Sr. Carol Keehan, R.N., M.S., is Chair of the Board of Trustees, Sacred Heart Health System, Pensacola, FL; Chair of the Board of the Catholic Health Association; Member, Committee for Domestic Policy, USCCB.

Sr. Carol spoke about poverty in the U.S. through the lens of the health care system which leaves out so many families and children, especially low income workers and those who are just above the poverty level.

You have come to Washington, DC at a critical time. The budget for 2006 has just been released and we have a new congress. We hear lots of predictions regarding the “budget debate”.

Last week as I discussed with CHA Board the submitted budget, I said we must not let it be conducted as a, “budget debate” that is too neutral, too dry and masks the impact of this budget. We must call it what is.... a “values debate”.

Never before has it been so clear what kinds of choices we as a nation are making and these choices clearly reveal our values.

We are told that this is “lean” budget. We have a deficit; we need to support our troops, so we sacrifice.

About a week ago, James Carville was on television debating the values behind this budget and he said he could understand what poor people are being asked to sacrifice. . . $60 billion in Medicaid, TANF funding, educational funds, grants in multiple areas. Now what I can’t understand is what sacrifice the rich are being asked to make, what are they being asked to give up? The person debating him could not give him a single item the rich were being asked to sacrifice.
Well... let’s look at what the poor and middle class are giving up and what the rich are getting out of this budget.

In a time of sacrifice, we have been able to add dollars in this budget to NASA for the project to send robots to Mars, but we have reduced the dollars to send poor children to the doctor.

Let us look carefully at why we find ourselves needing to sacrifice.

Remember January 2001 when we had a $5 trillion surplus and today it is a deficit that exceeds $3.7 trillion?

What happened??? It is easy to say 9-11, the war, etc., but look at the Congressional Budget office data.

The tax cuts which primarily targeted the richest 2% of our citizens caused 48% of today’s deficit.

We are presented now with a new budget with a projected deficit of $4.5 trillion over the next 10 years; this does not even include any war expenses. To reduce the deficit, we have put in “discipline” in the congressional process. It is called, “paygo.” If you want to increase appropriations or add new appropriations, you must find the money somewhere, either in new revenue or new cuts. This is supposed to reign in those spendthrift congressmen.

Now in this budget that has been submitted, there is one thing that is exempt from the paygo provisions, guess what, the tax cuts. $60 billion out of Medicaid but continuing the tax cuts gets a free ride.

Now look at what the projected extension of the tax cuts costs in new money.

Isn’t it crystal clear that this is a values debate? These are stark choices and we must face that.

40 years after the publication of Gaudium et Spes, we look back at the exhortation and hope it held out. The values it espoused for social choices were crystal clear.

“This social order requires constant improvement. It must be founded on truth, built on justice, and animated by love; in freedom it should grow every day toward a more humane balance. An improvement in attitudes and abundant changes in society will have to take place if these objectives are to be gained.”

Do you think we have made progress in 40 years or huge steps backwards? Are our social choices today more founded on truth, built on justice and animated by love than they were 40 years ago?

I doubt it, or our Bishops would not have issued, A Place at the Table, reminding us that there are 34 million Americans living in poverty, in this the most affluent country in the world. The standard for poverty itself is so low (slightly below $18,000 for a family 4), that even significant increases would still leave one very poor.

Look at whose earned income has made progress in the decades since Gaudium et Spes.

The Bishops rightly point out that for many of these 34 million Americans economic poverty is only one of the challenges they face. Couple that with the inequities and injustices they cope with if they are racial or ethnic minorities.

Couple these 34 million with those Americans who have no health insurance and we have at least 45 million Americans.

45 million Americans with no ability to access health care for themselves or for their children. Having to use emergency departments when they are desperate or hoping to find a clinic that will let them pay a small amount. The constant struggle they have to buy food or fill a prescription.

The Institute of Medicine published a study recently that noted that there are 18 thousand preventable deaths annually due to a lack of insurance. Even that breathtaking figure hasn’t moved us to action. These are the people who can’t go to a doctor when they have a little chest pain, a little blood in their urine, a different lump in their breast.

We delude ourselves into thinking that these are the lazy, the unemployed when the reality is that 80% of the uninsured are in working households. They are picking our fruits and vegetables, caring for children in day care and our elderly parents, waiting on tables. For example, 86% of food service workers have no sick leave.

Then we say... well we are being overrun by immigrants when the reality is that 74% of the insured are U.S. natives. Another 5% are naturalized citizens. These are Americans whom we have disenfranchised.

