< PreviousBUSINESS NEWS A report released by the City Controller’s office reveals that the Kenney administration has a double standard when it comes to penalizing govern- ment contractors who have run afoul of city procurement laws. In the report, titled “Voting Technology Procurement Investigation,” con- troller Rebecca Rhynhart lays out the case that the city’s active contract with Election Systems & Software should be voided. The reason? ES&S, which is producing the city’s controversial new voting machines, failed to disclose that it had used consultants to lobby city offi- cials in the two years before the application deadline for the contract. Addi- tionally, according to Rhynhart’s report, ES&S “also failed to disclose recent political campaign contributions from its consultants … to Commissioners [Al] Schmidt and [Lisa] Deeley, the two officials who had the final say in awarding a $29 million contract to ES&S.” A spokesperson for ES&S told The Hill that such disclosures were “inad- vertently omitted in our vendor application” and that this occurred “due to our mistaken interpretation of Philadelphia’s contracting process.” According to the city’s rules, these kind of omissions disqualify a vendor from bidding. Although the city found out about ES&S’s violations after its bid was approved, the city retains the power to void the contract. But rather than do that, the city merely fined the company. ES&S now has to repay 10 percent of the contract amount (around $2.9 million) as a result of its violations. That’s a serious slap on the wrist, and it might seem a just penalty — if it weren’t for the fact that the city slit the throat of its largest minority contrac- tor only a few months ago for doing the exact same thing. It all happened last spring when the city disqualified U.S. Facilities, Inc., a minority-owned subsidiary of Philadelphia-based PRWT Services, from even bidding on a more than $14 million annual maintenance and security services contract after the company failed to disclose less than $500 in polit- ical campaign contributions in 2017. U.S. Facilities had held the contract — the city’s largest for a minori- ty-owned business — since 2003. In 2018, the company was the only one among the city’s top ten highest paid contractors to meet 100 percent of its minority-businesses enterprise (MBE) participation. (The ownership of the new winning bidder, Chicago-based Jones Lang LaSalle, is predominantly white.) Many Black community leaders argued at the time that the city’s pun- ishment was too severe, but Mike Dunn, a spokesperson for the Kenney administration, doubled down. “These laws are well-known for their strict, mandatory requirements for disclosing political contributions and the resulting consequences for non-compli- ance,” Dunn then told The Philadelphia Tribune back in April. So why is the same not happening to ES&S? If both companies failed to disclose their political contributions, both should receive the same conse- quence. By allowing ES&S — a white-owned company with less than 1 percent minority participation — to keep its contract, the Kenney administration made clear where it stands on diversity and inclusion. When given a bold opportunity to counter implicit bias, double standards, and racial inequity, the city proved what many Black and brown business owners already know to be true: The system is fundamentally stacked against them. When a minority-owned city contractor broke lobbying rules last year, it was banned from bidding again. Guess what happened when a white-owned firm did the same thing? OPINION When It Comes to City Contracts in Philly White Privilege Wins by Ernest Owens 8 | TALK MAGAZINE • FALL 2019 NEED TO KNOW Mahishia Dellinger, Founder, Curls (photo Curls.biz) by Pauleanna Reid When Target decided to test the market on natural hair care prod- ucts, they added four brands to their shelves. Among them was Mahisha Dellinger’s, Curls. At the time, Dellinger was still a new entrepreneur, with her products in just 100 retail stores. A year and half later, she had hit six figures. Now, seventeen years since launching, Curls is a multi-million-dollar brand on the shelves of 100,000 stores. What Black Female Entrepreneurs About Scaling Their Company SuccessfullyBUSINESS NEWS WWW.TALKMAGAZINEONLINE.COM | 9 It’s a success story that defies the odds. Eighty percent of businesses fail before year five, and less than 4% of Black women entrepreneurs make it to the million-dollar mark. Chelsea Crowder, a private wealth advisor with Goldman Sachs noted that, “Last year, only 2% of venture capital investment dollars went to women-owned enterprises. That number goes down to 0.2% when looking at women of color, and basically 0% for Black women.” Dellinger