The Right to Good Healthcare and Good Health

T h e Rig h t t o G o o d H e alt hcare
a n d G o o d H e alt h—Wh ere Is O ur
Bailo u t Pla n?

By: Marissa Beach, MPA Candidate, December 2009,
University of Washington, Seattle

Prepared for: Social Equity and Leadership Conference, Rutgers
University – Newark, New Jersey

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EXECUTIVE SUMMARY

This report analyzes state universal health care legislation through an international human rights
lens. It addresses some of the complexities of healthcare reform based on the author’s summer
2008 research at Uplift International, a Seattle-based nonprofit working in health and human
rights1. In sum, the report (a) addresses existing health disparities in Washington State, focusing
on King County, despite progressive legislation; (b) addresses different actors in society and
their actions for change; and (c) poses critical questions.

This report concludes the following:

! A variety of factors influence and affect national, state, and regional health disparities
(e.g. race, racism, income, socioeconomic position, poverty, geographic residence, and more);

! The majority of Americans with insurance (64%, data from 2005-2006) attain it through
their employer, thus, limited insurance for the unemployed, homeless, and other vulnerable
populations;

! Vulnerable populations such as children and the mentally ill, among other vulnerable
populations, face greater obstacles to achieving good health and attaining sufficient healthcare to
cover their needs—and their human rights;

! Nationally, 16% of the total U.S. population is uninsured, while individual states range
from 8 to 20 percent;1

! Many state universal healthcare bills introduced annually are stalled in the political
process or remain at the committee level with an unclear or unknown status; and

! For universal healthcare bills accessible at the time of this research, legislation has been
introduced in at least 14 states.

1
www.upliftinternational.org

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1 TABLE OF CONTENTS

1 TABLE OF CONTENTS ...................................................................................................................... 3
2 PURPOSE OF REPORT ....................................................................................................................... 4
3 METHODOLOGY ................................................................................................................................ 4
4 BACKGROUND ................................................................................................................................... 4
5 INTRODUCTION ................................................................................................................................. 5
6 U.S. HEALTHCARE AND RIGHT TO HEALTH .............................................................................. 5
6.1 U.S. Insurance ................................................................................................................................ 6
6.2 Hunger in the United States............................................................................................................ 7
7 STATE’S ROLE IN HEALTHCARE INITIATIVES AND POLICIES IN UNIVERSAL HEALTH
CARE............................................................................................................................................................ 7
7.1 Seattle, Washington........................................................................................................................ 8
8 CHILDREN’S HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 1990s ..................... 10
8.1 Diseases ........................................................................................................................................ 10
8.2 Violence and Delinquent Behavior............................................................................................... 11
8.3 Sexual Behaviors, STDs, and Unwanted Pregnancies.................................................................. 11
8.4 Poverty.......................................................................................................................................... 12
8.5 Youth’s Security: Sexual, Racial Harassment and Rape.............................................................. 12
8.6 Uninsured in King County (1991-1998)....................................................................................... 12
9 CHILDREN AND YOUTH HEALTH IN KING COUNTY - 21ST CENTURY................................ 13
9.1.1 CHILDREN’S ORAL HEALTH .......................................................................................... 14
9.2 Legislation for Children in Washington ....................................................................................... 14
9.3 Hunger in Washington.................................................................................................................. 15
10 PUBLIC HEALTH IN KING COUNTY, SEATTLE, WASHINGTON – 2008 ............................ 16
10.1 Uninsured in King County – Seattle, Washington.................................................................... 16
10.2 California .................................................................................................................................. 17
10.3 Maine ........................................................................................................................................ 17
10.4 Vermont .................................................................................................................................... 19
10.5 Massachusetts ........................................................................................................................... 19
10.6 California .................................................................................................................................. 20
10.7 Building Coalitions for Women’s Health & Human Rights ..................................................... 21
10.8 South Carolina .......................................................................................................................... 21
10.9 Florida....................................................................................................................................... 22
10.9.1 Coalitions in South Carolina and Florida......................................................................... 22
11 CONCLUSION................................................................................................................................ 23
12 WORKS CITED .............................................................................................................................. 34

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2 PURPOSE OF REPORT
The purpose of this report is to provide researchers and health professionals, specifically Uplift
International—a non profit based in Seattle, Washington working in health and human rights—
with a broad overview of the right to healthcare and health in the United States. Uplift
International and other health advocacy organizations could use this report to advocate for health
and healthcare reform at all legislative levels.

3 METHODOLOGY
The author’s research took place during the summer (June to August) of 2008 as a Research
Assistant for Uplift International. Sources for this research come from a combination of online
legislative databases, academic journals, and health statistics. For research on the 2005 Seattle
Right to Healthcare ballot initiative, the author interviewed 10 Seattle city policymakers and
executive directors of health nonprofits, and 75 residents of Seattle to gage their awareness of the
ballot.

The ‘street interviews’ took place in various neighborhoods in Seattle, Washington at different
hours of the day on five separate days total. Survey questions gauged knowledge and opinions on
health and human rights and awareness of the 2005 Seattle Right to Healthcare ballot initiative.
One survey drawback was not asking residents their 2005 residency status, which would likely
influence their awareness of the ballot initiative.

4 BACKGROUND
The Health Insurance Portability and Accountability Act (HIPPA) in 1996 created the first
federal standards for health insurance. Post September 11, 2001 policies increased state public
spending on public health preparedness, a shift in available federal funds for terrorism and bio-
terrorism, which gave U.S. federal agencies the power to both intervene and coordinate a
national agenda for public health. At the same time, the shift often gave U.S. federal agencies
the power to disregard basic human rights.1

One such area of undermined human rights is the lack of a national single health care policy and
law entity, in such that contradicting policies, state and federal laws exist and public opinion
becomes a blur.2 There is a need to: “Bridge gaps between different policy-making authorities
between conflicting paradigms, legal doctrines, and public policies that coexist only because
they have never had to be reconciled.”3

Even when laws and policies are in place to guarantee certain rights or to implement new
poverty reduction programs related to health, they do not necessarily lead to the “right to
health.” For example, one of the goals of The International Conference on Population and

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Development held in Cairo, Egypt in 1994, was to “empower women to become ‘full and equal
members of society,’” but reduced the ‘problem’ to behaviors (i.e. impoverished women
perceived as not capable of putting on female condoms nor capable of telling their partners to
wear condoms).4

5 INTRODUCTION
Several international human rights documents address the right to health and healthcare.
According to the Universal Declaration of Human Rights (UDHR), “Everyone has the right to a
standard of adequate for the health and well-being of himself and his family…” The Second Bill
of Rights for Americans guarantees “the Right to adequate medical care and the opportunity to
achieve and enjoy good health.”5 According to the Convention on the Elimination of All Forms
of Discrimination Against Women (CEDAW), women need access to health care services,
facilities, and education to “help to ensure the health and well-being of families.”6

However, even though many countries have not ratified the international human rights
documents, some states and cities have introduced legislation based on international human
rights documents. For example, in 1998, San Francisco became the first city in the United States
to adopt CEDAW.