How many times have we heard that we just can’t increase the numbers on Medicaid because we can’t sustain the cost increases in Medicaid — the poor are bankrupting us. Well let’s look at the growth in per person costs between Medicaid recipients and us privately insured folks. 12.6% for privately insured people versus 6.9% cost increase for Medicaid recipients.

No matter how you measure it, we are not spending on the Medicaid patients what we spend on ourselves.

When we take $60 billion out of Medicaid, the 45 million uninsured will surely rise dramatically. The states will have to cut back on eligibility.

How can we continue to ignore the constant struggle and anguish of parents? How can we say we are pro life and leave people without maternity coverage? These stresses on a daily basis consume the poor.

Even those who have some form of insurance and who are not counted in the 45 million are often so unprotected. Did you ever try to get chemotherapy with a Medicaid card? To see a neurosurgeon or to get an implantable defibrillator? Imagine being the parent of a hemophiliac when their treatment can cost $100,000 a day? It is literally impossible.

It is a struggle you witness every day and try to help patch together one person or one family at a time.

Why do we let this happen? What do the American people believe in?

The CHA commissioned some research in January of this year on what the general public thinks...what they claim are their values.

First, when asked if all children living in poverty should be guaranteed health care, 96% say “yes”.

When asked if the Federal Government should be responsible for insuring that low income people have health coverage, 91% say it is very or somewhat important. Most say “very.”

It is even more interesting when that question is broken down by gender and race.

If we believe it is so important, why have we not demanded it of our elected officials?

Opponents have successfully created a fear every time it seemed like progress would be made. If we do this, what will it cost me or how much will I be diminished?

Is there any hope? Yes! We must always remember that we are people of hope. You are a great sign, your constant concern and your many efforts testify daily to the dignity and importance of these Brothers and Sisters of ours. Your example will pay off.

Another sign of hope is the Bishop’s commitment as evidenced by their letter entitled A Place at the Table. This letter is a perfect tool to use in multiple forums to raise conscientiousness. In it the Bishops point to Pope John Paul II words that when we fail to feed the hungry, to care for the sick, to clothe the naked, we are not just ignoring a simple invitation to charity, the Pope points put that the Church measures her fidelity to the gospel as much by this as she does by the orthodoxy of her doctrine.

Another sign of hope is a group that has been organized by those who formally killed each other’s proposals for covering the uninsured. This group has been meeting each month since October. We have committed to trying to forge a proposal that won’t be anyone’s first choice, but one that we can all support. The entire focus of this group is the uninsured not our own particular organizations other agendas.

It is facilitated by two organizations who have extensive experience in bringing very diverse groups to a common perspective. Our goal is to go to Congress and the White House with a proposal that everyone will stand behind, one that will make a substantial dent in covering the uninsured. Please pray for this group, not only because of the promise of the group, but because if this group falls apart, it will be hard to get this diverse a group together again, and these are the groups who consistently kill each others proposals.

CHA has begun a program called Covering a Nation to help deal with the apparent apathy regarding the plight of the uninsured and to help motivate various constituencies in this country to speak out forcefully on behalf of the uninsured. This initiative is embryonic right now but we have committed significant resources to it and you will be hearing more from them.

These and other efforts such as the Robert Wood Johnson Coalition for Covering the Uninsured are critical for creating a will to create a values based budget that respects all the people of our great nation.

You will soon be going to the Hill to visit our elected representatives. I was thinking about this on the third day of Lent listening to the reading from Isaiah and I urge you to... “cry out full throated and unsparingly.” Use your firsthand knowledge of the plight of the poor to advocate, to inform, to compel and, yes, to discomfort.

Don’t loose heart . . . the poor need you . . . continue to hunger and thirst for justice.

Partner even with strange bedfellows.

Don’t let people say, we can’t afford it. When we had huge budget surpluses we spent them on tax cuts and war. If as a nation, we have a will and perceive a compelling need, we find the money. Look at what we have spent on Homeland Security. We appropriated these huge funds for Homeland Security at a time when we had the most anemic economy because we believed it was essential. It was an important value for all Americans. The plight of the uninsured, especially in a country as affluent as ours, is a blight on the character of this great country — we do ourselves and the poor a great service when we labor to change that. Thank you for all you are doing.

Email us at sdwpmail@usccb.org
Social Development and World Peace | 3211 4th Street, N.E., Washington DC 20017-1194 | (202) 541-3180 © USCCB. All rights reserved.