says it’s statistics like these that inspire her to support other Black women entrepreneurs in the journey towards the million-dollar mark. From coaching the Furlough Cheesecake sisters to a six-figure business in just three weeks to mentoring Black female business owners on her OWN show, Mind Your Business with Mahisha, Dellinger has proven she is genuinely committed to this cause. Eager to take her support large scale, in July Dellinger launched the Black Women Making Millions Academy, a conference that brought together 100 Black businesswomen and key experts to help them execute, grow, and fund their business ideas. The four-day event included masterclasses, one-on-one sessions, wellness activities, and a private yacht cruise. The conference is the kind of thing Dellinger wouldn’t have even been able to imagine in her youth. The success and financial security she knows today was not something she grew up with. “[At home], there weren’t conversations about careers, ambition, women ‘making it.’ They were just trying to survive day-to-day, paycheck-to-paycheck. It was very hard where we grew up.” For Dellinger, her past is both a reminder of why she works as hard as she does and an incentive to empower other Black women. For those who didn’t get the chance to attend the inaugural Black Girls Making Millions Academy, I recently spoke with Dellinger who shared six tips for Black female entrepreneurs ready to take their businesses across the million-dollar threshold. Nail Down Your Millionaire Mindset Social media has made ‘keeping up with the Joneses’ a bigger problem than ever, and Dellinger notes that consumption-driven thinking is a stumbling block for aspiring millionaires. She explains, “To really create wealth, you have to live below your means. We are in a society of spending, consumers and not creators. The millionaire mindset requires a shift from spend and buy to save and invest.” ‘There’s Wisdom in Planning’ Dellinger’s ambitions have always been paired with a careful and calculated approach to business, always being patient enough to continued on page 28LATINO NEWS by John N. McGuire For Tiffany Tavarez, there are several reasons why she chose to pursue becoming part of the philanthropic side of a major corporation. One is that philanthropy helped her to build her own career, noting that donors such as the Hispanic Scholarship Fund and the W.W. Smith Charitable Trust helped fund her college education, providing her the wherewithal to become the first woman in her Dominican family to earn a university degree, graduating magna cum laude from Temple University. Another reason is that Tavarez believes corporations like Wells Fargo, where she now serves as a Vice President and Community Relations Senior Consultant for the bank’s five-state northeast region, should have representation that reflects the population of the communities they aim to aid with their philanthropic endeavors. About half say situation for U.S. Hispanics has worsened over the past year; majority worry that they or someone they know could be deported Half of Latinos say their situation in the U.S. has worsened over the past year, up from 32% in the weeks after Donald Trump won the 2016 presidential election and the highest level since the Great Recession. In addition, more say they have serious concerns about their place in American society now (49%) than in 2017 (41%). And a majority (55%) say they are worried that they, a family member or close friend could be deported. Many blame the current administration for what they see as the worsening situation of Hispanics, the nation’s largest minority group. Two-thirds (67%) say the administration’s policies have been harmful to Hispanics – a much higher share than during the administration of either Democrat Barack Obama (15% in 2010) or Republi- can George W. Bush (41% in 2007). Overall, six-in-ten Hispanics (62%) say they are dissatisfied with the way things are going in the country today, up since 2017 and the highest level since the Great Recession a decade ago, when 70% of Hispanics said they were dissatisfied with the nation’s direction. And yet, attitudes among Latinos are not monolithic. Slightly less than a quarter of Latinos (23%) identify as Republican or describe themselves as leaning Republican. Among this group, six-in-ten (59%) approve of President Trump’s job performance, compared with just 8% of Latino Democrats who say the same. In addition, half as many Latino Republicans as Latino Democrats (28% vs. 57%) say the Hispanic population’s situation has grown worse over the past year. Notably, partisan differences do not extend to voting. In each partisan camp, about six-in-ten (59%) registered voters say they are more enthusiastic about voting in the upcoming midterms than in the last congressional elec- tions. This year, more than 29 million Latinos are eligible to vote, up from 25 million in 2014. Half of Hispanic adults (49%) are foreign born, and as a group they have stronger concern than those born in the U.S. Immigrants are more likely than U.S.