“Healthcare” and “health care” are different beyond the space that separates them. With the space, “health care” refers to a provider’s actions; “healthcare,” one word, is a system. It is this system that holds facts, opinions, politics, and barriers to every aspect of the definition.
In 2008, United States President Barack Obama declared that health care “should be a right for every American”, but is healthcare a right in America? Many recent legislative actions taken in Ohio have impacted individuals’ freedom regarding healthcare, a phenomenon that raises the question of whether or not the United States provides a right to healthcare to its citizens.
The answer to this question is no, it does not. There are no clauses within nor amendments to the United States Constitution that provide citizens with the right to healthcare, and, furthermore, no U.S. Supreme Court decision has interpreted the Constitution as guaranteeing a right to healthcare for all Americans.
The U.S. Constitution does not contain the words “health,” “health care,” “medical care,” or “medicine.” That being said, the Court has found rights to privacy, to bodily integrity, and to refuse medical care within the vague right to “due process” contained in the Constitution. Furthermore, states are given the freedom to determine the extent to which their citizens receive access to healthcare.
Article I, Section 21 of the Ohio State Constitution states that “no federal, state, or local law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system.”
Nevertheless, healthcare professionals face more regulation than just about every other industry in the United States. They are subject to inspection, review, reporting requirements, and enforcement actions by both state and federal agencies, and they must follow a myriad of local, state, and federal regulations. The system, although not inherently political in theory, involves policies and obstacles that exacerbate existing social inequality. In Ohio, women’s reproductive rights, socioeconomic barriers, and LGBTQ+ healthcare access are all examples of the healthcare system that have been severely restricted or faced many barriers recently.
REPRODUCTIVE RIGHTS
Abortion is among the most debated topics in healthcare, and much more so since the overturning of Roe v. Wade in 2022 when The Supreme Court reversed the constitutional right to an abortion after almost half a century of granting women safe and legal services. While Roe v. Wade legalized abortion, it never protected access to abortion. Planned Parenthood, a nonprofit organization dedicated to advancing access to sexual healthcare and defending reproductive rights, explained how the case was overturned on their website, stating that, “On June 24, 2022, the Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization – a case involving a challenge to a Mississippi ban on abortion at 15 weeks of pregnancy. The ruling overturned Roe – ending the federal constitutional right to abortion in the United States.”
Within hours, the effects of reversing Roe v. Wade in the states hit as legislators wrote bans into laws. Lauren Beene, the co-founder and Executive Director of Ohio Physicians for Reproductive Rights (OPRR), commented on the change in reproductive healthcare in Ohio since June of 2022.
“A few hours after Roe was overturned, Attorney General Dave Yost signed into law a trigger ban that made abortion illegal at the point that fetal cardiac activity can be detected on the ultrasound, which usually occurs at about six weeks,” Beene said.
The trigger law was House Bill 598, which was first introduced in March of 2022, but the overturning of Roe v Wade was quickly enacted following the Supreme Court’s decision. The bill would ban all abortions in Ohio except for those performed “to save the life of the mother,” according to the bill.
“Ohio’s trigger ban was in effect for 11 weeks… In the fall of 2022, some smart attorneys including Jessie Hill argued that the trigger ban was unconstitutional in a lower court and it was put on hold. We then went back to functioning under the laws we had before we lost Roe,” Beene said. “In November 2023, the people of Ohio voted to protect abortion rights in the Ohio constitution.”
There are many organizations that back these barriers, such as Created Equal which works to “expose the truth” about abortions. Members of the group have stood outside Upper Arlington High School for a number of years with pictures of aborted fetuses, including last month, on Feb 8, 2024.
“We are here to show the truth of what abortion does to little babies, and talk to people about abortion,” Maggie Groover, a member of Created Equal, said. “Life begins right at fertilization, when that sperm and the egg fuse then they actually cease to exist themselves and become a new creature– a new human being is created right at fertilization from the very beginning… Abortion is always wrong because it always intentionally kills an innocent human being.”
While the governmental control over individuals’ access to healthcare can be overwhelming, there are ways to advocate for oneself within the healthcare system. Beene is a prime example of this, having co-founded the organization OPPR which led the citizen-initiated constitutional amendment to the Ohio Constitution that was adopted on Nov. 7, 2023.
“OPRR formed shortly after the Dobbs decision. I connected with a handful of concerned doctors on Facebook and we wrote a letter that ended up being signed by 1,000 Ohio physicians in less than five days,” Beene said. “It was published as a full-page spread in the Columbus Dispatch. When all of these doctors came together to sign our letter, we created our organization, OPRR.”
