConvergenceRI responded.

So, too, were just about everyone else who was a participant in the panel discussion – Director Alexander-Scott, Secretary Jones, Linda Katz, Peter Marino, Jane Hayward, and Ray Lavoie, among others.

The question ConvergenceRI asked was about the role that pharmacy costs were playing in driving medical costs higher in Rhode Island. All the recently analyses from claims data had shown that pharmacy costs, not utilization, were the primary drivers ofncreases in medical costs in Rhode Island.

Over the next three days, my anger grew. What was it about trying to ask a question while supporting oneself with trekking poles that was so jarring for Secretary Becerra?

Sen. Jack Reed, for instance, had gone out of his way to chat with ConvergenceRI in advance of the start of the event, kneeling down to ask how I was doing.

Gov. Dan McKee had spoken with ConvergenceRI after the event, promising to arrange to do an interview sometime in August.  So it goes.

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