-born Hispanics to say they have serious concerns about their place in U.S. society (57% vs. 42%), and they worry a lot or some about deportation (66% vs. 43%). Foreign-born Hispanics are also more pronounced in their criticism of the Trump administration: 71% say White House poli- cies have been harmful to Hispanics as a group, compared with 63% of U.S.-born Hispanics who say the same. These are among the key findings from a new nationally representative, bilingual telephone survey of 1,501 Hispanic adults, conducted by cellular and landline telephone from July 26 to Sept. 9, 2018, by SSRS for Pew Research Center. The survey’s margin of error for the full sample is plus or minus 3.1 percentage points at the 95% confidence interval. More Latinos Have Serious Concerns About Their Place in America Under Trump by Mark Hugo Lopez, Ana Gonzalez-Barrera and Jens Manuel Krogstad Tiffany Tavarez assists Wells Fargo in supporting regional non-profits and philanthropic endeavors. Wells Fargo welcomes a new Latina leader continued on page 28 10 | TALK MAGAZINE • FALL 2019 continued on page 28LATINO NEWS WWW.TALKMAGAZINEONLINE.COM | 11WWW.TALKMAGAZINEONLINE.COM | 11 By Ecleen Luzmila Caraballo Is the first Latin American woman (and fourth woman overall) to be the president of the U.N. General Assem- bly, María Fernanda Espinosa Garcés closed out the 73rd session last week making history. During her presidency, the Ecuadorian politician and diplomat was responsible for overseeing the sessions of the General Assembly, hearing arguments, working to address global issues through policy and meet with various leaders around the world. While an intermediary, she maintained that the people were always her top priority. “Each and every one of my actions will bear in mind the fact that the main recipients of our commitments and decisions are our people. We are working for them,” she said when she first took the position back in September 2018. Espinosa Garcés, a fierce defender of the earth, also prioritized issues of environmental justice. With a master’s degree in Amazonian studies and social sciences, in addition to a postgraduate diploma in anthropology and political science, she understood the need to center climate change. During her tenure, she fought to make the U.N. a sin- gle-use plastic-free venue. Even more, one of her last guests to speak to the assembly was 16-year-old environmental activist Greta Thunberg. While her time as president has been noteworthy, Espinosa Garcés said there remains a lot of work to be done. In an interview with Oprah Magazine, she discussed the problem of gender disparity at the U.N. “You have to twist arms here to make sure that all our panels have gender parity, that the negotiations are equally co- chaired with female ambassadors and male ambassadors,” she told the publication. A barrier-breaker, fulfilling the role of the 73rd presi- dent of the U.N. General Assembly is just one of Espinosa Garcés’ firsts. According to the U.N., she was also the first woman to become a permanent representative of Ecuador to the United Nations in New York. Additionally, her ex- cellency (since that’s the proper way to refer to her – a true reina!) is also a published poet. Her message to those she has inspired? “You have to have a passion for fixing the world. Be a dreamer.” As UN General Assembly’s María Fernanda Espinosa Made History Latin American Woman President FirstHEALTH NEWS 12 | TALK MAGAZINE • FALL 2019 “Ulcerative colitis is an autoimmune process where the body attacks the colon or large intestine,” says Dr. Jacob Skeans, a gastroenterologist at The Ohio State University Wexner Medical Center. This process causes inflammation and ulcers in the lining of the colon. Because ulcerative colitis is an autoimmune disorder, it’s likely caused by a combination of genetics and environmental triggers. As such, “the foods you eat don’t cause you to develop ulcerative colitis. But food definitely plays a role in your symptoms.” When you’re having a flare-up, certain foods can make you feel worse, while some are better for you. Dr. Andrew Ho, associate chief of gastroenterology with Santa Clara Valley Medical Center in San Jose, California, agrees that diet doesn’t cause the problem, but it can help you feel better or worse. “While I do not specifically restrict certain foods in my IBD patients, some patients may have increased gastrointestinal symptoms with certain