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Why California women of color need universal health care

Cal Matters
March 15, 2023
By Indira D’Souza

In Summary
Women of color in California experience some of the worst social inequalities, especially when it comes to health care. A UC Davis student argues that universal coverage would help address disparities causing higher infant mortality rates and pregnancy-related deaths.


Addressing racial and economic inequality in California requires policies that improve the material circumstances of those groups in our society who face the greatest hardship. One such group is women of color, and one such policy would be the introduction of universal health care coverage.

The experiences of women of color are highly racialized and tied to the institutional legacies of American slavery, Jim Crow and discriminatory social policies that limit their access to benefits and incarcerate them at higher rates.

Women of color are also subject to disparities when it comes to health care. For example, infant mortality rates are highest for African-American women across all education levels. As annual pregnancy-related deaths increase across the U.S., it is low-income, minority women who face the highest maternal mortality rates.

Racialized and gendered health inequalities require bold, creative policies designed to improve the socioeconomic status of women in relation to men. Medicaid already covers 50% of births in the U.S., but Medicare only covers people aged 65 and older, and can be expanded at the state level to ensure that all births in California are covered by health insurance.

Accordingly, Californians need a system of single-payer, universal health care coverage such as “Medicare for All.”

Countries with universal health care coverage, such as Canada and Britain, have significantly lower maternal mortality rates than the U.S. with 6.5 and 8.6 deaths per 100,000, respectively, compared to 17.4 in the U.S. Universal health care coverage would improve the health of infants and pregnant people by providing free maternity care to all Californians pre- and post-birth.

Since a large share of maternal deaths occur in the postpartum period, the Medicare-for-all system could include incentives to train and license midwives and provide home visiting programs, two evidence-supported methods to improve outcomes for the pregnant person and the infant. Home visits are essential to assess social determinants of health for families such as housing and food access, and to provide mental health support for new parents.

While the Affordable Care Act improved gendered health disparities by requiring that insurance plans include contraceptives and banning gender discrimination for insurance premiums, Medicare for all builds on the ACA and Medicaid expansion to provide quality care regardless of socioeconomic status.

Mirroring Senator Elizabeth Warren’s plan to provide federal universal coverage, an ideal route for California could begin with a public option. Under the Warren plan, children and families earning below 200% of the federal poverty line would be automatically enrolled in the public option with no premiums or cost-sharing, and adults over 50 could opt into Medicare, significantly reducing rates of uninsurance.

Continuing with Warren’s public option proposal, those with employer-based insurance could opt into the public plan with mandatory employer contributions and significant reductions in premiums (capped at 5% of income) and copays (capped at 10%). The public option would ensure greater bargaining power with pharmaceutical companies (helping to reduce drug prices), pay providers more to incentivize participation, and cover benefits such as prescription drugs, dental and vision.

Thanks to reduced administrative and provider costs when compared to private insurance, Medicare for all would ultimately save money. Over five years, Warren’s transition plan ensures that premiums and cost-sharing would be reduced to zero. This would create a state-level single-payer healthcare system that, like Bernie Sanders’ proposal, will be funded through wealth, capital gains and income taxes directed at the wealthiest Californians and Silicon Valley corporations. Private plans, which have been steadily increasing in cost for workers while covering fewer services, would be eliminated in favor of the state health plan.

The transition from a public option to a single-payer healthcare insurance would provide health care access for vulnerable communities, increase competition, drive costs and drug prices down, and reduce health disparities for pregnant people.

Most importantly, it would help to alleviate disparities in health care access faced by low-income women of color. As such, Medicare for all would be an important step towards reducing racial and socioeconomic inequality across California.

Indira D’Souza is the winner of the 2023 UC Davis Center for Poverty and Inequality Research Black History Month Student Essay Contest, from which this commentary was adapted.


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