But how are such documents enforced? Who plays the role of the watchdog and who is/are the
decision-maker(s)? What actions have states, cities, counties—and everyday citizens and
activists taken? Across the country, coalitions have been built, partnerships established, and
legislation introduced. Seattle, Washington is one such place, although it is not alone.

In addition, hundreds—if not, thousands—of bills introduced each year in the U.S. Congress are
related to health and healthcare. State-run programs greatly depend on federal resources and
federal officials to renew programs and funding. Because state and city governments are often
bound to limited federal resources, the decision-making power often falls at the national level.

6 U.S. HEALTHCARE AND RIGHT TO HEALTH
At least 25 organizations, agencies, and federal programs nationwide work on policies and/or
jointly with states to develop policies for the hungry. Such policies are aimed at vulnerable
populations, such as those whose income falls below the Federal Poverty Level (FPL) and
children, and the cross-population of the two categories.

U.S. national health programs that state programs model and/or implement vary in size and
scope. A few examples are: The National School Lunch Program (1946); the Temporary
Assistance for Needy Families (1996); and the State Children’s Health Insurance Program
(1997). In Washington State, school meals, the Basic Food Program and Apple Health provide
thousands of families with basic food and health insurance needs. In addition, since 2004, the
Children’s Alliance—a children’s health advocacy organization in Seattle, Washington—

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advocated for at least 25 legislative bills that were approved that restored previously cut funding
for nutrition programs with the goal of insuring all children by 2010.

Despite these programs and legislation, access to healthcare has long been an issue for
vulnerable populations. There are appalling racial disparities in the United States and a gap
between what citizens want (and need) and what state and local governments have provided. For
example, HIV-AIDS efforts during the 1990s focused on helping decrease the number of white
gay men with AIDS, meanwhile women—especially minority women—and issues such as
domestic violence were largely underfunded and given less attention, if not, outright ignored.7

The term “right to health” is rarely seen both in national and state bills and in the language of
ordinary citizens as testimonies to human rights organizations. Instead, the language “right to
healthcare” and “universal healthcare” have been frequently used by various actors to address
access to health services and health disparities.

Cities and states have also introduced numerous bills on universal healthcare (see Appendix 1).
Nonetheless, “the right of everyone to the enjoyment of the highest attainable standard of
physical and mental health,” as stated in Article 12 of the International Covenant on Economic,
Social and Cultural Rights (ICESC), as a component of universal healthcare has been largely
ignored.

According to a member of the Healthy Washington Coalition—a coalition advocating for
healthcare reform in Washington State—language including human rights such as the “right to
healthcare” or the “right to health” does not move people because they “are afraid of losing what
they have…They’re frightened of healthcare.” 8

6.1 U.S. Insurance
U.S. Health Insurance Coverage 2005-2006
Although 16% (approximately 47 million
Americans) of the total U.S. population is
uninsured (2005), state uninsured rates range
from 8% to 20%.9 In addition, countless
Americans are underinsured, facing high out- Individual
Employ er
of-pocket health care expenses and stress due 64%
6%

to unexpected unemployment and thus health
Medicaid
insurance loss, especially in times of economic 15%
downturns.
Medicare
Ot her Public
14%
1%
One factor that influences public health is
politics. Public officials determine what to fund
and what to cut. Each year, bills are introduced

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and assigned to committees that are often left untouched, forgotten, or unknown depending on
the state’s legislative database. If the bills are sent to committees, only by contacting the
individual state governments or reading state and local newspapers could one find out about
specific committee tasks, a tedious task for researchers and state legislators seeking comparative
data.

Politics is one reason that legislation is not guaranteed to continue from one year to the next. In
response, many nonprofits and alliances through out several states are advocating for health care
reform with varying degrees of success. Regardless, however, the majority of Americans are
willing to pay more taxes to provide every American health insurance, especially children,
according to a 2007 New York Times survey.10

6.2 Hunger in the United States

An average family in the United States receives $400 less in benefits per year due to the 1996
cuts. In addition, that same year Congress denied food stamps to legal immigrants but later
restored legislation to many, albeit not all of these individuals.

Unlike national myths, more than 98% of food stamp benefits go to eligible households
compared to 15% of taxpayers that underpay their taxes, according to an Internal Revenue
Service report. The majority of Americans (75%) despite a tight budget year say that the Food
Stamp Program should be protected from administration or Congress’ cuts.

Nationwide, 11 million people (3.8% of the U.S. population) experience “very low food
security,” where at least one family member goes hungry at times due to lack of money for food.
Hispanic, African American and Native American households have much higher rates of hunger.

In 2007, Congress froze the value at $134 of the standard deduction for food stamp recipients to
subtract from their income to reflect non-food items, a barrier that remains in effect today.11 To
keep pace with inflation, this amount should have been $184 fiscal year 2007 and $205 fiscal
year 2012.

7 STATE’S ROLE IN HEALTHCARE INITIATIVES AND
POLICIES IN UNIVERSAL HEALTH CARE
States play three basic roles in the health care industry: regulator, purchaser, and provider.12
States set different qualifications for federal-funded health programs, such as policies to run
Medicaid Programs within federal guidelines. Income eligibility for states in 2005 for Medicaid
ranged from below 40% Federal Poverty Level (FPL) to over 110% FPL.

States purchase federal healthcare through Medicaid, State Children’s Health Insurance

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Program (SCHIP), and/or provide state employees with health insurance. In addition, states
often use federal funds for other health services such as Title V; Women, Infants, and Children
(WIC) programs; AIDS treatment, and so forth. Of all state spending, 72% is spent on Medicaid
(see Appendix 2).

At the time of this research, at least 14 states2 have introduced legislation of universal
healthcare to attempt to address health inequities and insurance coverage.13 Previously, other
states that introduced universal right to healthcare legislation did not become law due to various
factors. Most bills have died at the state committee levels (see Appendix 1). The following is an
explanation of the major universal health care reforms across different states.

7.1 Seattle, Washington

In 2003, King County Executive Ron Sims created a Health Advisory Task Force (HATF) with
the mission to: “Recommend an innovative and achievable set of strategies to improve the
quality of health care while moderating costs in the Puget Sound market.”14

In December 2004, Sims created a public-private partnership to that lead to The Puget Sound
Alliance.15 Alliance members included: King County, Starbucks, Washington Mutual, the State
of Washington, Group Health Cooperative, the City of Seattle, and Recreational Equipment Inc.
(REI); and later joined by Virginia Mason Medical Center, Seattle Surgery Center, Regency
BlueShield, Community Health Plan of Washington and the Hope Heart Institute.16

The Puget Sound Alliance categorized patients only to include “employees and their families,”17
thus excluding numerous vulnerable populations such as the uninsured unemployed, homeless,
and immigrants afraid to seek care to their citizenship status. Among HATF’s key outcomes
were to implement strategies to “reduce the increase of total health care expenditures” by
mitigating “increases in personal costs/financial responsibility for health care benefits for King
County employees.18

In its 2005 final report, HATF concluded:

! Medical professional lacked infrastructure elements, such as “state-of-the-art tools, a
common measurement system for data collection and analysis, an organized forum, and regional
leadership”;19

2
California, Delaware, Hawaii, Iowa, Illinois, Kansas, Maryland, Minnesota, Missouri, New
Mexico, North Carolina, New York, Ohio, and Rhode Island.

