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The health care gap

Beginning last August, student journalists from the University of Maryland's Philip Merrill College of Journalism in partnership with the non-profit Kaiser Health News were dispatched to West Baltimore to answer this simple question: In a city with some of the finest health institutions in the world, how could there be such enormous disparities in health outcomes?

Their results, published this week (Special Report: Baltimore's Other Divide and In Poor Health by the student-run Capital News Service), detail the obstacles, big and small, that keep people living in Sandtown-Winchester and some adjoining and similarly disadvantaged neighborhoods from receiving appropriate medical care. It should be mandatory reading, not only in the halls of local government in Baltimore and Annapolis, but on the presidential campaign trail where the chronic problems facing American's urban centers have so far gotten precious little attention.

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That low-income families in Baltimore suffer far worse medical outcomes than people living elsewhere is well-documented and a fact we've noted on these pages before. Heart disease, diabetes, obesity and hypertension are all substantially worse in West Baltimore compared to neighborhoods a few miles away. Even the fact that far more people living there now qualify for Medicaid, a circumstance made possible by the expanded health insurance coverage under the Affordable Care Act, seems not to have bridged that gap. Why?

What the journalists found was not individuals or families disinterested in proper health care or unmotivated to act on their own behalf but a health care system that failed them over and over again. What many of us take for granted — a car to take us to medical appointments, a computer to send email inquiries, a phone to call a provider, a credit card to make payments, all of which are increasingly necessary to function in the modern world — are far out of reach for many individuals who live in Freddie Gray's old neighborhood.

Take, for instance, Sharlene Adams who recently needed a blood pressure cuff. To buy one required no less than four bus rides, a stop at her doctor's office for his signature, a visit to two different pharmacies and a side trip to borrow money to make the required co-pay. The 55-year-old eventually got her hands on the $40 item in East Baltimore 5 1/2 hours after starting on her quest, the Maryland students documented.

Think that's extreme? Think again. What the students discovered over and over again is that merely being Medicaid eligible is not enough. Indeed, many have difficulty qualifying for Medicaid, including inmates recently released from jail who may not have the required government-issued identification card. Then there's the matter of finding a medical provider who will accept Medicaid patients. In some cases, the students found, West Baltimoreans have to travel great distances by bus simply to find a clinic that will take them for a common procedure like an endoscopy.

Of course, one might be tempted to argue these matters with one's doctor, nurse or insurance provider — except that for people like Ms. Adams who have a limited number of minutes allowed them each month on a Medicaid-funded cell phone, getting stuck on hold can mean losing one's phone privileges for weeks without necessarily addressing the issue that got you put on hold in the first place.

Getting better health care to West Baltimore isn't a new idea. There are advocacy groups, non-profits, churches and others who have been trying to bridge this gap for years. Most recently, state hospital regulators agreed to increase rates in order to create 375 new jobs at area hospitals, including community health workers to help address the disparity. But it's also clear more needs to be done not only to improve health outcomes but to steer low-income people away from hospital emergency rooms, a costly and inefficient place to address medical conditions that have usually reached crisis proportions by the time they show up.

Still, how outrageous that the dominant national conversation, particularly among those running in the Republican presidential field, is about eliminating Obamacare and not about making the nation's health care system work better and more efficiently or effectively. Those students who spent months on the front lines talking to West Baltimore residents and health experts alike deserve an "A" for shining a light on a complex problem while those in Congressional leadership who might be able to make the needed reforms get their usual "F" — or perhaps it should be an "M" for the higher mortality rates that Sandtown-Winchester residents are facing as a result of their inaction.

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