Issue Position: Health Care and Public Health

Issue Position

Introduction

Massachusetts' 7th Congressional district is one of the most diverse districts in our Commonwealth, but it is also one of the most unequal. That persistent, destructive inequality is reflected in the critical inequities in health outcomes that exist between residents of different communities throughout the district. In Boston's Back Bay neighborhood, the average life expectancy is 92 years old; in Roxbury, less than three miles away, that age is less than 60.[6] In 2017, Everett and Chelsea both had rates of opioid-related overdose deaths that were higher than the state average[7] - already one of the highest in the nation.[8] Across our district, families are struggling with some of the highest per capita health care costs in the nation,[9] even as they live in the shadow of some of the best health care institutions in the world.

Health in all communities is impacted by a number of factors: access to affordable health insurance; access to high-quality, culturally-competent care; income; housing conditions; education; access to healthy food; air and water quality; access to addiction and mental health services; exposure to violence and trauma; and many others. Improving health outcomes will require a comprehensive approach that recognizes current disparities in access to and delivery of health care, as well as critical environmental factors impacting different communities.

My work on the Boston City Council has focused on improving health outcomes for groups that are too often marginalized and overlooked in our national health care debate, including women and girls, those impacted by trauma and gun violence, men and women who are homeless, individuals and families struggling with addiction, and immigrants facing barriers to care. Those are the same communities whose challenges I will elevate in Congress. And just like in Boston, where I have worked closely with providers, advocates, and community organizaers and community members, my approach to policy-making in Washington will be collaborative and grounded in the needs of our district.

Health Care

Children's Health

Restructure federal programs to reimburse school nurses for covered health care services. Our school nurses are on the front lines of addressing complex medical conditions like asthma, autism, drug use and trauma, and are often providing health care services that are reimbursable in other health care settings, including clinics and hospitals. Building on my work in Boston championing investment in school nurses, I will introduce legislation to ensure that covered health care services provided in school settings are eligible for reimbursement from Medicaid, CHIP, and private insurers, reducing the burden on state and local budgets, and helping to ensure that every student has access to a full-time nurse.
Ensure access to school-based mental health services. Children throughout the 7th District and beyond are struggling with significant behavioral health challenges ranging from loneliness and depression to substance use and suicidality; a challenge further compounded by traumatic stressors like abuse, neglect, addiction and violence. Research shows that, nationally, hospitalizations among teens for suicidal thoughts and attempts have risen, especially during the school year.[10] In Congress, I will push for more funding to scale up and support school-based mental health initiatives that promote social and emotional wellness and provide equitable access to services, like BPS' Comprehensive Behavioral Health Model. I will also push to review data collection and reporting protocols for suicide among children.
Advocate for lead poisoning prevention and childhood asthma prevention. Pediatric asthma hospitalizations and exposure to lead can be drastically reduced with common sense investments in our local infrastructure. Too often, our youngest residents in the 7th District face lifelong health challenges associated with environmental factors they are exposed to as children. In Congress, I will build on the CHIP Health Services State Plan Amendments proposed by Maryland, Missouri, Michigan, New York, Oregon and Rhode Island to allow every state to use CHIP funding to replace lead paint and eliminate mold in public housing.
Access and Coverage

