The Compassion Gap in Healthcare

On Tuesdays and Thursdays YOUR VOICE features political commentary from students and young professionals.

Last month Nicholas Kristof wrote about the dangers of assuming that poverty is a direct result of irresponsible lifestyles. In his New York Times op-ed, “The Compassion Gap”, Kristof wrote,“To break cycles of poverty, we have the tools to improve high school graduation rates, reduce teen pregnancies and increase employment. What we lack is the will to do so.”

While disagreement about ameliorating poverty and the use of welfare programs exists, everyone should agree that certain groups are in dire need of help, and not just help from generous individuals, but from social welfare programs. One of these groups is the young adult population in the foster care system. Foster youth are one of the most vulnerable groups in society, yet there are currently questions around whether one of their most basic needs-  healthcare- can be met.

The Affordable Care Act (ACA) remains in the national spotlight, however one key provision has gone relatively unnoticed by the public- health coverage for foster youth who have “aged out” of the system. Aging out occurs when children turn 18 (21 in some states) and are no longer eligible to be in foster care.

With the passage of the ACA, a specific provision intended to expand healthcare coverage through Medicaid to former foster care youth was enacted to address the very complicated medical and psychological needs of this population. The expansion allows those who have aged out of foster care to receive coverage until they are 26. However, the interpretation of the statute limits which foster youth can receive coverage based on whether they grew up in that state’s foster care system or recently moved to the state.

Young adults under the age of 26 can currently receive health coverage under their parents’ plan. It is interesting, and perhaps disconcerting, that there is a widespread recognition that young adults, in general, greatly benefit from this expansion of healthcare coverage, yet the young adults who age out of foster care may not receive this benefit simply because they do not have parents.

The legislation says that Medicaid coverage is provided to those under 26 who “were in foster care under the responsibility of the State” when they aged out of the system. The Center for Medicare and Medicaid Services has decided that the law lets each state decide whether to cover foster youth who aged out of care in a different state from their own. Senator Mary Landrieu, who advocated for this provision, said, “No residency requirement exists for the young people who receive health coverage through their parents’ plans and no such requirement should exist for foster youth.”

If there is a “compassion gap,” current and former foster youth certainly fall into it. To penalize them for having the misfortune of being parented by the state and not their biological parents seems like a fundamental disregard for their dignity and desperate need for healthcare. The transition to adulthood for foster youth is difficult enough; denying them access to healthcare only makes that transition more strenuous. From an economic standpoint, there is great incentive to keep these youth as healthy as possible and give them access to medical resources. The young adults who have aged out of care often suffer from medical and emotional problems related to abuse and neglect, which will likely get worse and require costly treatments from healthcare providers as the youth age.

Foster youth often represent those in our community who are most marginalized and have the greatest need for government welfare. If we deny foster youth the opportunity to receive healthcare when young adults throughout the country can remain covered under their parents’ plans, what are we saying about the dignity and worth of these youth’s lives?

-Cristina Martinez graduated from Princeton University with a degree in Anthropology and a certificate in Values and Public Life.  She completed a fellowship in Philadelphia to start a mentoring program for those aging out of foster care. Cristina is now a first year student at SMU Dedman School of Law.