foods. Some foods may cause cramping, bloating and/or diarrhea.” What to eat and what to avoid to keep flare-ups away. Foods to Eat During a Flare-up During flare-ups, your gastroenterologist may recommend that you change your diet to help your digestive system heal. Dr. Hardeep Singh, a gastroenterolo- gist with St. Joseph Hospital in Orange, California, says, “for the most part, it does not appear that diet causes ulcerative colitis to flare.” But certain foods may help you feel better faster or, at a minimum, cause less discomfort. If you’re experiencing a flare-up, consider eating the following foods: Salmon and other fish that contain omega-3 fatty acids. These compounds can help reduce inflammation. Lean meat and poultry . During a flare, many people have difficulty extracting the nutrients they need from food and may deplete stored reserves. Consuming enough protein can help you keep from losing weight and muscle mass. Peanut butter, tahini and flaxseed oil. Seeds and nuts are a good source of protein, but for people having a flare-up, they can be hard to digest and cause additional inflammation. However, if they’re ground into a paste or refined into an oil, this jump-starts the digestion process and makes them easier to tolerate and gentler on an inflamed gut than their whole or raw counterparts. Eggs. High in protein, eggs are easy to digest and usually well tolerated by people experiencing ulcerative colitis flare-ups. Low-fiber foods. Most doctors encourage people to consume high-fiber foods such as leafy greens, raw vegetables and whole grains for general health. But for people experiencing an ulcerative colitis flare, lots of fiber can make you feel worse. “If you have a lot of inflammation in the colon, that increases symptoms,” Skeans says. Therefore, when your colon is inflamed, eat easy-to-digest, low-fiber foods like white rice, white bread, plain pasta, bananas and applesauce. Protein shakes. Ho recommends protein shakes or oral nutritional supple- ments if you need additional calories. Other foods that can be challenging for people in ulcerative colitis flare include: High-fiber foods. “When there is a flare of colitis, you want to try to avoid high-fiber foods, especially what we call insoluble fibers,” Singh says. “Examples would be fruits with skin. High-fiber foods can cause gas or cramps when the colon is inflamed.” Seeds, nuts and popcorn. Small, hard-to-digest foods such as seeds and nuts can cause increased bowel urgency, and cramping or bloating. This includes fresh strawberries because the tiny seeds that dot their flesh can be problematic for people with an inflamed digestive system. High-fat foods. Ulcerative colitis can make it difficult for you to break down and absorb fat, which can lead to worsening symptoms. Coconuts, fried foods and salad dressings, especially those that con- tain poppy seeds, might be hard on your system during a flare-up. Sugary foods and sugar substitutes. This includes dairy products because lactose, a type of sugar found in milk, can exacerbate gas output, Singh says. Sugar substitutes, including sorbitol and aspar- tame, can also exacerbate symptoms. Alcohol, caffeine and carbonated beverages. “Both alcohol and caffeine can act as irritants to the intestinal lining,” Singh says. Caf- feine is also a stimulant, which can make your digestive system work faster than usual, leading to diarrhea. Soda and other carbonated beverages can make you gassy and increase bloating. Beans. They’re known as the “musical fruit” for a reason – they can cause excess gas, which for some people can feel worse during a flare-up. They’re also very high in fiber, which can be difficult for an inflamed gut to handle. Corn. Notoriously difficult to digest, corn kernels often pass through the gut undigested. Therefore, if you’re having a flare-up, it’s probably best to skip corn on the cob. Raw vegetables. Because of their higher fiber content, raw vegeta- bles are more difficult to digest than their cooked counterparts. Fatty cuts of meat. The fattier the cut of meat, the more difficult it will be for your system to digest. Chocolate. As delicious as it is, chocolate contains a lot of sugar and some caffeine, two ingredients that are common triggers for people with ulcerative colitis. Spicy foods. These foods can also be taxing on the digestive system and worsen your symptoms. Foods to Avoid During a Flare People with ulcerative colitis are more likely to have other food sensitivities and intolerances, such as being lactose intolerant (unable to digest the sugars in dairy products) or having celiac disease (unable to digest gluten, a compound found in wheat). “Sometimes, patients may feel that when they eat a certain food, that is causing their colitis