By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    sailing health benefits
    Essential Gear to Enjoy the Health Benefits of Sailing
    March 7, 2024
    Gut Health in Athletes: Nutrition, Hydration, and Performance Optimization preview
    Gut Health in Athletes: Nutrition, Hydration, and Performance Optimization
    June 6, 2024
    healthcare facility expansion is to carry out a complete needs assessment
    How to Implement Strategic Facility Growth Planning for Healthcare Centers
    August 11, 2024
    Latest News
    5 Steps to a Promising Career as a Healthcare Administrator
    August 3, 2025
    Why Custom Telemedicine Apps Outperform Off‑the‑Shelf Solutions
    July 20, 2025
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 17, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Hurricane Preparedness Tips for Older Adults & Caretakers
    September 17, 2012
    A Doctor Pans Electronic Health Record Incentives
    December 24, 2011
    Heart Disease Prevention
    Fighting Heart Disease Using the Web: 3 Tips for Success
    November 20, 2012
    Latest News
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
    How Health Choices and Legal Actions Intersect After an Injury
    July 17, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 17, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: The Geographic Divide: How Federalism Has Formalized Health Disparities
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > The Geographic Divide: How Federalism Has Formalized Health Disparities
Health ReformPolicy & Law

The Geographic Divide: How Federalism Has Formalized Health Disparities

Brad Wright
Brad Wright
Share
6 Min Read
Image
SHARE

ImageJimmy Carter once said that America is not a melting pot, but a beautiful mosaic. We have all sorts of people here, but we want them to maintain their unique identities, not assimilate into some generic unity. However, this very characteristic that makes our nation so wonderful also provides the context for stigma, segregation, and hate crimes.

ImageJimmy Carter once said that America is not a melting pot, but a beautiful mosaic. We have all sorts of people here, but we want them to maintain their unique identities, not assimilate into some generic unity. However, this very characteristic that makes our nation so wonderful also provides the context for stigma, segregation, and hate crimes. We’ve come a long way in the past two centuries: from slavery to emancipation, segregation to civil rights. But de facto segregation still exists, and while it’s often about race, it’s also about poverty–and both race and poverty are often connected to health disparities.

On the one hand, groups self-segregate for a variety of reasons, and it’s not entirely clear whether this is good or bad. Self-segregation may be about the joys and comforts of sharing a common culture or language, or it may be about banding together to survive oppression. The best thing I’ve come across on this topic is Beverly Daniel Tatum’s book Why Are All the Black Kids Sitting Together in the Cafeteria?

On the other hand, we segregate in other important ways that seem not quite right. We have affluent neighborhoods and low-income neighborhoods and there are a host of institutional factors and personal behaviors that reinforce these divides. For example, although illegal, realtors often steer potential homebuyers away from certain “undesirable” neighborhoods. Banks follow questionable lending practices. Local governments zone industrial plants near housing projects. You get the idea.

More Read

Reasonable Goals for Health Insurance Coverage and Defining Medical Necessity
Ultraprocessed Foods Lead to Chronic Illnesses
Employer-Backed Health Insurance Plans On Life Support?
Britain Shows Support for Genetically Modified Embryos to Prevent Disease
Frank Discussions About Oral Cancer Therapies

Capitalizing on these patterns of residence, the political parties gerrymander districts that will help them win elections. Have you seen a map of North Carolina’s Congressional districts? Those long skinny districts and the highly irregular borders are not drawn for convenience; they demarcate the racial composition of the population across the state.

All of these are primarily local issues. They occur because of people’s inherent biases and, with the exception of gerrymandering, they are not established by laws or regulations. They are just the way society seems to work. But, knowingly or not, the Supreme Court’s decision to make the Affordable Care Act’s Medicaid expansion optional for states has created the opportunity for health disparities to be formalized into law, thanks to federalism and our country’s deep partisan divide.

It’s old news that only 26 of our 50 states have decided to expand the Medicaid program to all U.S. citizens residing in their state with incomes below 138% of the federal poverty level, but the expansion has only been a reality for 6 months. Now we are seeing how it is playing out on a personal level. One of the concerns among policymakers was that low-income people would emigrate from non-expansion states and flood into expansion states. A consensus is emerging that, while this may happen to some extent, it is unlikely to be a major issue–mostly because low-income people don’t have the resources to relocate.

What is particularly striking to look at are towns on either side of a state border. In some cases, single towns actually span state lines. And, if one state has expanded Medicaid, while the neighboring state hasn’t, whether or not a low-income person has health insurance may depend on what part of town they live in. Texarkana is one such town, and Annie Lowrey writes about this issue in the New York Times. Her point–and the one I am echoing here–is that we have formalized the unequal treatment of similarly situated persons based on nothing more than where they happen to hang their hat.

Somehow we tend to be okay with this unequal treatment when there’s enough of a buffer in place. For example, if the low-income in California are treated differently than the low-income in Indiana, we’re able to come up with reasons–real or imagined–that allow us to reconcile that to ourselves. But reduce the geographic distance, and focus on the unequal treatment that exists between residents of Chicago, Illinois and Gary, Indiana, and suddenly it gets much harder to ignore. We may all be different, and our differences may be part of what makes us beautiful as a nation, but we are all Americans. As such, it doesn’t seem right to deny some of us health insurance just because we don’t live in the right part of town.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

technology in medical research
The Tools Helping Medical Researchers See the Full Picture
News Technology
August 3, 2025
5 Steps to a Promising Career as a Healthcare Administrator
5 Steps to a Promising Career as a Healthcare Administrator
Health
July 31, 2025
holistic dental
Holistic Dentist Services Are Natural and Safe
Dental health Specialties
July 28, 2025
botox certification
Help Improve People’s Skin Health Via Botox Certification
Skin Specialties
July 22, 2025

You Might also Like

malpractice
BusinessPolicy & LawPublic Health

Are Doctors Sued Enough for Medical Malpractice?

May 10, 2014
medical marijuana facts
BusinessPolicy & LawPublic Health

The Medical Marijuana Movement Deconstructed

September 27, 2014
The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
Health care

The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims

May 13, 2025
Readmission Reduction Program
BusinessFinanceHealth ReformPolicy & LawPublic Health

9 Criticisms of the Readmission Reduction Program

June 6, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?