This letter was written and published as a response to Ohio House Bill 258, a proposed bill that would make abortion illegal as early as six weeks gestational age (two weeks after a woman’s first missed period), which is when proponents claim that a “fetal heartbeat” can be detected.
The letter reads as follows:
Dear Patients,
We are physicians in the state of Ohio, gravely concerned for the well-being of our citizens, particularly of women and pregnant persons. With the Supreme Court’s overturning of Roe v. Wade and the enactment of Ohio House Bill 258/Senate Bill 23 (aka the “heartbeat bill”), it has become painfully clear that women are now losing bodily autonomy, basic human rights, and access to life-saving medical care. We stand steadfast in our support for the sanctity and privacy of the patient-physician relationship. Withholding treatment until a preventable medical emergency occurs is antithetical to our roles as healthcare workers. We wholeheartedly believe that a woman’s mental health is essential in the discussions regarding medical necessity and emergency; suicide is a leading cause of death amongst women of child-bearing age. A government that takes away the freedom of women to access critical medical care and threatens physicians with criminal penalties for upholding their oath is un-American.
What defines and necessitates abortion is nuanced. Women may require abortion in order to undergo life-preserving treatments such as chemotherapy. Women may choose to have an abortion to terminate an unviable pregnancy, and to be spared the emotional anguish and physical threat of carrying a fetus that cannot survive outside the womb. A woman (including a child or an adolescent minor) may choose to have an abortion after being raped and impregnated. A woman may choose to have an abortion simply to protect her future. No explanation should be required for a choice that allows a woman to enjoy the same status in society as a man: freedom to preserve her health and wellbeing. The decision to perform an abortion should be left solely to a woman and her physician. Doctors are guided by evidence-based medicine and are bound by our commitment to do no harm. The “heartbeat bill” is an intrusion of government on personal autonomy and will directly lead to oppression, illness, and death of countless women. This will disproportionately affect women of color and individuals without the financial means to seek other options and will perpetuate the cycle of poverty. Anyone who supports this legislation is complicit in the greatest assault on women’s rights in our lifetime. As physicians of many specialties, we are calling on Ohio Governor Mike DeWine, as well as all elected and appointed government officials in the state of Ohio, to protect the lives of women and persons capable of becoming pregnant. We call on other physicians to uphold their duty to their patients and on our patients to organize for their personal bodily autonomy.
We demand that Ohio House Bill 258/Senate Bill 23 be repealed. We ask our elected officials to defend the separation of church and state, to support reproductive autonomy, and to respect our basic rights to life, liberty, and the pursuit of happiness.
One Thousand Ohio Physicians
Beene drafted the letter herself, unaware that this decision would eventually lead to an amendment to the Ohio state Constitution.
“After having a terrible first day back at work after the Dobbs decision, I went home and started writing a letter. I shared it on a physician women’s Facebook group thinking that people may want to use it to reach out to their legislators,” she said. “An ICU physician saw the letter and suggested we put it into its own Facebook group. We started inviting our doctor friends to join the Facebook group so they could sign the letter, and in 4.5 days over 1,000 physicians from Ohio had asked to sign the letter. It was incredible.”
Following the publication of this letter, Beene and a group of Ohio physicians officially formed the Ohio Physicians for Reproductive Rights organization.
“Ohio Physicians for Reproductive Rights is dedicated to reproductive healthcare advocacy,” Beene said on the OPPR. “Our guiding principle is to uphold and expand access to safe, legal, equitable, and comprehensive reproductive medical care for all Ohioans, while fiercely protecting patients’ right to make their own reproductive healthcare decisions, free from government interference.”
Shortly following its formation, the OPPR began drafting the Reproductive Freedom Amendment. The amendment, formally known as the Right to Make Reproductive Decisions Including Abortion Initiative, was the abortion ballot that signed the right to an abortion in Ohio. This amendment was initiated in order to provide a state constitutional right to “make and carry out one’s own reproductive decisions, including but not limited to” decisions about abortion, contraception, fertility treatment, miscarriage care, and continuing pregnancy, and allow the state to restrict abortion after fetal viability, except when “necessary to protect the pregnant patient’s life or health.”
“We helped write the reproductive freedom amendment along with a team of experts. We pushed strongly for Issue One to be on the ballot in 2023,” Beene said. In the November 2023 election, the Right to Make Reproductive Decisions Including Abortion Initiative was the first issue on the ballot. “We built a coalition of volunteers and organized a significant portion of the volunteer signatures gathered. Three people from OPRR including myself were eventually on the Issue One campaign committee which led the large statewide campaign leading up to November 2023.”
