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Health & Education 2013 Care continued from page 9 care costs continue growing faster than both wages and the economy as a whole, accounting for an ever-larger share of spending for employers and workers alike. It now accounts for nearly 18 percent of U.S. economic activity, up from 5 percent in 1960. Annual premiums for employer-spon- sored family coverage jumped nearly 4 percent this year, and single coverage rose almost 5 percent, according to a report released last week by the nonprofit Kaiser Family Foundation. The foundation expects prices will begin rising faster as the economy improves. Economists say soaring health care costs are driven primarily by industry consolida- tion and expensive new medical technologies and prescription drugs. The Affordable Care Act’s cost-contain- ment section reduces Medicare reimburse- ments to providers and requires commercial insurance companies to issue refunds if more than 20 percent of their revenue goes to profits, salaries and over- head. Hospitals will face penalties when patients develop conditions while in their care. The federal law also promotes ``account- able care organizations’’ within Medicare, which are charged with improving coordi- nation to reduce wasteful spending. But much of the experimentation on reducing costs is driven by state govern- ments and private businesses. Oregon has tried to tackle rising costs by focusing on Medicaid, which serves 550,000 people in the state and is expected to grow by 200,000 under the Affordable Care Act’s Medicaid expansion that starts next year. Gov. John Kitzhaber last year spearhead- ed a new model of delivering services under Medicaid. His initiative led to a state law that created ``coordinated care organi- zations,’’ which attempt to integrate mental, physical and dental care as they improve the way chronic conditions are managed. These organizations are required to manage their costs within a fixed rate of growth. Some coordinated care groups are hiring staff to work intensely with Medicaid patients who frequently visit the emer- gency room. ``We try to deal with the medical part. But everything they go through, we have to take into account, because if you don’t have money to pay your bills, you’re going to have stress’’ that complicates medical problems, said Ruby Ibarra, a community health specialist for Multnomah County, which is part of a coordinated care organi- zation in the Portland area. Elsewhere in the state, Trillium Commu- nity Health Plan in Eugene has a program starting this month that gives up to $200 in prepaid debit cards to pregnant mothers who quit smoking. Oregon’s law also has led to the rapid expansion of ``health homes,’’ supporting a system of primary care that calls for clin- ics to stay open longer and offer same-day appointments. The clinic serves all patients, including those with Medicaid, Medicare and private insurance. The federal Affordable Care Act also encourages wider adoption of the health home model. Invisible continued from page 12 precocious” or for being “unladylike.” NAM: Beyond schools, what other insti- tutions should address the needs of young women of color to put them on a pathway to success? What do you propose they could do? Morris: Public sector institutions (i.e., government, nonprofits, and foundations) are important to launching and sustaining critical conversations and interventions that generate new pathways to success for girls and women of color. I must say that mental and physical health institutions are critical to the successful development of girls and women. Educational institutions could be mindful about the ways in which they unnecessarily criminalize black femininity and develop alternative interventions for girls who are vulnerable to dropping out of school and other forms of victimization. Ultimately, public service sector institutions should work to develop culturally competent and gender-responsive interventions for girls of color, and to engage them in practices that provide them with an opportunity to active- ly define and address their own conditions. Private sector institutions should also engage in a shared conversation about girls’ pathways to success. Their role as employ- ers and shapers of public perception about the femininity of women of color (via media and advertising) must not be ignored. NAM: After the Trayvon Martin shooting, parents of young black men referred to “The Talk,” conversations about how to stay safe in a society that sees you as a threat. Is there a similar “talk” parents should be having with their daughters? Morris: Between 2005-2010, black females age 12 and older experienced sexu- al victimization at a rate of nearly 3 percent, higher than their white (2.2 percent) and Latina (1.4 percent) counterparts. Females and males experience nonfatal firearm vio- lence at about the same rate (1.6 percent and 1.9 percent per 1000, respectively). While black and Latino males experience fatal firearm violence at higher rates than other segments of the population, the invisibility of female homicide victims is particularly troubling. In the aftermath of the Zimmer- man trial, the question was raised whether we would even know Trayvon’s name if he were a female. Where is the movement for Tasha Hill, who was beaten by a White man in front of her 7-year old daughter at a Cracker Barrell in Georgia? Where were the marches or proposed laws named for Rekia Boyd, the unarmed young woman in Chica- go who was killed less than a month after Trayvon was fatally shot? As with boys, the “talk” with black girls and young women is also a discussion about racism in America; and as with boys, it should include tips for how to be safe in the presence of law enforcement and include clear instructions about how to behave when they are suspected of wrongdoing in the presence of someone with a gun. But the talk also requires a candid discussion about sexism and patriarchy in our society and our racial justice movements. Our girls need to know how to identify sexism in all its forms, how to understand the ways it inter- sects with racism to create problematic narratives about the femininity of girls of color, and how their own education and self-determination can change these narra- tives and their devastating effects on policies and practices associated with edu- cation, justice, and the economy. NAM: Is this an issue that you address in your forthcoming book, “Black Stats?” Morris: “Black Stats: African Americans by the Numbers in the Twenty-first Centu- ry,” is a book of quantitative facts that illustrate the quality of life for black Amer- icans. It covers a broad spectrum of top- ics—from basic demographics and entertainment to the environment, military, and electoral politics. In the chapters on education and justice, I do include specific statistics that are aimed to inform the public discourses on school discipline, achieve- ment, and risk of confinement for black females—and males. There are some sur- prises, so people should read carefully. August 28, 2013 The Portland Skanner Page 11
