From Civil Rights to the ACA: House Majority Whip James Clyburn on Fight for Health Equity in America

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Mark Masselli : We're speaking today with Congressman James Cl yb urn House
Majority Whip and third ranking Democrat in the US House of
Representatives. He was elected to Congress in 1993 , l ater serving as
C hairman of the Congressional Black Caucus and C hair of the House
Democratic Caucus. He has been assistant Democratic l eader of the
H ouse since 2011. Hi s 2015 memoir, blessed experiences , G enuinely
Southern P roudly Black has been hailed as a pr i mer for anyone
considering going into public service. Congressma n, welcome back t o
Conversations on health C are.

James Clyburn: Thank you so much for having me.
th
Mark Masselli : Yeah, we're so proud to have this conversation with you. It's our 500
show , a nd certainly we have watched your career with great
admiration . Y ou entered into public service early as a civil rights
activist in your native South Carolina. It greatly informed the work you
continue to do today . Y ou were instrumental in the passage of the
st
Affordable Car e Act, which you've called the civil rights a ct of the 21
century, and it's still the law of the land, though it's run through a
gauntlet of challenges. Tak e us back over this past decade and tell us
what you're most proud of around this ACA having been passed.

James Clyburn: W ell, you mentioned that I often refer red to the Affordable Care Act
st
as civil rights act of the 21 century. I did that in large measure based
upon my own experiences and my connections with the Civil Rights
Movement . You recall, that Martin Luther King Jr. said , that of all the
inequalities that exists, the injustice in health care is the most
shocking and inhumane. W hen you think about the life and death
decisions that have to be made, I think about my own mother who
died at the age of 55 of multiple myeloma . I remember her sayi ng to
me on one occasion, if I don't have a chance to get well, I don't want
you all sp ending all of my savings, i f I don't have a chance . Well, we
knew she did not have a chance , a nd we did spend all of our savings.
It was in la rge measure because she had a j unk policy , she ha ve what
she thoug ht was a good health care policy, she paid into it religiously,
but it was all gone in two months.

T hat takes me to what I think was the best thing about the Affordable
Care Act. A lot of people say it's because of pe ople, recovering people
with pre existing conditions , t hat's not the best strength to me. The
best strength to me was not being able to kick people off the health
care policies, o nce they got s ick . T hese j unk policies that people
bought found themselves, m any of them in bankruptcy. The things
that people don't talk about in the Affordable Care Act are things that
I think are very, very important. T he 80 - 20 rule that you must return
in the form of benefits to your policy holders at least 80% of the
premiums, and if you don't, you have to send them a refund check .
That 80 - 20 rule, no more than 20% of the premium cost can go to the

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insurance companies. These are things about the Affordable Care Act
that never get talked about , a nd I think the y are most importan t
thing s that we did . All that we have is sort of a civil rights order to it.

Margaret Flinter: Well, Congressman, thank you for highlighting each of those areas
a nd of course for recalling those words of Martin Luther King, wh ich I
think it's safe to say we recall and live by a ll the time. But ti me has
gone by since the passage of the ACA we've lived through years of
being able to see its impact. In recent years, partisan politics certainly
has become the status quo . W hat we’re seeing is that the divides a re
not only drawn along party lines, but it seems racial lines as well as we
saw with the singling out by the White House of lawmaker s of color
for personal attacks. W e see these ongoing efforts to undermine the
Affordable Care Act , a nd of course, we've se en bills that would move
the agenda on health care and other social issues forw ard being
stalled in the Senate. Y our thoughts on how we rise above the current
partisan stalemates to address some of these big challenges that
everybody in the nation is facin g.

James Clyburn: Well, I say to people all the time, we have to really come to grips with
the fact that our society moves like a pendulum on the clock , will
always going back and forth. This country has move d left for a period
of time, then it tops out an d goes back right for a period of time.
T hat's the way the country has always been , b ecause when you have
a kind of system of government like we have , emotions tend to set
the tone for stuff. We topped out to the left with Barack Obama, f rom
the moment he was s worn in , the country started going back to the
right . It seem ed to have topped up with the current occupier of the
White House , a nd already we see polls indicating that the country is
moving back to the left.

W hat we have to do is to stay engage d and be vigilant and make sure
that the country doesn't go too far left or too far right . W h en the
pendulum i s going left to right and right to left , i t’ s passing through
the center, which means we spend twice as much time in the center
as we do to the left or to the right. T o me that ’s what we have to do,
be vigilant. I remember speaking with Desmond Tutu on the evening
before Barack Ob ama was sworn in. W hen it my time to speak, I sort
of would often attributed to Thomas Jefferson, that the price of
liberty is eternal vigilance . We were celebrating victory of Barack
Obama. We validated our beliefs a n d the dreams. Martin Luther King
Jr. had been validated by that victory.

