Domestic Violence and Medicaid Expansion

DVAMSpeaking at a recent press event on North Carolina’s failure to expand Medicaid, I brought up the fact that October is Domestic Violence Awareness Month. There are very real and substantial connections between access to health care and efforts to end domestic and sexual violence.  I would hope that people can connect these dots, but I know that is not typically the case.  Having personally spent over a decade providing support to victims of domestic and sexual violence, I know there are many who claim to care about this issue, and claim to care about providing support to victims. But I also know many of those same people, including some in our state leadership, ideologically oppose efforts that would actually prove that support, including the effort to expand Medicaid in North Carolina.

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 can certainly be one reason.

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 we continue to approach domestic violence as a public health issue that should be treated as the systemic and entirely preventable community problem it is, 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 – who is not a service provider – still regularly receives phone calls from women in crisis across the state who searched on-line 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 this 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 3 in 10 women and 1 in 10 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 – that 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 said “Ignoring medical need is violence” when listing the ways we as a society fail our vulnerable citizens.  That violence is compounded when the medical needs we are ignoring are of those experiencing violence in their daily lives. We challenge those who want to support domestic violence victims to truly do so, and expand access to health care in North Carolina.

Tara Romano, President, NC Women United