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! High quality health care performance should be rewarded instead of the current state and
national system of not rewarding high quality performance and not punishing low-quality
performance;

! “All the local players in the health care system (patients, providers, purchasers, and
plans) are unhappy and searching for solutions;20

! A region-wide partnership was needed with specific components that included: giving
patients more information to make informed health-related decisions and financial incentives for
consumers and health professionals, and others.

It is worth noting that the Task Force did not include any human rights advocacy group, but
rather, was made up with public and private sector members. Although many members came
from the health arena, there were virtually no health nonprofit organizations that formed part of
the alliance, despite that the Alliance became a nonprofit itself.

Although the Alliance was originally formed partially as a result of HATF’s recommendations,
it has nothing to do with legislative health care reform, according to one member who requested
anonymity. Instead, it aligns incentives and uses a market-based approach.

The Alliance currently has 170 organizations and avoids partisan politics despite the fact that
politics has everything to do with changing market-based incentives. “It’s important to help
people understand that right now [2008] so many decisions are being made in total darkness,”
the same member said. “Why is it we’re willing to tolerate an arcane approach to health care?”

In 2005, Seattle voters passed a right to healthcare ballot measure by a majority (69% yes, 31%
no) to tell the City Council: “Every person in the U.S. should have an equal right to quality
health care.”21

Although the “right to healthcare” ballot measure gave residents a “unified voice in advising the
City of Seattle to take concerted action,”22 healthcare disparities cannot be changed over
night—nor seemingly over a couple of years. The ballot told the City to “take the necessary
steps to help realize this right for Seattle residents and others.”23 This included but wasn’t
limited to:

! “Ask Washington State representatives and senators in the U.S. Congress to adopt
legislation that provides universal access to quality health care;

! “Ask the Washington State legislators to support our efforts and work toward this goal;

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! “Support education of the public about this issue and support advocacy on this issue;

! “Research ways that the City Council can improve health care access for the uninsured;

! “Compile data and publish an annual report on local health care indicators including
information on access to health care;

! “Convene a panel of experts to prepare a report and make recommendations to the City
about specific steps the City and Seattle private employers could take to improve insurance
coverage for Seattle residents.”24

After street surveys of 74 Seattle residents in various neighborhoods, the author found that just
9.5% knew about the 2005 ballot, despite that the large majority (approximately 88%) agreed
that health is a human right. This survey shows a lack of or little use of communication
regarding important health care rights, a method that would go beyond publishing the document
online.

8CHILDREN’S HEALTH IN KING COUNTY, SEATTLE,
WASHINGTON – 1990s
In order to properly address health in the 21st century for residents of King County, it is
appropriate to provide an overview of children’s health in the 1990s. Children and youth of King
County in the 1990s faced a variety of health problems: chronic diseases, substance and alcohol
abuse, firearm and handgun ownership in households, poverty, sexual transmitted diseases, and
sexual harassment and rape both at school and outside of school, among other issues. These
behaviors and environments put children at risk for mental and physical abuse and thus affect
children’s health status.

8.1 Diseases

During the 1990s, children faced increasing rates of asthma, obesity, and accidental poisoning
mostly due to illicit drug overdose, while infant mortality and smoking during pregnancy
dramatically decreased among teenage mothers.!

Between 1987 to 1996, child (ages 1-14) asthma rates increased by 22%, according to Public
Health Watch data. In addition, according to the Center for Disease Control (CDC), childhood
asthma hospitalization admissions increased 53% (from 505 to 772) between 1987-1998 in King
County." By 1998, asthma was the leading cause of hospitalization among children in King
County. Most cases of hospitalization for asthma were significantly higher for children ages 1-4

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through out the late 1980s to mid-1990s and significantly higher for those living where poverty
was greatest.

Hospital charges more than doubled from 1998-2004. From 1988 to 2004, the average inflation-
adjusted hospital charge rose from $6,968 to $17,620. In 2004, the average charge for a hospital
visit was $19,328, not adjusting for inflation.

8.2 Violence and Delinquent Behavior

The health of youth in King County since 1990 has fluctuated, remained unchanged, or increased
depending on the grade level and year.25 Overall, substance and alcohol usage has increased for
most grades, ranging from a 1-to-8% increase in alcohol, tobacco, marijuana, and cocaine usage
in the last 30 days.

In addition, violent and delinquent behavior was not uncommon in the 1990s. In 1998, a quarter
(25%) of King County school children in Grade 10 were drunk or high at school; 15% attacked
to hurt; 7% had been arrested; 5% had stolen a vehicle; 7% had carried a handgun; and 12% had
been suspended. Grade 6 children engaging in the same behaviors ranged from 1% to 21% less,
except for intentional violence where 14% had attacked to hurt.

Other risky behavior such as not wearing a car seatbelt, bike helmets, and life jackets and motor
vehicle crashes were common among youth. The leading causes of death among youth age 10-17
from 1996-1998 was unintentional injury (37%), followed by homicide (14%) and cancer (12%).
For young adults age 18-24, unintentional injury was also the leading cause of death (40%),
followed by suicide (19%) and homicide (18%).

8.3 Sexual Behaviors, STDs, and Unwanted Pregnancies

Although sexually transmitted diseases (STDs) have decreased dramatically overall in the 1990s,
youth continued to engage in unsafe sex. Gonorrhea rates for youth ages 15-17 dropped from 412
cases in 1987 to 137 cases in 1997. Rates for Seattle youth and young adults remain significantly
higher compared to those living outside Seattle. Chlamydia rates for females ages 15-17 and 18-
24 also decreased dramatically from 1988 to 1997, increasingly slightly in 1994 and 1997 from
their previous years, which may be attributed to better detection from improved screening and
better access to treatment facilities.

For females under age 25, pregnancy, birth, and abortion rates were high during the 1990s. There
was an average of 82% of unintended pregnancies from 1993-1997, 55% of which ended in
abortion and 27% in live births. Birth rates differ significantly when accounting for
neighborhood poverty. In a neighborhood where 20% or more of the residents live in poverty,
teenage birth rates were 3 to 10 times higher than neighborhoods where 5% or less live in
poverty.

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8.4 Poverty

Poverty affects educational and social outcomes and varies among cities in King County. In
addition, there are many racial disparities that exist in King County. Seattle had the highest
percentage of school-age children and youth living below the poverty level in both 1989 and
1995, while Mercer Island and Issaquah had the lowest. In 1995, nearly one in five Seattle
School district school-age children and youth attending schools lived in households below the
FPL.

8.5 Youth’s Security: Sexual, Racial Harassment and Rape

Sexual assault and rape were also major problems in the 1990s among youth. For King County
public school children Grades 8, 10, or 12, unwanted sexual touching ranged from 13-15%. In
Washington State, 18% of Grade 10 students reported unwanted sexual touching in 1995. That
same year, rape among public high school students in Seattle ranged from 10-12% with twice as
many females reporting as males.