W hile we were celebrating those Vs we left vi gilance , we passed
Afford able Care Act residenc e and went on to do something else. We
didn't go out and explain to people exactly what it was that we had
done. I venture to say th at I've mentioned this morning a couple of
things that most people never even focus on those in the Affordable

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Care Act , a l ot of people don't know that 80 - 20 rule is there because
we didn’t go out to tell them. We were not vigilant, celebra ting
victories, validating our exist ence , b ut we did not go to that other V .

Mark Masselli : I want to talk a little bit about the center, t he right and the left coming
to the center. I want to talk about community health centers .

James Clyburn: Sure.

Mark Masselli : W hich you have would you have been supportive of, and I want you
to know that when we were starting our health center back in 197 2, it
ran through South Carolina . A young woman left Florence, South
Carolina and she made her way to M iddletown, Connecticut , Lillian
Reba Moses . R eba was with us w hen we started, she chaired our
board of directors. She just brought in credible influence i nto the work
that we do. But it reminds me that people, rich people, poor people,
people on the right , people on the left came together to support
community health centers. Y ou and Senator Bernie Sanders and
o thers have introduced a program that really con tinues to expand on
that. I'm wondering if you could talk a little bit about that bill, but talk
about the role that you see health centers playing all across this
country.

James Clyburn: I go way back more than 50 years with community health centers .
Star ting out studying what was going on up in Massachusetts,
[inaudible 00:08:22 ] . The n I think it was a book that Fritz Hollings,
which I mentioned when I eulogize d him , The Case Against Hunger .
When he wrote that book, and in consultations with Dr. Getz down in
Gifford, they thought [inaudible 00:08:39 ] comprehensive health care
center , so I've been involved through all of that . I still believe that the
ultimate health c are safety net in this country to me is the health
centers . I think that that w hy I work a s hard as I can to strengthen
them , b ecause those community health centers , if you bring people
together, organize around and that's what community health centers
are all about . B ringing local people together, developing approaches ,
being involved in their own health care and doing it from a
community perspective.

I think that it provides a safety net like nothing else can. I do believe
that w e will strengthen these centers w ith this new effort that I've
undertaken, and that is r u ral broadband deployment. I think that
every community health center ought to be a hotspot. The
c ommunity health c enters need to be connected to teach ing
hospitals, an d they can do that through t ele health. I just think
between community health centers, rural hospitals, t ele health
pr ograms, I think we could have the ultimate delivery of effective
healthcare to everybody in America. I'm all for getting 100% coverage
of community health centers throughout this country. I'm pleased to
work with Bernie Sanders to try to get that done.

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Mar garet Flinter : Well, Congressman for all of us engage d in health center work, when
we look at the nearly 30 million people that get their care in
community health centers, one thing that underlies so much of their
lives is poverty, right? We know poverty a s a independent variable
plays a huge role in health outcomes for individuals and families. W e
are so interested in the anti - poverty bill that you've recently co
sponsored along with Senator Cory Booker, which really is seeking to
address so many of these upstream causes of ill health. How does this
bill seek to mitigate the effects of income ineq uality, poverty in this
country?

James Clyburn: W hen we were putting together the so called recovery package, the
stimul us bill, I remember saying in our very firs t bipartisan meeting, I
said to the bipartisan group that day that we could not put together a
recovery package that would do to the community that I represent
what the last big recovery package did , we call the new deal. The new
d eal left too many people out, left too many communities out.
S omeone asked me, w ell, what would you do? I said to them, I would
take the census results, the Census Bureau has determined that every
community w here 20% of the mortal population [inaudible 00:11:35 ]
level for the last 30 years is categorized as a persistent poverty
community. W hat I thought we ought to do is say , when we put this
bill together let us stipulate that at least 10% of this money must be
invested i n those communities with 20% o f mortal populations, the
[ina udible 00:11:53 ] for the last 30 years. They thought it was an
intriguing idea, but t hey weren't too sure how it w ould work.

T hey let me do it in four sections of the agricultural plot of the
Recovery Act, it worked famously . Senator Booker and I have
spon sored legislation that wi ll expand this into census track s so that
we won't leave urban communities out , b ecause there are a lot of low
income communities. For instance, Kings County, New York, that's
parts of Brooklyn, it’s a persistent poverty c ounty . T h is bill is working
famously, the new emergency health care facility in Bamberg County ,
South Carolina was built because of 1020 30. W ater systems being
installed all over rural communities because of the 102030 and
nothing is more paramount to good health t han safe drinking water.