to flare,” Singh says. “But usually in my experience they may just have a simple dietary intolerance that may be causing gas or cramps or intermittent diarrhea.” Nevertheless, if there are foods that you know make you uncomfortable, it’s best to avoid those. This article is based on reporting that features expert sources including Jacob Skeans, MD; Andrew Ho, MD; Hardeep Singh, MD by Elaine K. Howley Food for Ulcerative Colitis FOR PEOPLE WITH ulcerative colitis, the simple question of “what’s for dinner?” doesn’t always seem like such a straight-forward proposition. Ulcerative colitis is a form of inflammatory bowel disease (along with Crohn’s disease) that causes a variety of symptoms, including diarrhea, cramping, bloating and bloody stools. And depending on where you are in your disease cycle, you may need to be following different diets. continued on page 28HEALTH NEWS WWW.TALKMAGAZINEONLINE.COM | 13 A combination of the following factors is causing these inequities: Behavior risks / lifestyle – tobacco smoking, physical inactivity, obesity, alcohol use, consumption of diets high in fat and processed foods. Environmental – living where there is increased exposure to chemicals and pollution. Social and economic – poverty, less education, lack of access to high quality health care, higher rates of uninsured. Cultural / religious beliefs – sometimes we don’t like to talk about cancer or we have religious beliefs that may delay entry into medical care. The good news is that many advances have occurred in cancer care, and many cancers can be treated. The key is screening, early detection and treatment. There are other preventive measures you can also take to lower your risks of developing cancer or detecting it early: Eliminate cigarette smoking and tobacco use – tobacco is linked to cancers of the lung, esophagus, oral cavity, stomach, kidneys and bladder (to name a few). Increase physical activity. Diet – eat less sugary and fried foods high and eat more fresh fruit and vegetables. Limit alcohol intake. Environmental risk factors – learn what these are and ways to decrease exposure. Avoid infections – such as Human Papillomavirus (HPV) - which is linked to cervical, anal and oral cavity cancers. Know your family history and how that puts you at risk. It’s also important to talk to your doctor about screenings and tests that are right for you based on your age, gender and risk factors. Here are few you can ask about on your next visit: PAP test and Mammogram (Women) Prostate examination (Men) Physical examination (Men and Women) Colorectal cancer screening tests (Men and Women) Take steps today that promote your overall well-being and talk to your friends and family about prevention – it could help save a life! For more information please visit the follow websites: http://www.cdc.gov/cancer/ https://www.cancer.gov/about-cancer www.cancer.org http://www.athighmark.com/healthEquity/ PLEASE NOTE: This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Consult your physician before participating in activities described by this article. What You Can Do to Close the Gap African American Cancer Health Disparities Dr. Rhonda M. Johnson, M.D., M.P.H. Senior Medical Director, Medical Management and Quality, Highmark Inc. What are Cancer Disparities? Simply speaking, the term “cancer health disparities” refers to a higher burden of new cases of cancer, cancer deaths and complications in African Americans compared to other populations in the United States of America. Did you know that the top three cancers in black men are prostate cancer, lung cancer and colorectal (colon and rectum) cancer? For black women, the top three cancers are breast cancer, lung cancer and colorectal cancer. In addition, African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. Black women are more likely than all other women to die from breast cancer. And their tumors are more likely to spread more quickly. TMAG 2019 AFRICAN AMERICAN/LATINO photos by Ricco JL Martello Roundtable Civil War and WWI vets had utilized an addictive amount of Morphine to treat wounds. Alcohol Prohibition through the 18th Amend- ment soon followed. The Comprehensive Drug Abuse Prevention and Control Act came into play in 1970, leading Nixon to finally declare a war on drugs in 1971, with drugs becoming Public Enemy Number One. At that time, Crack Cocaine was the drug of choice and the ‘color’ behind reform. The way in which drugs were viewed mattered in both perception and criminal outcomes. In 2011, The Global Commission on Drug Policy declared the War on Drugs as a failed one, disconnected from the very real reality of addiction and disease. The argument was simple, drug use was a result of a diseased group of individuals, and not criminals. While the consensus was that drug use was a disease, it did not deter from its criminality. Drugs still resulted in jail time, with marijuana carrying the burden as the face of criminal deviance. The cultural shift in drug use seemingly began when the use of Opioids and prescrip- tion drug abuse began to increase. According to the National Institute on Drug Abuse, there was an estimated 72,000 drug overdoses in the USA in 2017. The most obvious spike in drug use has come in death related to pentenyl and synthetic opioids, accounting for approx. 