Cossy Hough, LCSW
The discussions and planning for the repeal of the Affordable Care Act (ACA) demonstrate how privilege weaves its way through the decision making processes, and that people in power may not be aware of their privilege or, possibly, that privilege even exists. Arguably, none of the examples of privilege in the ACA conversation have received as much attention as the statement made by Representative Jason Chaffetz (R-UT) in March 2017 when he said “So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care." What this statement appears to show is that Rep Chaffetz is unaware of the day-to-day lives of people who live on limited incomes and often rely on a smartphone, not as a luxury item, but as a lower cost replacement for a combination of home telephone, home computer, and Internet Service Provider. Smartphones can be the only method some families have to get online to perform tasks such as monitoring children’s schoolwork, banking, applying for jobs and even enrolling in healthcare coverage. Rep Chaffetz’s statement shows he speaks from the point of view of someone who is detached from the daily lives of Americans with limited incomes.
Privilege is a necessary concept to understand other’s points of view. It is offers some vital lessons to consider when making policy decisions that will impact millions of people. Since people and their needs are, by nature, diverse, if policy makers attempt to understand the world using only the point of view they know, they run a high risk of making uninformed decisions. Webster’s defines privilege as “a right or immunity granted as a peculiar benefit, advantage, or favor.” Social scientists and those advocating for social justice have taken this concept further and have defined privilege as the (sometimes hidden) advantages that those in power have over those who do not have power. Those with privilege might not be aware of their privilege, but it is nevertheless there, in their values, the decisions they make and, potentially, in how they treat people.
As an example, a person who is white may have the privilege of a mostly positive relationship with law enforcement and so does not worry about police violence when they are pulled over for speeding. A person of color may not have that same privilege. This example spills over into law enforcement and criminal justice policy when decisions are made coming from a perspective of white privilege. As the ACLU reported in 2017 “Bail amounts for black men average 35% higher than those for white men, even when controlling for seriousness of the offense.”
There are many ways the discussions of the ACA and its possible repeal have privilege running through them. Additional examples of privilege are likely to emerge as the GOP attempts to repeal the ACA again, but here are some standouts so far:
Of course, some of structure of the ACA itself is based on privilege; the privilege of an education and a health literacy level that allows understanding of the complexity of healthcare coverage, deductibles and premiums; the privilege of having personal access to the internet, or transportation to someone or someplace that does have access, in order to enroll in the ACA coverage; the privilege of being born into a country that provides some type of healthcare coverage. Ultimately, the ACA didn’t solve all the issues with healthcare in the U.S. but it’s a start, something to build on, until healthcare becomes less about privilege and more about rights.
Will Francis, LMSW
Government Relations Director,
National Association of Social Workers,
Cossy Hough, LCSW
Clinical Assistant Professor, The University of Texas at Austin,
School of Social Work
Anna Stelter, LMSW, MPH
Health Policy Analyst
Texas Health Institute
Alison Mohr Boleware, MSSW
Mental Health Policy,