I just think that if you look at what we're trying to do with this is really
an anti - poverty program . Bernie Sanders like d to refer to it as being a
form of reparations. W e think it something that's an effective way to
battle pover ty without putting gender or race or any other
classification on it, nothing other than the income levels that exist in
communities.

Mark Masselli : We're speaking today with Congressman James Cly burn Majority
Whip and third ranking Democrat in the US House of Representatives.
Congressman Cl y burn , hallmark of your leadership in Congress has

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been the focus in on addressing racial disparities. One thing that
makes us smile is a recent study conducted by Yale concluded that the
passage of the Affordable Care Ac t significantly improved access to
cancer care for people of color, who typically suffer far worse
outcomes. One of the things that we've been worried about is that
too m any of the studies that have done do not represent all of us.

One of the programs that we were involved in as our health center is
the NIH A ll of U s initiative, really focus ing on having a research study
that represents the true color of America. I know you have focused
intensely on this area of trying to make sure that not only the access
in the treatment is there, but also the fundamental research, but I
know you're working to make progress in this area. Could you talk a
little bit about the work you're doing?

James Clyburn: Yes, I am , b ecause we have to admit that we have not -- these cli nical
trials have not taken place with enough people of color involved in it.
We come up with a lot of solutions based upon clinical trials that have
not been broad enough to make solutions applicable to people from
every walk of life. There's a reas on my skin is the color that it is , a nd
that needs to be taken into account when we ’re doing clinical trials. I
am very pleased with the study of Yale. In fact, my granddaughter,
who's now at the M edical University of South Carolina, did a summer
up at Yale doin g research two years ago, looking at diabetes, and why
it is that diabetes is so much more prevalent among people of color
than it is among others. We're not going to know the answer to those
questions unless we make sure that the clinical trials or what - - and it
could very well be bec ause of the environment . Then we have to look
and see w hy is it ? I s it because of living patterns ? A ll these living
patterns voluntarily, or have they been forced? So yes, I do spend a
lot of time trying to make sure that cli nical trials include everybody.

Margaret Flinter : Well, Congressman, the house recently passed another
groundbreaking measure , the Equality Act , seeking to advance
protections for all Americans from discrimination of any kind, and
particularly for the LGB T Q community. M aybe no surprise, there's
been pushback against such protections in certain parts of the
country. But tell us how this legislation will advance and protect basic
civil rights for all Americans ?

James Clyburn: This law is a great law, I've wo rked hard to pass it. Now, here's the
thing that I think we have to be careful of in all these kinds of laws.
T his is the debate that we are having now with things like Medicare
for all , and that is making sure that we put these bills together in such
a wa y that nobody will feel that you are disrupting that which already
exists. T hat is we would get on this battle for years. When I was
Majority Whip before we had this issue, what we had to do was to
make sure that the people in the civil rights community fe lt

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comfortable that what we were doing with this legislation wouldn't
uproot some of the laws that have already been built upon the 1964
Civil Rights Act and the 1965 Voting Rights Act. W e took a lot of time
to make sure that t he civil rights community, th e L BGTQ community
that they were all got on the same page, and we finally got it done.

Now, the next step is for Mayor Pete Buttigieg to continue to run his
campaign and the way he's doing it, and that will grow people's
acceptance of these kinds of laws t o further a cause that needs to be
furthered. My own grandson is very actively involved in Mayor Pete’s
campaign. I was very pleased to see the maturi ty that he and his
girlfriend are demonstrating in working in that campaign because they
feel very strongl y that this is a cause that must be put on the same
level that the civil ri ghts and fair housing laws were passed on. I feel
good about what we did. I think that this campaign that Mayor Pete is
runn ing will add to it and I think by the time we finish the 2020
elections next year, we will have a much broader acceptance of these
issues.

Mark Masselli : Well, that's making us all feel good , s o thank you so much . W e've
been speaking today with Congressman James Cliburn Majority Whip
and third ranking Democrat i n the House of Representatives. You can
learn more about his policy initiatives an d his work by going to
Majority whip .gov. You ca n follow him on T witter @ WhipClyburn.
Congressman Cly burn, thank you for the dedication to lifting up all
Americans for your li felong commitment to public service to the
values that are fundamental to a fair and just society and for joining
us on Conversations on Health C are.

James Clyburn: Thank you so much for having me . I really enjoy it.