30,000 deaths. On average, 21 - 29% of patients abuse prescribed opiates. 80% of individuals using heroin first misused prescription opioids. The prescription medication abuse is one the rise, and this leads to many individuals looking at the way we have managed drug use and abuse over time. While new legislation has led to many conversa- tions over the way in which race has seemingly played a much larger role in drug addiction that it should have, many are now wondering how to coincide cultural competence, social justice, and pain management to address growing drug abuse across cultures. Opioid addiction, much like crack cocaine addiction, causes adverse effects to psycho- logical and physical functionality of the body. Treatment for overdose and misuse of drugs is still an ongoing process, with social deter- minants effecting if one is considered ‘sick’ or just deviant. Many who are sick are still being applied punitive care rather than medical care. Treatment in modern society must take into account historical context of the crack epidem- ic in order to begin the process of addressing treatment and sustainability of the addict. While both means of addiction may seem connected, the historical occurrences from a legal and social othering standpoint leads to many complexities in addressing crack addiction the same as opioid addiction. Understanding those differences first and foremost can help to create a platform for further advocacy and similarly constructed frameworks in addressing a sound solution for both equally moving forward. Historical context aside, and with an already understood identification of the disparities in criminality, the need for treatment for both with equal effort is key. Drug addiction, as we have always known it to be, is an addiction; a disease. Handling a disease requires a sense of under- standing precipitating events that lead to the behaviors, focusing on many of the cultural as- pects that might both bring those trends together or set them apart. Cultural competency within diagnosis, assessments, and treatment helps families to understand root causes, physicians to understand best level of treatment, and societies to implement programming which serves the need of the addict more holistically. Treatment facilities must consider how culture plays a role in pain management, counseling, religious or holistic treatment options, etc. The opioid epidemic shares strikingly similar characteristics as the crack cocaine epidemic, which is both promising and alarming. While the opioid epidemic is much widespread due to its geographical and, frankly, racial composition for its users, it does not echo in how society has re- acted to its use or its treatment. More and more, the need to address drug epidemics has come into focus. In order to move forward, a fuller scope of drug abuse is needed, with a historical analysis of both the problem and our successes and failings in solutions. As a society, there is a need to recognize that this new age of aggressive pill distribution hinders successful outcomes in treatment from occurring, and treatment facili- ties must be better equipped with the economic tools to apply vigorous treatment programming in its facilities. Step down programming from treatment to mental health facilities are a prom- ising solution being offered, one that addresses the duality of the disease. With talks of mental health, the conversation for drug abuse and treatment come into play as well. Mental health services see a strong trend in identified drug users seeking treatment. Dual services oftentimes aid in servicing both of those needs, but without ap- propriate funding, collaboration, and education, both users and community members alike are left wondering about the best solution for treatment. Nontraditional avenues for treatment are on the horizon, and with it, more ways of address- ing any and all addiction comes with it. Both addictions, the ones left behind as well as those at the forefront, now have a stronger army for advocacy and relief efforts. The goal has now been reignited to find treatment facilities which detox to help prevent deaths, with more facilities helping to keep