Racial and ethnic disparities in the health care system have long impeded our nation’s health and well-being. For everyone in the U.S. to achieve their full potential—and for our nation to achieve its full potential—we must ensure equitable access to high-quality health care. This report presents an anti-racist re-imagining of the Medicaid and CHIP programs that actively reckons with the racist history of health care coverage. The report offers recommendations to advance racial equity in Medicaid and CHIP. It also provides principles to guide anti-racist policy transformations that center program participants and their communities.
Medicaid is a core pillar of the U.S. healthcare infrastructure that helps ensure that everyone — regardless of income — can have access to quality care. But for decades, the federal government has treated Puerto Rico unequally, covering only half the share of the cost (in comparison to a maximum of 83 percent for states). And the amount of federal funding is subject to an extremely low, arbitrary and unstable cap set by Congress. The perverse result is that one of the poorest jurisdictions in the United States is treated as one of the wealthiest states for Medicaid funding — a program specifically designed to help people and families with low incomes access quality medical care.
An America where no one experiences poverty is possible. Already, the U.S. has programs with the potential to make this vision a reality, including programs that provide cash assistance, like Temporary Assistance for Needy Families (TANF). The current TANF program provides very little cash assistance and is marked by stark racial disparities, but it has the potential to reduce child poverty, increase economic security, and advance racial equity. This report offers a vision for an anti-racist approach to the TANF program, with new statutory goals and policy recommendations to advance racial justice.
Unrepayable Debt: How Economic, Racial, & Geographic Inequality Shape the Distribution of Parent PLUS Loans
Each year, millions of parents across the U.S seek to help their children pay for higher education using the only source of federal financial aid for parents: the Parent PLUS loan program. Despite offering an additional college financing option, Parent PLUS disproportionately distributes unrepayable debt by income level, race and ethnicity, geography, and higher education sector, burdening low-income parents with immense debt. This chartbook examines key features of Parent PLUS loan borrower experiences, finding that Parent PLUS burdens parents and students from low-income households, Black families, and students attending postsecondary institutions in the South. Understanding this uneven distribution of Parent PLUS debt is vital in order for policymakers, postsecondary administrators, and advocates to redesign the program and develop a more equitable higher education financing system for parents and students.