[Music]

Mark Masselli : At C onversations and H ealth Care w e want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori R obertson is an award - winning journalist and managing
editor of FactCheck.org , a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US politics. Lori,
what do you got for us this week?

Lori Robertson: Does the Amazon produce 20% of the world's oxygen ? No. T hat
popular factoid is incorrect. Scientists estimate the percentage is
closer to 6 9% , and t he Amazon ultimately consumes nearly all of that
th
oxygen itself. On August 20 , Brazil's space agency sparked a media
frenzy when it released satellite data showing an alarming number of
wildfires in t he Amazon r ainforest over the past year. N early 40,000
or a 77% rise compared with the same time period in 2018. Most of
the fires have started since June. As news outlets across the globe
picked up the story, journalists began to spread this false but catchy

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factoid that the Amazon produces 20% o f the world's oxygen.
Politicians then joined in, including Senator Kamala Harris, and French
President Emanuel Mac ron, but scientists say the 20% figure is
overblown. Not only is the number too high by at least half but it also
obscures the fact that the Amazon consumes almost all of the oxygen
it produces.

Plants suck up about half of the oxygen they produce as they , like
humans , re spire using oxygen to break down carbohydrates to grow
and survive in the inverse reaction to photosynthesis. The remaining
h alf or so of the Amazons oxygen is consumed by other creatures,
mostly micro organisms, which help decompose d eadwood and other
rainforest debris. The Amazon isn’t critical because it makes oxygen
for humans to breathe , that was largely done by phytoplankt on in the
sea over millions of years. Instead, it's because of the area's rich
biodiversity , i ts vast stores of carbon and the way the forest
influences the local and global climate.

The Amazon fuels the local wet climate as trees absorb water and
then rel ease much of it into the atmosphere as water vapor. In term s
of limiting climate change, p reserving the Amazon is incredibly
important because of the immense amount of carbon stored within
the forest. Scientists suspect an absent Amazon would alter
conditi ons elsewhere on the globe, changing how heat is spread and
where vegetation grows. T hat's my fa c t check for this week. I'm Lori
Robertson Managing Editor of FactCheck.org.

Margaret Flinter : FactCheck.org is committed to factual accuracy from the country ’ s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you ’ d
like checked, e - mail us at www.chcradio.com , we ’ ll have
FactCheck.org ’ s Lori Robertson check it out for you here on
Conversations on Health Care.

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives . Asthma is one
of the leading causes of trip s to the emergency room for children.
T here are often a correlation between high density low income
neighborhoods and more trips to the hospital for treatment and
inter vention. When officials at Boston Children's Hospital notice d the
spike in asthma outbre aks in certain neighborhood clusters t hey
decided to do something about it. They launched t he Community
Asthma Initiative t hey realize that if you could treat the environments
in the patient's home that might reduce the need to treat the patient
in the eme rgency room

Dr. Elizabeth Wood : The home visiting e fforts work with children and families that have
been identified through their hospitalizations and emergency room
visits as identification of having poorly controlled asthma and also it's

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a teachable mome nt.

Mark Masselli: Dr. Elizabeth Wood heads the program and says, t he first step is to
identify the frequent flyers . T hose kids who make repeated trips to
the emergency room. Then they match with the community health
worker who visit their home several tim es and assess es the home for
asthma triggers.

Dr. Elizabeth Wood: T hey work on three areas , understanding as much it self ,
understanding the medications and the need for control medications
and then working on the environmental issues.

Mark Masselli: Famil i es are given everything from HEPA filter vacuum cleaners to air
purifiers . T hey are told not to clea n with certain toxic products and
the homes are mon itored for the presence of pest or rodents. The
result says Dr. Wood , has been pretty dramatic.

Dr. Eliza beth Wood: What's remarkable is that there was a 56% reduction in patients with
any emergency department visits and 80% percent reduction in
patients with any hospitalization.

Mark Masselli: W hile this program is expensive, there is a return on investment in
reduced hospital costs and healthier children. The program has been
so successful i t's been deployed in other hospital communities around
the country. The Community Asthma Initiative , a simple re - shifting of
resources aimed at removing the cause of dise ase outbreaks in the
community, leading to healthier patient populations , n ow that's a
bright idea.

[Music]

Mark Masselli: You ’ ve been listening to Conversations on Health Care. I ’ m Mark
Masselli.

Margaret Flinter: And I ’ m Margaret Flinter.

Mark Masselli: Peace and health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected], or find us on Facebook or Twitter. We love hearing from you. This show is brought to you by the Community Health Center.