individuals safe and alive with alternative medications. There are more facilities designed with culturally and linguistically appropriate staffing to address addiction, and increased funding towards programming efforts to address recovery for all drug users. Whether or not the conversation shifted because the color of the identified addict has will always be up for question. However, moving beyond that into solution-based strategies will help to guide the new narrative of addiction as an ever- growing problem within our nation. The ‘War on Drugs’ is an ongoing war with no shortage of casualties. In 1971 President Nixon declared a war on drugs, a highly televised campaigned that was said to devote funding that would prevent individuals from becoming addicted while also rehabilitating current addicts. This public statement served to send a clear message about drugs in America. They were unwelcomed here, and the country was prepared to do what it must to prevent the widespread epi- demic. Nixon provided an unreserved amount of funding on a federal level for military intervention of illegal drug trade and set initiatives to develop drug policies to aid in the eradication of drugs. What seems like a drastic move was a long time coming. Heroin infused cough syrups and over the counter children’s medications had just been discontinued in 1912 after creating thousands of household addicts. 16 | TALK MAGAZINE • FALL 2019 The Color of Drug Reform and Treatment by Fiordaliza WhiteWWW.TALKMAGAZINEONLINE.COM | 17 Under the ACA, as of 2014, Medicaid coverage expanded to nearly all adults with incomes at or below 138% of poverty in states that have adopted the expansion, and tax credits are available for people with incomes up to 400% of poverty who purchase coverage through a health insurance marketplace. Millions of people enrolled in ACA coverage, and the uninsured rate dropped to a historic low by 2016. Coverage gains were particularly large among low-income adults in states that expanded Medicaid. Despite large gains in health coverage, some people continued to lack coverage, and the ACA remained the subject of political debate. Attempts to repeal and replace the ACA stalled in summer 2017, but there have been several changes to implementation of the ACA under the current administration that affect coverage. In 2017, the number of uninsured rose for the first time since implementation of the ACA to 27.4 million. Those most at risk of being uninsured include low-income individuals, adults, and people of color. The cost of coverage continues to be the most commonly cited barrier to coverage. Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy they are. Uninsured people are far more likely than those with insurance to postpone health care or forgo it altogether. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected. While the safety net of public hospitals, community clinics and health centers, and local providers provides a crucial health care source for uninsured people, it does not close the access gap for the uninsured. For many uninsured people, the costs of health insurance and medical care are weighed against equally essential needs, like housing, food, and transportation to work, and many uninsured adults report financial stress beyond health care. When uninsured people use health care, they may be charged for the full cost of that care (versus insurers, who negotiate discounts) and often face difficulty paying medical bills. Providers absorb some of the cost of care for the uninsured, and while uncompensated care funds cover some of those costs, these funds do not fully offset the cost of care for the uninsured. Under current law, nearly half (45%) of the remaining uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they are subject to immigrant eligibility restrictions, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options. Ongoing efforts to further alter the ACA or to make receipt of Medicaid more restrictive may further erode coverage gains seen under the ACA. On the other hand, state action to take up the ACA Medicaid expansion could make more people eligible for affordable coverage. The outcome of current debate over health coverage policy in the nation and the states has substantial implications for people’s coverage, access, and overall health and well-being. by Rachel Garfield, Kendal Orgera, and Anthony Damico The Uninsured and the ACA: A Primer - Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance, and the number of uninsured Americans grew over time, particularly during economic downturns. By 2013, the year before the major coverage provisions of the Affordable Care Act (ACA) went into effect, more than 44 million nonelderly individuals lacked coverage.Next >