Seattle students were more likely to be sexually harassed involving sexual comments at school or
on their way to or from school with females accounting for over half of the cases. For example,
53% of female students in Grade 8 and 51% of female students in Grade 10 reported such
harassment in 1995. Harassment due to perceived sexual orientation was also a problem; about
8% of Seattle high school students reported such harassment.

In 1995, 51% were Latinos and 51% of multiethnic students in Seattle were racially harassed,
followed by 48% of whites. Southeast
Asians were least likely to report
Uninsured in King County, 1998
racial harassment (35%).

In a 1998 survey, households with 3%
youth age 13 to 17 had high 6%
o
tin

percentages of firearm and gun 83%
La

ownership; 19% of these households 76%
c/
ni

te

with youth had handguns and 30%
pa

hi

Race / 10%
is

W

had firearms.
H

Ethnicity 13%
l
Is
c.

1%
Pa

2%
n/

% of Total
8.6 Uninsured in King
n
ia

Population
ia
As

nd

6% % Uninsured
County (1991-1998)
-I

9%
er

er
Am

m

0% 50% 100%
-A

Studies show that the uninsured both
an
ric

in King County and nationally in the
Af

United States tend to have poorer
health, die prematurely, have

Page 12 of 38

decreased access to needed preventative services and face increasing out-of-pocket costs, and
thus confront many unmet needs.

In 1998, over 50% of uninsured King County residents reported an unmet medical, dental,
prescribed drug, or vision care need.”26 Although whites made up the highest percentage of
uninsured (76%), they are the only race that has a lower percentage uninsured compared to the
percentage of total population. Minorities were disproportionably uninsured in 1998 compared to
whites.

Similar to national patterns, the majority (77%) of King County adult residents ages 18 to 64
who are insured obtained insurance from their employers or unions in 1998. However, those
earning less than $25,000 were less likely to have an employer-sponsored insurance than
households earning more than $25,000 (62% versus 82%).

The uninsured faced major unmet needs from lack of coverage for prescription drugs, mental
health, dental, and eye-glasses for King County residents age 18 and over (ranging from 18 to
40%), which in 1998 was more common than lack of medical insurance. 68% of older adults
lacked dental insurance in 1998.

In the late 1990s, those who were near the poverty levels earning $15,000-$24,999 had the
highest percentage of uninsured (33%) than any other income group, including annual household
income ages 18-64 earning less than $15,000 (28%). In 1998, 11% of King County residents
(~120,000 people) age 18 to 64 lacked health insurance, compared to 13% for Washington State
and 15% for the United States.

Those without health insurance living in households with incomes between $15,000 and $24,999
more than doubled from 14% in 1991-1993 to 33% in 1996-1998. In 1995-1997, for this income
group, the percentage of uninsured surpassed the lowest income group. Among the different
racial groups, Whites, Asians, and non-Hispanic Latinos had lowest percentages of being
uninsured, although higher rates of uninsured were found among sub-groups of Asians.

When comparing age groups, young adults ages 18-24 had the highest percentage of uninsured
(23%), while 8% of children (about 30,000 children) under 17 were uninsured in 1998. Although
children living below 200% of the federal poverty level (FPL) qualify for Medicaid,
approximately 17% of those who qualified were not enrolled in 1998.

9 CHILDREN AND YOUTH HEALTH IN KING COUNTY -
ST
21 CENTURY
Infant mortality and smoking during pregnancy in King County as steadily decreased since the
late 1980s as the percent of mothers receiving prenatal care in the first trimester has increased
dramatically among African Americans, Hispanics, and Native Americans, but nonetheless are
still 5-15% lower than white mothers.

Page 13 of 38

In 2003-2005, the infant mortality rate (deaths per 1,000 live births) in Washington was lower
for each race and ethnicity than the U.S. rate.27 In the United States, non-Hispanic Blacks had an
infant mortality rate of 14 during 2003-2005. The United States has the second worst newborn
mortality rate in the developed world, according to a 2006 report using the “Mothers’ Index.”28

INFANT MORTALITY RATE (DEATHS PER 1,000 BIRTHS) 2003-2005
Washington U.S.
Non-Hispanic White 5 6
Non-Hispanic Black 9 14
Hispanic 5 6
Total 6 7

In addition, in the 21st Century, youth have faced depression and eating disorders. In 2004, 14%
of 8th graders, 17% of 10th graders, and 16% of 12th graders reported engaging in disordered
eating behaviors. Depression is the most common mental health problem. In 2006, 30% of 10th
and 12th graders surveyed reported symptoms of depression in the past year.

9.1.1 CHILDREN’S ORAL HEALTH

Dental caries or tooth decay is the single most common chronic childhood disease. The disease
has increased among WA children since 1994. In 2005, 20% of 2nd and 3rd graders in WA had
untreated dental caries and only about 45% had received dental sealants. Nationally, 80% of
dental caries in the permanent teeth is concentrated in 25% of the child and adolescent
population.

Dental caries (tooth decay) has increased among Washington children since 1994. Race and
socioeconomic status greatly influence oral health. Children eligible for Free and Reduced
Lunch and Head Start of non-white ethnicity in 2005 had higher rates of untreated tooth decay
than those not eligible and white children.

9.2 Legislation for Children in Washington

At the turn of the 21st Century, in 2002, Washington eliminated the state-funded Children’s
Health Program.29 There were numerous administrative barriers for Medicaid eligibility,
resulting in 40,000 children who dropped from the Medicaid program, and numerous budget cuts
to other vital programs for children. In 2004, Child and Family Services Review (CFSR) scored
Washington among the bottom third of all states in the nation meeting CFSR standards.

In 2004, an annual client survey of 2nd Harvest Inland Northwest in Spokane found at:

Page 14 of 38

! 56% of clients going to their food bank had worked during the past year;
! Over half of the parents (60%) skipped meals so their children could eat;
! 27% skipped meals at least once a week; and
! Nearly half of their food bank clients were children.

Fortunately, the Children’s Alliance advocated for over 30 bills since 2004 to increase funding
for children’s programs, restore previous budget cuts with the new Governor, Christine Gregoire,
especially programs aimed at foster children, racial disparities in health, and childhood hunger.
In 2005, the “Health Care for Every Child” (HB 1441) created comprehensive health coverage
program for immigrant children below the FPL not eligible for Medicaid and Washington
legislators promised to insure all children by 2010.

In addition, in 2005, Washington legislators passed bills to:

! Expand school breakfast to all high-need schools in the state (where at least 40% of
students are eligible for free or reduced-price meals);

! Fund the WIC Farmer’s Market Nutrition Program, nutritious foods for low-income
families;

! Improve child welfare for allegations of abuse, chronic neglect, and education for
coordinators of foster children;

! Fund the Kinsap Care Navigator Program to address disproportionality for children of
color.

9.3 Hunger in Washington

“Food insecurity of hunger”—households where at least one family member goes hungry at
times due to lack of money for food—increased in Washington households from 275,000 in 2003
to 292,000 in 2004. In 2005, 12% of all Washington families, including senior citizens living on
fixed incomes, and low-income working families (276,000 households) lived with hunger or the
threat of hunger, according to the U.S. Department of Agriculture. Nearly 7.3% (520,401)
Washingtonians use their food stamp benefits to buy food, receiving on average $0.93 per meal
or $251 to feed a family of three for a month. The average food stamp benefit is less than $1 per
person per meal. Nationally, hunger increased slightly from 11.2% (2001-2003) to 11.4% (2002-
2004).