Pass Medicare-for-all. In Congress, I will support efforts to pass legislation ensuring universal, Medicare-for-all health care coverage, while also working in the interim to address gaps in coverage and care that occur within our existing health care and insurance framework. Under our current system, low-income people and communities of color - particularly African-American, Hispanic/Latinx, and immigrant populations - continue to experience significant disparities in health outcomes, and costs continue to climb unsustainably. A Medicare-for-all approach will meaningfully address disparities in access to health care coverage, and would help contain costs in the long-run by significantly increasing bargaining power.
Address language barriers that inhibit patients from receiving high quality, culturally-competent medical care. In the 7th Congressional district, 43 percent of households speak a primary language other than English.[11] Too often, members of these households go without needed medical care because they lack access to medical services in their native language and cannot afford expensive translation services. As your Congresswoman, I will introduce legislation that requires all insurance providers - including Medicaid, CHIP, and private insurers - to cover costs related to interpretation and translation services. Funding language services as part of a patient's health plan will substantially improve health care access and outcomes for non-English and ESL speakers.
Ensure access to competent primary care for members of the LGBTQ+ community. According to the Kaiser Family Foundation, "Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual's sexual orientation or gender identity." The Patient Protection and Affordable Care Act, signed into law by President Obama, made significant progress towards providing equitable coverage to members of the LGBTQ+ community by expanding access to coverage, codifying nondiscrimination protections, and including new requirements for data collection and research.[12] In Congress, I will fight to maintain this critical piece of legislation, which provides a vital safety net for members of the LGBTQ+ community, as well as all Americans.
Address the underlying causes of mental health and substance use disorders among members of the LGBTQ+ community. LGBTQ+ individuals are at elevated risk of experiencing depression, anxiety, and substance misuse, partly as a result of decades of stigma and discrimination.[13] Research shows that, in Massachusetts, LGBTQ+ individuals report experiencing depression at rates 20 percent higher than non-LGBTQ+ individuals.[14] In Congress, I will fight to address the underlying causes of depression, anxiety, and substance misuse among many LGBTQ+ individuals, by co-sponsoring legislation like the Customer Non-Discrimination Act and the Safe Schools Improvement Act. And I will work with local providers like Fenway Health to ensure that members of the LGBTQ+ community struggling with mental health challenges have access to high-quality care in respectful settings.
Preserve Medicare, Medicaid and CHIP. Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), collectively enroll more than 130 million Americans, according to the Centers for Medicare and Medicaid Services (CMS). These programs provide a critical safety net for seniors and families struggling to afford quality healthcare. Republican proposals threaten to undermine these critical protections by creating block grants or privatizing core services. In Congress, I will advocate for the preservation of these programs, and work to ensure that they remain sustainable for future generations.
Protect funding for public health infrastructure. Established by the Patient Protection and Affordable Care Act (ACA), the Prevention and Public Health Fund represents one of the federal government's primary investments in public health programs, including clinical prevention initiatives, immunizations and screenings, public health infrastructure, and public health workforce training, according to the U.S. Department of Health and Human Services. However, this program has frequently been the target of funding reductions, or used as an offset to fund other programs;[15] given the importance of public health funding to improving health outcomes and lowering health care costs in the long term, I will push to ensure robust, continued funding for this program. I will also support funding for continued grants from the Centers for Disease Control (CDC) to states that provide resources for the creation of basic public health infrastructure, including workforce training and updating information systems.
Substance Use Disorders

Adopt a treatment-based approach to combat addiction and substance use disorders. The federal war on drugs has criminalized addiction and substance use disorders in a way that has devastated communities and diverted critical resources away from efforts to expand access to treatment and care. In Congress, I will support efforts to reframe our approach and invest in programs that prioritize prevention and treatment over incarceration. And this approach must be extended to individuals and communities struggling with all types of substance use disorders, including prescription opioids, but also including alcohol, crack cocaine, and heroin.
Support the Comprehensive Addiction Resources Emergency (CARE) Act. Introduced by Sen. Elizabeth Warren and Rep. Elijah Cummings, this legislation would provide $100 billion to states and communities most impacted by the opioid crisis - the kind of substantial, long-term investment we need to meaningfully address the epidemic.
Increase access to Medication Assisted Treatment (MAT). At least half of incarcerated individuals in the United States are struggling with substance use or dependence disorders.[16] Court involvement and/or incarceration represent a key opportunity to connect individuals with treatment and mental health services. The Middlesex Sheriff's Office has piloted a successful Medication Assisted Treatment (MAT) program - combining medication with counseling and other therapies - that has improved outcomes for inmates experiencing opioid use disorders, but funding and regulatory hurdles continue to limit the scope of such programs. In Congress, I would support increased funding and legislation to streamline the implementation of MAT programs in corrections settings across the 7th District.
Maternal Health

Support the Mothers and Offspring Maternal & Morbidity Awareness (MOMMA) Act. As your representative in Congress, I would co-sponsor this legislation, recently introduced in the U.S. House of Representatives by Rep. Robin Kelly, which seeks to address the rising rate of black maternal mortality in the US. The legislation would establish standardized obstetric care protocols, better data collection systems, and would extend Medicaid coverage for new moms up to one year after giving birth.
Support holistic care models that include alternative birthing options. Doulas, midwives, lactation counselors and paraprofessionals are an underutilized yet growing force in maternal health care. In Congress, I will work to expand access to alternative birthing options, including licensure for doulas, standards for midwives, improvement in postpartum mental health services, resources to reduce disparities in breastfeeding, and the consistent coverage of holistic care by public and private insurance plans.
Reproductive and Sexual Health

