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Dr. Martin Luther King, Jr., once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” This quote is the touchstone of a new report, State of the Dream 2014: Healthcare for Whom? Enduring Racial Disparities, the 11th annual MLK, Jr. Day report from United for a Fair Economy (UFE).

State of the Dream 2014 claims to document “the heavy toll that continued racial segregation and concentrated poverty takes on people’s health.”

According to the report, high poverty communities often lack adequate health-care facilities, full-service grocery stores, and green space to walk or jog. These communities also face higher exposure to lead and other toxins, mold and even industrial pollutants. These factors, coupled with the physical stress of caring for one’s family amidst high crime rates and poverty all exact a price.

People of color face the brunt of these issues as poor blacks are 7.3 times as likely as poor whites, and poor Latinos are 5.7 times as likely, to live in such high-poverty neighborhoods.

The state fights over Medicaid expansion under the Affordable Care Act (ACA) — also known as Obamacare — make matters worse, according to the report. “It’s bad enough that communities of color face additional health hazards and stressors,” said Brian Miller, executive director of UFE and author of the report. “Now we have politicians around the nation trying to block health insurance coverage that would have otherwise been extended to millions of low-income Americans.”

Blacks make up only 13 percent of the population according to the new report, but account for 27 percent of those who will fall through the 25-state coverage gap of states rejecting the ACA’s Medicaid expansion.

Latinos make up 15 percent of the population, but account for 21 percent of those who fall through the gap. More than 1 million of the nearly 5 million who will not benefit from the Medicaid expansion live in Texas. Florida has the second largest Latino population among the 25 states currently not expanding coverage.

Rev. William Barber, leader of the Moral Mondays Movement in North Carolina, writes in the foreword, “The greatest myth of our time is the notion that extreme policies harm a small subset of people such as people of color. However, these policies harm us all. What we’ve seen in North Carolina and other parts of the country are wealthy extremists playing on the fears of working class and white people… Our job is to unpack the truth about these extreme policies and how they adversely impact all people.”

In addition to pressuring the 25 states to expand their Medicaid programs, the report calls for “bolder action.”

“As long as we depend largely on employers to provide health insurance, our health-care system will simply reflect the vast racial disparities of employment,” adds Miller. “People of color, who are often relegated to low-wage, part-time, and temporary jobs that offer little or no health insurance, are the ones left behind in such a system. The ACA’s Medicaid expansion attempts to address this shortcoming, but the real fix is to move to a universal, single-payer system.”

The report lifts up Vermont’s new single-payer system, scheduled to come online in 2017. Leveraging the rules and funding from the ACA, Vermont’s new Green Mountain Care will provide health insurance to all residents, including undocumented immigrants who work in the state’s many dairy farms.

“The fight today is over implementation of the Affordable Care Act, and ensuring that as many Americans as possible get health insurance,” adds Miller. “But long-term, we need to look at the real underlying causes, break up concentrated poverty, and begin promoting a more broadly-shared and inclusive prosperity. That’s the movement we hope to support with this report.”