In early 2006, the Children’s Alliance found that 26 counties in Washington had high levels
(20% or above) of poverty of school-age children; 51,000 of these children were food insecure
and 18,820 were hungry.30 That same year, 97,519 children were uninsured and 68,128 (or
nearly 70%) of these uninsured children were eligible for publicly funded health programs such
as Medicaid, SCHIP, Basic Health, and Children’s Health Program. However, “very low food
insecurity” or hunger as previously termed, decreased in the period 2003-2005 when compared

Page 15 of 38

to 1996-1998 (4.7% compared to 3.9%).31

10 PUBLIC HEALTH IN KING COUNTY, SEATTLE,
WASHINGTON – 2008
Health disparities and insurance status differences exist depending on income, and thus, place on
the FPL, place of residence, and race in King County. Low-income residents often have greater
needs that are unmet contributed by a lack of access to services or lack of financial cushion.

10.1 Uninsured in King County – Seattle, Washington

King County residents are about as likely to lack health insurance today as they were 10 years
ago; however, disparities have increased dramatically.32 In 2000-2004, Hispanics had the highest
rate (35.5%) of being uninsured followed by Blacks (21.5%). From 2002 to 2004, uninsurance
rates increased in Washington State from 8.4% to 9.8% for a total of 606,000, or almost 1 in 10
Washingtonians uninsured.33

Overall, nearly 140,000 King County residents as of 2008 lack health insurance and another
120,000 (10%) are estimated to be underinsured. About 382,000 King County residents lack
dental insurance.

In the past 10 years, disparities between African Americans and Whites have increased
dramatically as have other minorities compared to Whites. About 29% of American
Indians/Alaska Natives and 25% of African Americans lack insurance compared to 11% of
Whites. Residents of southern King County are most likely to lack insurance (Tukwila/SeaTac,
27%; Burien/Des Moines, 23%; White Center/Boulevard Park, 20%).

In the last decade, the uninsured rate of uninsured in King County among African Americans,
people ages 45 to 64, and people with low- and middle-income categories increased. In addition,
uninsured residents in the South King County region have also increased.

Over four in 10 (43%) of near-poor residents (annual household income between $25,000 to
$35,000) in King County lack health insurance, the highest rate of all income groups.34 Almost
one in every two (47%) of the working poor lack insurance. About 382,000 of King County
residents lack dental insurance.

Nearly 65,000 low-income residents are in need of publicly funded mental health services for a
serious mental illness yet less than half (43% or 28,000) low-income county residents with
Medicaid receive on-going outpatient mental services and only about 500 low-income people
without Medicaid receive outpatient mental services.

Gum disease is linked to heart disease, stroke and diabetes. The latest data (2001) shows that

Page 16 of 38

about 382,000 adults lacked dental insurance.

10.2 California

Senator Sheila Kuehl introduced SB 840, the California Health Insurance Reliability Act, in
February 2005, a bill that would provide all Californians with universal health care. Governor
Arnold Schwarzeneggar, however, promised he would veto it35, and then proposed his own
universal health care plan that would be financed by state lottery revenues and based on income
in relation to the Federal Poverty Level (FPL).36

Kuehl did not support the Governor’s health care proposal and voted it down with her
colleagues at the Senate Health Committee, despite the confusing label by media outlets as
“universal health care.”37 Although the Governor’s proposal for universal health was not as
progressive as the Massachusetts reform, it was neither as conservative as Kuehl espoused it to
be.

Governor Schwarzeneggar’s proposal would:

! Require all Californians to purchase insurance;

! Help low-income Californians do so by expanding access to public programs such as
Medi-Cal and Healthy Families;

! Cover all uninsured children below 300% FPL regardless of residency status;

! Limit individual annual out-of-pocket health expenses to $7,500 and family to $10,000;
and

! Create “Healthy Actions Incentives/Reward” programs in the private and public sector to
focus on preventative practices and behavioral changes incorporated into health plans.38

The Governor pushed his proposal on the November 2008 California ballot.

10.3 Maine

In 2003, Governor John Baldacci of Maine created the Governor’s Office of Health Policy and
Finance (GOHPF) and signed into law the Dirigo Health Reform,39 a comprehensive health care

Page 17 of 38

plan implemented by various state agencies.3

Under Dirigo Health, Governor Baldacci’s goal is to provide all Maine people with access to
health care by 2009. The Dirigo Health Agency administers the Dirigo Health plan while
GOHPF is responsible overall for the Dirigo Health Reform and is the liaison for the former.

The Reform of 2003:

! Created DirigoChoice, which gave businesses with fewer than 50 employees, the self-
employed, and individuals monthly payment discounts and deductible reductions and out-of-
pocket expenses based on household size and income;40

! Created the Maine Quality Forum, an independent division of Dirigo Health whose
mission is “to advocate for high quality healthcare and help each Maine citizen make informed
healthcare choices;”41

! Includes 100% coverage for prevention services and the Healthy ME Rewards Program;

! Provides two options for plans (see Appendix 3);42

! Partnered with Anthem Blue Cross and Blue Shield as the providers.

Then, in 2007, Governor Baldacci introduced Dirigo 2.0, which made three changes to the
above reform. It:

1. Formed a new partnership with Harvard Pilgrim Health Care to replace the previous
provider;43

2. Implemented Employer and Individual Shared Responsibility by making health insurance
obligatory for all Mainers by July 2008 and January 2009 respectively; and

3. Allowed Dirigo to self-administer.

3
The Bureau of Insurance, the Department of Human Services and the newly created Dirigo Health Agency
along with the Governor’s Office of Health Policy and Finance (GOHPF). The last office would be the main
coordinator working with all state agencies.

Page 18 of 38

Although Maine’s health reforms do not parallel the health care reforms of Massachusetts, the
state at least has taken the initiative to implement new standards for state agencies, to analyze
other states’ reforms, and to recognize that access to health care is an ongoing prominent issue.

10.4 Vermont

In 2006, both the Vermont House and Senate passed The Health Care Affordability Act that
changed the state health care focus from acute illness treatment to chronic disease management;
and created Catamount Health to provide comprehensive affordable insurance to the uninsured.

Eligibility criteria for Catamount Health is limited to:

! Vermont resident adults;
! Those not eligible for a public health program;
! Those uninsured for at least 12 months;
! Those without access to health insurance through their employer.

Catamount Health is part of a broader package of health care reform in Vermont to fulfill
Section 902 of Title 2: “By 2009, Vermont has an integrated system of care that provides all
Vermonters access to affordable, high quality health care that is financed in a fair and equitable
manner.”44 There are exceptions for those who had health insurance but lost it due to loss of
employment, divorce, and other reasons.45

In addition, goals set for 2009 and 2011 under House Bill 887 would provide state schools with
time to:

! Comply with new nutrition guidelines to promote health;
! Increase access to healthy foods in communities;
! Promote physical exercise and healthy living; and
! For the Vermont Department of Health to make nutrition recommendations on issues
such as trans-fat for the entire state.

