First, our historical steps wed healthcare to employment. That relationship breeds most of the current rhetoric about responsibility and healthcare coverage (e.g. Responsible people know they need healthcare. Responsible individuals work, so they can have healthcare). Many people work and have no healthcare provided to them. Many people cannot afford to buy individual healthcare plans even when they are fully employed. How is this a sexual justice issue? Transgender, lesbian, gay people can lose their jobs without cause based on perceived or known sexual orientation or gender identity in many states, and their healthcare right along with it. Healthcare plans still exclude pregnancy plans, contraception coverage, or fertility treatment because women’s reproductive health is not seen as “common” or “necessary” (a.k.a., a need men have).

Second, healthcare has always been an individual benefit. Healthcare was not seen as a basic need to be provided and certainly not one that we as a country bear a responsibility to provide. When we provide healthcare to the poorest of the poor or the elderly, people begin to argue that we shouldn’t make it too good, because we don’t want “them” relying on it. This argument fails to grasp how many factors in our lives contribute positively and negatively to our health. It is not personal will that determines our health. Our health is impacted by our income, education, occupation, neighborhood, housing, social stress, and so on. A June 2009 report by the Kaiser Family Foundation, “documents widespread disparities in access to health insurance and health screenings, and finds that there are ‘racial and ethnic disparities in health status and health care in every state in the nation, often disparities that are quite stark’.” The abortion rate among women living below the federal poverty level is more than four times that of women at or above 300% of the poverty level (44 vs. 10 abortions per 1,000 women). Poor women are disproportionately from racial/ethnic minority groups. Moreover, LGBT youth represent 20–40% of all homeless youth. Many leave their homes because of conflict with their families’ religious beliefs, others experience verbal and physical harassment in their communities and schools causing both emotional and physical pain requiring treatment by healthcare professionals.

Third, growing from arguments of individual responsibility, what can and cannot be covered has been an on-going argument. Medicaid and Medicare were signed into legislation in 1965, I imagine ever since people have disagreed (specifically about Medicaid funding) for reproductive healthcare. How is this a sexual justice issue? In some cases, poor women were involuntarily sterilized to cut costs for subsequent pregnancies and childrearing. That is called eugenics, since policies only targeted poor women, often racial/ethnic minorities. In other cases, contraception or abortion funding was cut or restricted (and is still being pushed as a needed cut) causing increases in unintended pregnancies and STIs.

What if we started over? Dump the history of healthcare reform. Start with Healthcare is a human right. Recognize that individual choices AND social systems bear on our healthiness, including the environment in which we live, job availability, effectiveness of school systems, our racial/ethnic backgrounds, etc. And, accept that sexual and reproductive health are equally important healthcare issues. Would the conversation be different? Maybe we could get healthcare reform before the August break instead of the end of the year!

*This blog entry was also guest posted to Sexuality and Religion: What's the Connection?