Want to reduce domestic violence? Then expand Medicaid
Speaking at a recent press event on North Carolina’s failure to expand Medicaid, I highlighted the fact that October was Domestic Violence Awareness Month. I’m sure many were initially surprised to hear me make the connection between these two subjects. It’s clear that many important state leaders who often pay lip service to the issue of domestic violence don’t see it.
Having personally spent more than a decade providing support to victims of domestic and sexual violence, however, I can affirm that they are linked on multiple levels.
How can expanding Medicaid benefit victims of domestic violence? There are many ways, not the least of which is making healthcare more affordable to the approximately 500,000 North Carolinians who currently do not have access to quality health care, some of whom are surely experiencing domestic abuse. Invariably when discussing abuse, someone will ask “why do they stay?” Losing access to health care because your insurance coverage is through your abuser’s health plan is one of the most obvious and common reasons.
How else can expanding access to health care benefit victims of domestic violence? We are – finally – starting to move away from treating domestic violence as an individual failing on the part of the abused who only gets treatment after the fact. As more and more people begin to approach domestic violence as a public health issue that should be treated as a systemic and entirely preventable community problem, the medical community has a big role to play.
Domestic violence will no longer be considered a “pre-existing” condition that raises one’s health insurance premiums; and domestic and sexual violence screening will be considered a regular part of wellness exams. This cultural shift is in the beginning stages, but we hope that as this type of thinking takes hold, more victims of domestic violence will connect with the medical, counseling, legal and community support services available to help them heal and transition to a life free from abuse.
And that connection is needed. Despite the fact that there is a domestic and sexual violence victim support agency in almost every county in North Carolina (nearly 100 agencies), NC Women United – which is not a service provider – still regularly receives phone calls from women in crisis across the state who searched online for help. We are grateful that we can share with them the local agency resource that they had no idea was there. But we certainly see a need for more effective tools in making these connections.
The shame and hopelessness many abuse victims experience can create an isolating effect, and reaching out for help can be difficult, particularly if they fear their searching will be found out. So how do we get support and information to those around us suffering silently with their abuse? We get that information out to them any way we can.
Currently, domestic violence advocates work with health care entities – such as family doctors, OB-GYNs, mental health counselors, emergency rooms and urgent cares – to stock their waiting rooms with hotline and agency brochures. We place posters in the restroom stalls of doctors’ offices and hospitals, so abuse victims can take down numbers in private that they may one day decide to call. We ask doctors to include a question about domestic violence on the confidential patient screening forms, and we train medical providers to recognize red flags for abuse. We teach providers how to talk about abuse and why it’s important they do so; and we give them the tools they need to have that conversation. We create an environment that tells abuse victims they have a safe space to finally discuss what is happening to them.
I am often asked how best to help someone in an abusive relationship. I always suggest regularly and gently reminding the person that there is support available, because you never know when the message will finally resonate with that person. As we diligently work with health care providers to share that message with patients, we believe that regular access to health care can be an effective entry point into the support system many domestic violence victims need.
We don’t yet know the statistical impact of this initiative. We do know there were over 116,000 calls to North Carolina domestic and sexual violence hotlines last year; and not less than 60 intimate partner homicides in the state every year for a number of years. Nationally, we know that three in ten women and one in ten men experience abuse. We also know that in many cases of fatal domestic violence, the victim never made contact with any support services.
This crisis – which has been around longer than anything we normally label a “crisis” – requires an effort from all of us; and we owe it to those in need to utilize all the tools we have. Access to health care is one of those tools.
Coretta Scott King once said that “ignoring medical need is violence” when she was listing the ways we as a society fail our vulnerable citizens. That violence is compounded when we ignore the medical needs of those experiencing violence in their daily lives. We at North Carolina Women United challenge those who want to support domestic violence victims to truly do so by expanding access to health care to all North Carolinians.
Tara Romano is President of North Carolina Women United.
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