10.5 Massachusetts

In 2006, the Office of Health and Human Services expanded access to health care through
reform.46 General funds were allocated in 2007 for education and prevention programs and a
MassHealth insurance program to provide universal health care coverage. The state used a
combination of individual mandate, subsidies for low income, and public insurance for the

Page 19 of 38

uninsured to purchase.47

For college students, mandated insurance is nothing new; since September 1989, both part and
full-time students by law have purchased insurance.48 Members of the Commonwealth Care—
the new insurance program to insure the uninsured—will pay a maximum of $200 per calendar
year in co-payments for pharmacy services and $36 for other services.49

The Health Care Reform Law of 2006:50

! Requires state residents to purchase health insurance or face a fine that began July 2007;

! Imposes a surcharge on employers who do not offer coverage, excluding employers who
already do;

! Expands existing public health insurance safety net, including MassHealth (Medicaid and
State Children’s Health Insurance Program);

! Expands eligibility for children from 200% of the federal poverty level (FPL) to 300%;

! Provides incentives for residents with healthy behaviors. 51

Some have praised the Health Care Reform, while others such as President Bush immediately
began predicting its’ failure.52 Some argue that those who benefit from mandated health
insurance are those who previously could not afford expensive procedures or costly premiums
(i.e. low-income and/or the poor working class) but now can thanks to health care reforms.53

10.6 California

Mayor Gavin Newsom created a Universal Healthcare Council (UHC) in February 2006 to
develop a plan to insure the uninsured. The UHC’s recommendations led to the Health Access
Program (HAP), an expanded health care safety net—not insurance, albeit the city’s goal is to
enroll the uninsured into their programs. Since July 2007, the San Francisco Department of
Public Health has operated HAP.

HAP (eventually named Healthy San Francisco) is open to uninsured San Francisco residents,
regardless of employment or immigration status, or pre-existing medical conditions. As of June
18, 2008, Healthy San Francisco has been serving 23,184 participants from various districts by
providing them with a “Medical Home,” one of the 27 San Francisco Department of Health
Clinics and San Francisco Community Clinic Consortium Clinics.

Page 20 of 38

A Medical Home consists of a primary care physician, nurse practitioner, or physician assistant
to develop and direct a plan of care for each participant.54 Participants choose a Medical Home
and maintain the relationship for 1 year, after which they can choose to change their Medical
Home or stay with the same one.

Healthy San Francisco medical services emphasize “wellness, preventive care and innovative
service delivery,” but exclude vision, dental, infertility and cosmetic services.55 Participants pay
depending on their Medical Home and household income. Hospital, urgent, and emergency care
are only provided at San Francisco General Hospital. Each Medical Home specializes in a
variety of services with multilingual staff. Languages include Mandarin, Russian, Spanish,
Tagalog, and many more depending on the district.

On January 9, 2007, judges ruled in favor of San Francisco to make businesses provide health
care to their employees, a city version of universal health care, challenged by a “local restaurant
trade group.”56 City ballots and initiatives are outpacing—if not, competing with—the state
government’s role in universal health care as the demand for a systematic change has increased
over the years due to the rising health care costs.57

10.7 Building Coalitions for Women’s Health & Human Rights

Policies based on patriarchal beliefs or partisan politics instead of statistical data are not
uncommon. In a study comparing South Carolina and Florida, racial disparities and limited
access to healthcare sparked a coalition of professionals and academics to advocate for women’s
reproductive rights.58

In 1996, the Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA)
further hindered low-income women’s access to health care by giving states incentives to “enact
measures to reduce out-of-wedlock childbearing and to promote abstinence-only education.”59
The Act decreased Medicaid responsibilities by eliminating the requirement that recipients be
given family planning services. This policy trend is seen at the forefront in South Carolina and
Florida.

10.8 South Carolina

Although three-quarters of South Carolina state residents believe that sexuality education should
emphasize abstinence but should also address contraception and be taught in schools, the State
Department of Education prohibits instruction of sexual practices outside of marriage or
practices unrelated to reproduction except in the context of disease. Only 38% of schools taught
students how to correctly use a condom.

Page 21 of 38

Data shows that African-American women in South Carolina are disproportionably affected and
receive inadequate preventative care, such as clinical breast cancer screening, mammograms, or
Pap smears. Breast cancer is the second leading cause of death for women in the state and the
mortality rate is nearly double for African American women to that of white women.

In addition, abortion rights are gravely threatened both by violence and by lack of access to
abortion clinics. In South Carolina, 66% of women live in a county without an abortion provider
and any health care provider or health facility can legally deny a woman an abortion for any
reason. South Carolina has also increasingly incarcerated pregnant women for drug and alcohol
abuse under state child abuse laws, instead of providing treatment (or prevention), an example
seen in South Carolina vs. Regina McKnight.60 Luckily, the case was eventually overturned.61

10.9 Florida

During the 1990s, Florida was similar in a similar stance on women’s health and human rights.
In the entire state, there are only 311 publicly funded family planning clinics. Breast cancer is
also the second leading cause of cancer related death for both black and white women, although
black women die of breast cancer at a higher rate. Florida has the second highest number of
known cases of HIV infection and the third highest number of AIDS cases in the nation.

In 1998, Florida sponsored a statewide Abstinence Education Program, and in 2002, the Florida
Department of Health launched a statewide abstinence-only-until-marriage campaign called “It's
Great to Wait.” However, activists and medical professionals did not wait for state campaigns to
change their policies regarding health.

10.9.1 Coalitions in South Carolina and Florida

The Women’s Health and Human Rights Initiative (WHHRI) of the Mailman School of Public
Health of Columbia University in 2003 offered research and organizing assistance for advocacy
capacity-building in South Carolina and Florida to “build coalitions of advocates working
towards improving the reproductive and overall health care of low-income women.”62

Their work paid off as they partnered with National Advocates for Pregnant Women (NAPW).63
In September 2004, after strategic meetings with South Carolina advocates, 59 health
organizations, agencies and university departments formed the “Women’s Health Coalition of
South Carolina.” This Coalition has organized letter-writing campaigns; written commentary
articles in local newspapers; and is mobilizing around SC Senate Bill 1084, Unborn Victims of
Violence Act, a bill that incarcerates persons who commit a violent crime against an unborn

Page 22 of 38

child; however, unrelated to abortion.64

In Florida, WHHRI partnered with the Bylley Avery Institute, a long-standing health advocacy
organization, and hosted the first statewide meeting on women’s health in December 2005. In
attendance were about 40 health care providers, legislators, academics, and activists
representing 20 organizations from across the state who participated in informational sessions
on HIV/AIDS, access to care, an overview of state level reproductive health policy, and more.
Similar to South Carolina, after March 2006 the coalition formed the “All Women’s Health: A
Florida Partnership for Change.”