Issue One passed by a large margin, with a 56.6% vote for the initiative to be added to the state Constitution. That being said, while a majority of Ohioans voted to decriminalize abortion, there are still laws that serve as barriers to abortion access. Targeted restrictions on abortion providers, or TRAP, laws are legal barriers to abortion that have been implemented across the state of Ohio following the Dobbs decision. Planned Parenthood defines TRAP laws as “targeted restrictions on abortion providers designed to close them down rather than to make them safer for women.”
“There are a number of TRAP laws that are still on the books and don’t just automatically go away,” Beene said. “Those laws are now each being challenged by people who have to argue in court why the TRAP laws violate our new constitutional amendment.”
Ohio’s TRAP laws include reporting requirements and require “ambulatory surgical facilities” to have written transfer agreements with a hospital. Ohio law restricts the provision of abortion care to physicians. Providers who violate Ohio’s abortion restrictions may face civil and criminal penalties. Section 2919.17 of the Ohio revised code states that “whoever violates this section is guilty of terminating or attempting to terminate a human pregnancy after viability, a felony of the fourth degree.”
Physicians that violate these TRAP laws may have their physician’s license to practice medicine revoked and are “liable in a civil action for compensatory and exemplary damages and reasonable attorney’s fees to any person, or the representative of the estate of any person, who sustains injury, death, or loss to person or property as the result of the performance or inducement or the attempted performance or inducement of the abortion.”
Legislative action has also been taken regarding gender-affirming and LGBTQ+ care in Ohio recently. Gender-affirming healthcare is one of the most commonly sought after forms of healthcare among community members. Within Ohio, this type of healthcare encompasses all surgical, nonsurgical, and mental healthcare services available to transgender, non-binary, and gender non-conforming Ohioans. The service that faces the brunt of backlash is surgical procedures and medication, or any physically fluctuating healthcare.
As citizens of a democratic nation, Americans have the privilege and the ability to advocate for changes within the existing governmental framework. Grassroots organizations in America have a long-withstanding history with healthcare reformation and the demand for universal healthcare.
LGBTQ+ HEALTHCARE
Conflicting views on healthcare topics exist beyond reproductive rights. Healthcare consists of varying topics that all hold the push-and-pull of public and political opinion, and for members of the LGBTQ+ community, there are many encounters with laws and organizations aiming to restrict access to services in Ohio.
In June 2021, Governor DeWine signed the 2022-2023 biennial budget bill into law. This bill included a clause known as the Healthcare Denial Law, which is a law that “allows medical providers, hospitals, and health insurance companies to refuse to provide or pay for a medical service if they believe doing so would violate their religious, ethical or moral beliefs or principles”.
On May 31, 2023, the American Civil Liberties Union, or ACLU of Ohio filed an amicus brief on behalf of Equitas Health, a non-profit organization based in Ohio that advocates for LGBTQ+ healthcare, in City of Columbus v. State of Ohio.
“The Healthcare Denial Law was snuck into an unrelated appropriations bill in the eleventh hour behind closed doors,” ACLU of Ohio attorney Amy Gilbert said in a statement. “Our constitution’s single-subject rule serves an essential democratic purpose in placing concrete limits on the power of the General Assembly.”
Those who opposed the law expressed concerns that it would prevent LGBTQ+ citizens – most notably minors – from receiving potentially life-saving healthcare. This was not the first and certainly not the last law to be passed with the intent to prohibit sexuality and gender-affirming care.
In the 2023 legislative season, Ohio lawmakers introduced four anti-LGBTQ+ bills that restricted LGBTQ+ Ohioans’ access to healthcare, a number that was among more than 725 proposed laws across the nation, according to a report from the Movement Advancement Project (MAP).
The most recent bill regarding LGBTQ+ healthcare to be introduced within Ohio legislation was House Bill 68, a prime example of gender-affirming legislation facing political and public discussion. The bill banned gender-affirming care for patients under the age of 18 in Ohio, including the use of hormones, puberty blockers, and surgeries, as well as prohibiting transgender girls from participating in middle and high school sports. There was a prior iteration of this bill, House Bill 454, or the Save Adolescents from Experimentation (SAFE) Act.
“What we’re just simply saying is, let kids grow up,” Rep. Gary Click (R-Vickery) said, who reintroduced the bill in February 2023 after the legislation failed to pass Ohio’s General Assembly in 2022. “Children are incapable of providing the informed consent necessary to make those very risky and life-changing decisions.”
Ohio’s Governor Mike DeWine vetoed House Bill 68 on Dec. 29, 2023, but a vote to override the veto was held and passed on Jan 10. House Bill 68 is set to become law 90 days after the Senate vote, or in mid-April of 2024. At that time, transgender youth will no longer be able to receive gender-affirming care in the state of Ohio.