Repeal the Hyde Amendment and Protect a Woman's Right to Choose. The prohibition on the use of federal funds to pay for abortion services disproportionately impacts low-income women, women of color, immigrants, and young people who rely on Medicaid for their healthcare coverage. In Congress, I will continue to be a fierce advocate for reproductive rights, and push to repeal this ban.
Support Comprehensive Sexual Health Education. On the Boston City Council, I have been a champion for providing comprehensive sexual health education in public schools - we cannot be focused solely on abstinence-only education, which has been proven ineffective. In Congress, I will continue to fight for equitable access to sexual health education that is inclusive of LGBTQ+ youth, medically accurate, and promotes healthy relationships. As part of my advocacy, I will co-sponsor the Real Education for Healthy Youth Act, introduced by Rep. Barbara Lee, which would "provide grants for comprehensive sex education to public or private entities that focus on adolescent health and education or have experience with training sex educators."
Fund Effective Programs for Addressing Teen Pregnancy. I will fight the Trump administration's efforts to eliminate funding for evidence-based programs like the Teen Pregnancy Prevention Program (TPP), which "many medical professionals credit with helping to drive the nation's teen pregnancy rate to an all-time low."[17] These programs have a real and tangible impact here in the 7th District; the potential loss of federal funding through TPP has forced the Massachusetts Alliance on Teen Pregnancy to close its doors at the end of June.[18] We should be doubling down on funding for these critical, effective programs, not cutting it.
Protect the Right to Access Complete and Accurate Reproductive Health Care Information. I will vehemently oppose any cuts in funding or requirements that restrict a women's right to access important information about her healthcare, including information about safe, legal abortions. In Congress, I will protect Title X funding for all family planning centers, including Planned Parenthood. I will support the Women's Health Protection Act to prohibit restrictive state and federal laws that interfere with reproductive health care services for women, including laws that prevent crisis pregnancy centers operating as comprehensive health care clinics from offering comprehensive information on the full range of health care options available to expectant mothers.
Public Health Issues

Gun Violence

Enact common-sense gun reform at the national level. Massachusetts has some of the strongest gun laws in the nation, but guns continue to flood our communities, many acquired in surrounding states with looser laws - that's why comprehensive gun control at the national level is so important. I support federal legislation that would ban assault weapons, bump stocks, and high-capacity magazines, raise the legal age to purchase a gun to 21, and require comprehensive background checks for all gun sales.
Fund CDC research on gun violence. The recently passed omnibus spending bill provides authorization for the Centers for Disease Control (CDC) to study gun violence as a public health epidemic, but provides no dedicated funding, effectively undermining this critical and long overdue research. Gun violence clearly represents a public health epidemic in our communities, and I would advocate for robust funding for the CDC to study the root causes of the epidemic and propose potential solutions.
Close the "boyfriend loophole." Federal law prohibits domestic abusers from purchasing a gun from a licensed dealer, but only if "he's currently married to, formerly married to, has a child with, or lives with the victim. That leaves a gaping loophole for dangerous abusive boyfriends and stalkers to walk right through," according to advocacy organization Everytown for Gun Safety.[19] In Congress, I would co-sponsor the Zero Tolerance for Domestic Abusers Act, which would close this dangerous loophole.
Trauma

Create and fund a "Survivors Bill of Rights" for all individuals experiencing trauma. The Sexual Assault Survivors Bill of Rights provides critical protections for survivors of rape and other sexual violence. I believe we should build on this concept to create statutory rights for all individuals experiencing trauma, whether that trauma stems from abuse, neglect, fear of deportation, displacement, violence, incarceration or addiction. Left unaddressed, trauma perpetuates cycles of violence, poverty, and other negative outcomes. Survivors should be proactively informed of their rights and connected with available resources, including through dedicated trauma coordinators - support should not be contingent on survivors' ability to navigate complex systems. In Congress, I will work with survivors, advocates, and community organizations to develop legislation that safeguards the rights of all survivors.
Support trauma-informed practices in schools. In a trauma-informed school, all of the adults in the school community are prepared and resourced to recognize and respond to students who have been impacted by trauma and toxic stress. Systems and structures are built to address the underlying context that impacts students behavior. As your Congresswoman, I will continue to champion critical investments in trauma informed education and specifically advocate for additional increases in flexible funding to support innovative local efforts on this front (through the Every Student Succeeds Act Title IV A) and new legislation calling for a trauma informed education toolkit highlighting evidence based approaches jointly developed by HHS and the Department of Education.
Environment