This advocacy model bridges the traditional gap between activists and health professionals. It
allows for coalitions to engage in state-level policies and for policymakers to pay attention to
women’s reproductive health and human rights. Many ideas and strategies for this model were
taken from the HIV Law Project in New York City from the 1990s, a legal assistance service for
low-income HIV positive women who did not qualify for state AIDS-related benefits and
services.

11 CONCLUSION
In conclusion, the term “universal healthcare” has varied definitions, evident by the diverse
characteristics of such plans in various states. Numerous bills have been introduced to both state
and house senates but their current statuses overall tend to be unknown as the information is
unavailable online. Even when bills are referred to committees, online information is seemingly
missing as to the current status of the bills (i.e. implementation stage, waiting period, etc.).

Passing universal health care legislation requires joint collaboration both from the house and
senate, the political will of politicians, and ballot initiatives or public forums so citizens can
have a voice in the political process. It is no easy task to brainstorm a national solution to the
U.S. health care problems.

Nonetheless, the right to health and healthcare has been a forefront issue of many national, state,
and city advocacy organizations. Given the uninsured rates, increasing healthcare costs, and
public health budget cut-backs, many Americans, especially vulnerable populations, will
continue to face health care burdens.

Page 23 of 38

APPENDIX 1: State Universal Health Care Bills, page 1 of 4

STATE BILL NAME YEAR SUMMARY AND STATUS
Established Alaska Health Care Board & mandatory health insurance.
Alaska HB 242 2007 Status: Referred to Committee.
California AB 8 & ABx1 2007 Failed in Senate
Would establish the California Universal Healthcare System.
California SB 840 2007 Status: Passed Senate, In Assembly
Established UHC plan task force to study feasibility of adopting one.
Connecticut HB 5694 2008 Status: Introduced
Would create a non-government run program and cost effective single
Delaware SB 177 2007 payer health care system. Status: Referred to Committee
Employers pay for 50% premiums for 20hr or more employees
Hawaii Prepaid Health Care Act 1974 Status: Passed
Established Hawaii Health Commission to develop universal health care.
Hawaii HB 2898 2008 Status: Referred to House Committee on Health
Would establish the state health authority to propose a plan to provide
medical assistance for all citizens of Hawaii.
Hawaii SB 2101 2008 Status: Referred to Committee
Would establish an agency to operate a single-payer universal healthcare
insurance system.
Hawaii HB 1598 2008 Status: Referred to Committee
Illinois HB 806 2005 Establishes the Covering ALL KIDS Health Insurance Program. Status:

Page 25 of 38

Signed into law by governor
Would create the Health Care for All Illinois Act.
Status: Referred to Health Care Availability and Access Committee
Illinois HB 311 2007 Hearing
Creates a plan of health insurance to provide primary coverage to every
resident of Indiana
Indiana HB 1680 2007 Status: Referred to House Committee on Public Health
Relates to health care reform in Iowa including the Iowa health care
coverage exchange
Iowa SB 3140 2008 Status: Referred to Senate Human Resources Committee
Enacts the Kansas Small Business Health Policy Committee Act
Kansas SB 540 2007 Status: Referred to Senate Financial Institutions and Insurance Committee
Establishes the health reform fund
Kansas SB 541 2008 Status: Referred to Senate Health Care Strategies Committee
Establishes the Kansas Health Care Commission, providing health
Kansas HB 2001 insurance coverage for all residents of the state
Legal research commission to conduct feasibility of UHC
Kentucky HCR 79 2007 Status: Posted in committee 2007
Creates a UHC program
Maine LR 289 2007 Status: Assigned House Paper number 519 and LD 688
Creates Blue Ribbon Commission on Dirigo Health
MAINE Exec Order 30 2005 Status: Passed
Maryland HB 1125 2008 Establishes the Maryland Universal Health Care Plan

Page 26 of 38

Status: Referred to House Committee on Health and Government
Operations
Would create an Act promoting access to health care (PATH)
Massachusetts H 4479 2005 Status: Passed to be engrossed by House - 131 YEAS to 22 NAYS
Individual mandate to require those who can afford to maintain health ins
through employer, state, or individual market
Massachusetts H 4279 2005 Status: Amended substantially in committee (H 4463)
Would create a Constitutional Amendment for UHC
MN SB 14 2007 Status: Carry-over to Committee
Would establish UHC
Minnesota HB 1856 2007 Status: Referred to Health and Human Services (carry-over)
Would establish the Missouri Universal Health Insurance Act for Missouri
residents
Missouri HB 1558 2008 Status: PENDING
This act would establish the Missouri Universal Health Assurance Program
MO SB 1101 2008 Status: Referred Senate Health & Mental Health Committee
Plans for UHC system for all Montanans
Montana SB 498 2007 Status: DIED in committee
New Mexico HB 147,588;SB 225,377 DIED

New York AB 7354 2008 Status: Referred to Health Committee
North An act to amend the North Carolina constitution to recognize the right to
Carolina HB 901 2007 health care

Page 27 of 38

Status: Carry-over to Committee
Directs the Legislative Council to study universal health care for North
Dakotans
North Dakota SCR 4024 2007 Status: Without recommendation
Would establish and operate the Ohio Health Care Plan to provide UHC
coverage to all Ohio residents
Ohio HB 456 (SB 168) 2007 Status: N/A
Would provide health insurance coverage to U.S. permanent resident
children and parents
Rhode Island SB 2220 2008 Status: Referred to House Committee on Finance
Creates Catamount Health Program
Vermont H 861 2006 Status: Passed
Directs the Joint Legislative Audit and Review Commission to study UHC
coverage possibilities for Virginians
Virginia HJR 158 2006 Status: HOUSE concurred in SENATE amendments
Requests that Congress enact a UHC system
Washington HJM 4005 2007 Status: Recommended to Committee to "do pass"
Health Care Rights of Conscience Act
West Virginia SB 673 2005 Status: Referred to two different Committees
Creates the Commission on Health Care Reform
West Virginia HB 4021 2006 Status: Passed
Creates the Wisconsin Health Plan
Wisconsin AB 1140 2006 Status: Introduced January 2007

Page 28 of 38

APPENDIX 2: U.S. Health Expenditures

Source: Steuerle, C. Eugene and Randall R. Bovjerg. “Health and Budget Reform As
Handmaidens,” Health Affairs, Vol. 27, Issue 3, 633-644.