Kaleidoscope Youth Center (KYC) is an organization that works to provide support for LGBTQ+ youth and their allies. Erin Upchurch, the executive director of KYC, commented on House Bill 68 on KYC’s website.
“Ohio’s youth, young adults, and their families deserve more,” Upchurch said. “They deserve better from the adults and leaders put into positions of power in interest of supporting and protecting their inalienable rights. Legislation and policies such as House Bill 68 do nothing to protect any child or young person; instead, only further marginalize. This is bullying behavior.”
SOCIOECONOMIC BARRIERS
In conversations about healthcare, the American healthcare system is often referenced as flawed. Advocates for universal healthcare point out the relative inaccessibility of medical care in the U.S. compared to other countries, citing high fees.
Stepping away from politics, there is much truth to this claim– according to the Commonwealth Fund, the U.S. has the highest annual healthcare spending in the world, with numbers ranging in the trillions. Americans pay an average of over $13,000 each year in medical care, far surpassing the rates of other economically developed countries.
“I think there’s many times where financial barriers became an extreme issue with my ability to seek medical treatment. Due to pricing of drugs and care there [were] often times where I couldn’t start a drug or schedule an appointment due to the sheer cost of it, even with insurance. There’s also been many times where I almost couldn’t get things done such as tests or getting my blood drawn because a simple procedure [costs] way too much for it to make sense financially. This is an extreme issue within the U.S., and what I’ve faced isn’t even the worst of it,” an anonymous respondent to a survey conducted by Arlingtonian said.
Despite insurmountable costs, the U.S. has more malpractice suits and lower quality of care than countries such as Canada, rendering arguments that higher prices correspond with better treatment null.
Financial difficulties have left healthcare to be considered a luxury for many, widening pre-existing gaps between people of different socioeconomic statuses. Perhaps most obviously, low-income individuals and people in poverty experience difficulties paying for necessary medicine. The National Health Council states that poverty and poor health outcomes are directly correlated for a variety of reasons.
First of all, people in poverty frequently live in conditions that lead to health problems. For example, low-wage positions are more likely to involve dangerous or dirty work and provide less room for workers to self-advocate. Said conditions often lead to illness or work-related injuries, creating a greater need for medical care within low-income demographics.
Low wages combined with high costs of medicine make it nearly impossible for some to pay for the treatment they need. Failure to seek treatment enables health problems to persist, and chronic illnesses or disabilities can lead to an inability to work at all or as often.
The cyclic nature of poverty and healthcare produces a trap– one that makes it incredibly difficult for people in poverty to access life-saving treatments that are available to the wealthy.
The healthcare system doesn’t only target the poor– other minority groups have been historically discriminated against by an institution supposedly founded purely on science and the right to a healthy life. Medical racism is defined by YWCA as “the systematic and wide-spread racism against people of color within the medical system. It includes both the racism in our society that makes Black people less healthy, the disparity in health coverage by race, and the biases held by healthcare workers against people of color in their care.”
Medical racism dates back at least to the 19th century, according to AP News. Medicines’s roots are buried in racism; the father of modern gynecology, James Marion Sims, performed surgeries nonconsensually on enslaved women. Later, in the 1960s, experimental lobotomies were performed on Black children.
Medical racism is anything but a thing of the past– ideas from the last several centuries pervade modern medicine. In fact, a study published in “Proceedings of the National Academies of Science” revealed that half of white medical trainees falsely believe that Black people have higher pain tolerance, “thicker skin,” or other genetic aspects that result in Black people being perceived as needing less than sufficient care.
Attempts have been made to close the gap in medical care between socioeconomic classes. Medicaid is a federal program that provides healthcare for millions of Americans who are considered in some way medically disadvantaged. In Ohio, individuals must be pregnant, responsible for a minor, disabled, or over the age of 65 to qualify. Additionally, one must be categorized as low-income or very low-income.
President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010, in an attempt to make healthcare more affordable for Americans. The ACA, also known as Obamacare, has a primary goal of expanding Medicaid coverage to all adults with income below 138% of the Federal Poverty Line.
Critics of Obamacare refer to unintended negative outcomes that are harmful to the populations the law is designed to protect. For example, some businesses have employee hours to avoid covering healthcare costs, since only businesses with at least 50 full-time employees are required to. Additionally, many people who already have healthcare must pay premiums, and uninsured people without exemptions are fined.
So-called solutions to the healthcare crisis have backfired, creating further issues for low-income people and doing little to generate equal access to medical care.