Support the Climate Change Health Promotion and Protection Act. Climate change presents a number of serious threats to public health, including longer heat waves, more frequent extreme weather, and decreased air quality. The Climate Change Health Promotion and Protection Act would put public health considerations at the forefront of our national response to climate change; introduced by Senator Ed Markey, the legislation would direct "the Secretary of Health and Human Services to develop a national strategic action plan and program to assist health professionals in preparing for and responding to the public health effects of climate change."
Streamline data collection on environmental conditions and health outcomes. What gets measured gets done, and while there are many disparate sources of data at the federal level about environmental conditions and public health outcomes, streamlining these multiple data collection functions would meaningfully improve our ability to connect health outcomes to environmental hazards, and ensure that we design solutions that work for all of our communities.
Housing

Promote Medicaid support for housing-related services. Access to safe and healthy housing is inextricably linked to health outcomes, and we should make major funding streams like Medicaid more accessible to address housing challenges. I will support legislation that would open Medicaid as a funding source for housing-related interventions shown to improve health outcomes.
Advance the Affirmatively Further Fair Housing rule introduced by President Obama. In 2015, the Obama Administration introduced rules requiring municipalities to proactively address housing policies that lead to segregation and disparate outcomes. But the Department of Housing and Urban and Development (HUD) under Donald Trump has delayed implementation of the rule for several years, threatening progress that has been made to close gaps in health outcomes, wealth, and opportunity that flow from unequal housing choices.[20] In Congress, I would fight to advance this rule on its original timeline and promote equitable housing policy.
Expand vouchers for affordable housing. The Housing Choice Vouchers (HCV) program, the nation's largest rental assistance program, provides rent subsidies to low-income families in the private market. Unfortunately, just one in four eligible families have access to this popular program.[21] Stable housing greatly impacts physical and mental health outcomes. In Congress, I will push to review HCV and expand subsidies so that more households in the 7th Congressional District and beyond can afford to choose where they live.
Transportation

Adopt A Regional Multimodal Transit Solution. At a time of rapid economic development, increasing income inequality, increasing transit ridership, and environmental degradation across the 7th Congressional District, I will champion regional multimodality by creating the Congressional Transportation Equity Caucus. A critical element of ensuring that all of our communities have access to safe, active modes of transportation is being a champion for increasing investments in synthesized network hubs, including subways, walking and biking infrastructure, and gold standard bus rapid transit (e.g. dedicated right of way, busway alignment, off-board fare collection, intersection treatments, and platform level boarding).
Expand Funding for the Department of Transportation's Ladders of Opportunity Program. In 2015, the U.S. Department of Transportation launched the Ladders of Opportunity Transportation Empower Pilot (LadderSTEP) program, a pilot program designed to leverage transportation projects to generate sustainable economic development. Working closely with seven cities across the country, DOT provided funding and technical support to advance multi-modal transportation projects that included public transit, walking and biking infrastructure. To substantially improve the 7th Congressional District's transit network and provide more high quality, high-frequency on-street transit options, we need to expand funding for community-driven, public-private multi-modal transportation development.
Healthy Food

Build an equitable and sustainable food system in the 7th District. Too many of the residents in the 7th Congressional District live in "food deserts" and lack access to local produce and healthy meals within walking distance. I will advocate for federal tax credits and grants to build full-service grocery stores in underserved areas, and incentivize smaller retail markets to sell healthy and affordable foods. Everyone deserves access to affordable and healthy foods, no matter where you live.
Support the Healthy Food Financing Initiative. Created in 2010, the Healthy Food Financing Initiative leverages programs at the U.S. Department of Agriculture (USDA), Treasury, and Health and Human Services (HHS) to provide financial support for the development of grocery stores and other healthy food options in underserved communities. The program has provided millions in federal grant funding for organizations and municipalities in Massachusetts - where Chelsea and Everett rank among the cities with the largest gaps in resident access to supermarkets - but proposals like the recently-failed Farm Bill threaten to erode support for the program. As your representative in Congress, I will advocate for increasing resources for this program.
Co-Sponsor the Farm to School Act. For many children, school is the only place they regularly have access to a meal. I will support this legislation to expand access to healthy local foods in schools, while boosting economic opportunities for family farmers. This bill will build upon the USDA Farm to School Grant program and will increase program funding, expand access to preschool, summer and afterschool programs, and encourage participation for a broader range of beginning, veteran, and socially disadvantaged farmers.

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