Page 29 of 38

APPENDIX 3: MAINE’S TWO HEALTH PLANS

PLAN 1 PLAN 2
Max. Annual Out-of-Pocket for
Individuals $800 - $4,000 $1,600 - $5,600

Max. Annual Out-of-Pocket for
Families $1,600 - $8,000 $3,200 - $11,200

Individual Deductible $250 - $1,250 $500 - $1,750

Family Deductible $500 - $2,500 $1,000 - $3,500

Co-payment (CP) $20 network; $20 network;
$35 non-network $35 non-network

Network Coverage - 80% after deductible for hospital, emergency room - 80% after deductible for hospital,

Page 30 of 38

services, & professional services; emergency room services, & professional
services;
- 100% for physician office visits after $20 CP, deductible
n/a; routine/ preventative services - 100% for physician office visits after $20
CP, deductible n/a; routine/ preventative
services; specialists

Non-Network Coverage - 50% after deductible for hospital & professional - 50% after deductible for hospital &
services; & routine/preventative services after $35 CP; professional services; routine/
preventative services after $25 CP
- 80% after deductible for emergency room services;
- 80% after deductible for emergency
room services;
- 70% after $20 CP for physician office visits

- 70% after $35 CP for physician office
visits

Page 31 of 38

12 WORKS CITED

1
http://www.statehealthfacts.org/comparebar.jsp?ind=125&cat=3&sub=39&yr=1&typ=2
2
Havighurst, Clark C. “American Health Care and The Law—We Need To Talk!” Journal of
Health Affairs. Vol 19, Issue 4, 84-106. 2000.
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3
Ibid. (p. 86).
4
Ibid.
5
http://www.worldpolicy.org/projects/globalrights/econrights/fdr-econbill.html
6
http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm#article12

7
Gollub, Erica. “Human Rights is a US Problem, Too: The Case of Women and HIV.”
American Journal of Public Health. Vol 89, No. 10. Oct 1999. pp. 1479-1482. Accessible at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1508808

8
Interview on June 23, 2008.
9
http://www.statehealthfacts.org/comparebar.jsp?ind=125&cat=3&sub=39&yr=1&typ=2
10
http://www.nytimes.com/2007/03/01/washington/01cnd-poll.html
11
“Food Stamp Erosion in Washington: How Washington Families have lost hundres of dollars
in purchasing power.” May 2007. Children’s Alliance.
http://ww.childrensalliance.org/publications/reports.cfm.
12
http://www.kaiseredu.org/tutorials/StateHealth/player.html
13
http://www.ncsl.org/programs/health/universalhealth2007.htm
14
http://www.metrokc.gov/exec/hatf/

Page 34 of 38

15
http://www.pugetsoundhealthalliance.org/
16
http://www.metrokc.gov/exec/news/2005/0118_PSHealthAlliance.htm
17
“A Collaborative Strategy for Better Care, Healthier People, and Affordable Costs.” King
County Health Advisory Task Force Final Report. 30 June 2004. Accesssible at:
http://www.metrokc.gov/exec/hatf/
18
Ibid.
19
Ibid, p. 25 of Report.
20
Ibid, p. 34 of Report.
21
King, Brian. “Seattle Votes for a Right to Health Care.” Monthly Review. 22 Dec. 2005.
http://mrzine.monthlyreview.org/king221205.html. 17 July 2008.
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http://clerk.ci.seattle.wa.us/~scripts/nph-
brs.exe?s1=&s2=&s3=&s4=&s5=drago%5Bspon%5D+and+%40dtir%3E%3D20050000+and+
%40dtir%3C20060000&Sect4=AND&l=200&Sect1=IMAGE&Sect2=THESON&Sect3=PLUR
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23
Ibid.
24
Ibid.
"
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4941a1.htm
25
“Healthy Youth in King County.” Public Health Data Watch. Vol. 3, No. 2. Oct. 1999.
http://www.metrokc.gov/health/datawatch/dw-adol.pdf
26
“The Uninsured in King County 1991-1998.” Public Health Data Watch. Vol. 4, No. 1. Jan.
2000. http://www.metrokc.gov/health/datawatch/
27
http://www.statehealthfacts.org/profileind.jsp?ind=48&cat=2&rgn=49
28
Green, Jeff. “U.S. has second worst newborn death rate in modern world, report says.”
http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/
29
“2005 Washington State Legislative Session: Wise Investments in Children and Families.”
May 2005. Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm.
30
“Poverty and Food Insecurity Among School-Aged Children in Washington.” Jan. 2006.
Children’s Alliance. http://ww.childrensalliance.org/publications/reports.cfm.

Page 35 of 38

31
“Hungry in Washington.” Nov. 2006. Children’s Alliance.
http://ww.childrensalliance.org/publications/reports.cfm.
32
“Public Health King County Access.” 2008. (Beth Rivin’s document emailed to me).
33
“The Uninsured Population in Washington State.” 2004 Washington State Population Survey.
Washington State Office of Financial Management. Research Brief No. 31. Feb. 2005.
http://www.ofm.wa.gov/healthcare/spg/default.asp
34
“Public Health King County Access.” 2008. (Beth Rivin’s document emailed to me).
35
http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2006/09/05/state/n130430D47.DTL

36
http://igs.berkeley.edu/library/policy_desk/2007/univhealth.html#Topic3a
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Steinhauer, Jennifer. “California Plan for Health Care Would Cover All.” New York Time. 7
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http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0CE6D61530F93AA35752C0A9
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38
http://www.chhs.ca.gov/Pages/HCR.aspx. Click on “Health Care Proposal.”
39
http://www.dirigohealth.maine.gov/
40
Ibid.
41
http://www.mainequalityforum.gov/
42
http://www.dirigohealth.maine.gov/
43
Ibid. Information found at: http://www.dirigohealth.maine.gov/

44
http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2008/acts/ACT203.HTM
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http://hcr.vermont.gov/increase_access/enhance_private_insurance_capacity/uninsured
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http://www.kaiseredu.org/tutorials/StateHealth/player.html
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ying+Student+Health+Insurance+Program+(QSHIP)&sid=Eeohhs2&b=terminalcontent&f=dhcf
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2fdfb140904d489c8781176033468a0c_docName=content&javax.portlet.prp_2fdfb140904d489c
8781176033468a0c_folderPath=/About%20Us/Connector%20Programs/Benefits%20and%20Pla
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heTok=com.vignette.cachetoken
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53
http://www.npr.org/templates/story/story.php?storyId=91427522&ft=1&f=1007; and
http://www.hcfama.org/index.cfm?fuseaction=Page.viewPage&pageId=743&parentID=737&no
deID=2;
54
http://www.municode.com/content/4201/14131/HTML/ch014.html
55
Ibid.
56
McKinley, Jesse. “Judges Tell San Francisco It Can Begin Health Plan.” New York Times. 10
January 2008. http://www.nytimes.com/2008/01/10/us/10health.html?_r=1&oref=slogin
57
Davis, Ronald M. “Addressing the Rising Cost of Health Care.” American Medical
Association. http://www.ama-assn.org/ama/pub/category/18295.html

58
Please note that all information from the section “Building Coalition” was taken from the
following source unless otherwise noted:
McGovern, Theresa. “Building Coalitions to Support Women’s Health and Human Rights in
the United States: South Carolina and Florida. Reproductive Health Matters. Vol. 15, Issue 29.
May 2007. pp 119-129. Accesible at: http://www.rhmjournal.org/article/S0968-
8080(07)29290-0/abstract

Page 37 of 38

59
Ibid. p. 119.
60
http://www.drugpolicy.org/law/womenpregnan/whitnervsth_/
61
“Regina McKnight—Victory at Long Last.”
http://advocatesforpregnantwomen.org/blog/2008/05/regina_mcknight_victory_at_lon.php
62
See endnote 3. (p. 3).
63
http://www.advocatesforpregnantwomen.org/
64
http://www.scstatehouse.net/reports/hupdate/lu2310.htm

Page 38 of 38

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