By Ramona Rose, Member of Southeast PA Healthcare Committee
If there is one thing that no one likes when it comes to scheduling doctors appointments, it is the concern of insurance standing in the way. Whether it’s with an NSI number just so you can see a specialist, or being told you cannot access a specific medication because it’s “not covered,” a firm denial of benefits when you need them most will always remain the hassle that it is: health insurance puts profits over people. To have the ability to make my own medical decisions should be clear and simple. When I know I am sick or when I know my loved ones are sick, I take care of my needs and their needs because I am present in the situation. An insurance company is not present. It is only present in-so-far as it will be paid for services that they are claiming to cover but then can choose on a whim to not cover at all. Why is this? Because if the insurance company is not making a profit to give to their shareholders, then the venture is not worth the cause. That leaves us – the everyday folks, the working class – the people who are most affected by these sudden whims to worry and stress over what to do. What is a common experience we all share? Having the insurance company swoop in and tell us what we deserve in our health care, and what THEY are willing to pay out for it. All in the name of a shareholder making extra money without putting in the work.
When I was a teenager, I had a lot of discomfort with my body as well as anxiety and depression. I did not like shaving; I did not always like my breasts; and don’t get me started on periods. I was diagnosed with Premenstrual Dysphoric Disorder (PMDD) due to my sudden changes in mood and overall dysphoria of my body during the time of my menstrual cycle. As a teenager I had an irrational fear of losing friends if I so much as shared my experiences regarding my diagnosis. But in order to protect myself, I had to hide my true feelings about the perception I had of my body which took a mental and emotional toll back then. It would not be until much later in my life that I would realize I was genderfluid and learn to accept myself.
I consider now what gender-affirming care might have looked like had it been an option when I was a teenager going through all those experiences. Since 2014, gender-affirming care has been covered under Medicaid. Being denied that ability to take care of myself played a pivotal role in my overall health. I felt unworthy of care. In reality, I know I am worthy of care but what does that mean for others who have similar feelings and experiences regarding their health? It hurts us when we are made to feel that we do not deserve access to healthcare when in dire need.
However, having the ability to make healthcare decisions for myself precludes that I have access to healthcare. It is still hard to obtain any kind of health care if you are poor, working class, or a person of color. A major obstacle that keeps us from obtaining healthcare is insurance benefit denials. Medicaid offers many kinds of services to people of various backgrounds and identities. When I was on Medicaid in 2018, it relieved me to know I would be able to obtain affordable medications and seek care when I needed it. However, insurance companies are only interested in for-profit needs. The money in the palm of the company’s hand holds more value than the mind and physical health of any given person. A patient and their care is considered to be a transaction of goods rather than a continuation of overall health. For example, a patient might have a conversation with a doctor about gender-affirming care and/or HRT and be ready to start the process. But insurance, acting as the middleman, can tell that patient the dosage for their HRT does not meet the guidelines and parameters set and enforced by the insurance company. All kinds of care are denied by insurance, not just gender-affirming care. A plan of care is firmly established between the patient and the doctor. Yet someone who has no experience in the medical field gets between the patient and their ability to obtain medication from the pharmacy or a procedure that might save their life. We know what we need to take care of ourselves. The doctor knows how to give patient care on the ground. Why must an insurance company have final say in this decision?
I can only imagine our country’s children becoming adults and having to navigate Medicaid and insurance for the first time. Insurance companies should not have the final say in our health care. It is not just trans youth and adults who are affected by this. EVERYONE is affected by this!. Keep in mind that even though I refer to my plight as a member of the trans community, there are so many examples within our communities that need healthcare as a whole. Men, women, and children in this country muddle through the same issues with insurance denials. If we had the right to healthcare, we would not be struck by the worries and constraints of this system. In order to do that we must organize across all these lines that divide us! We can puncture the bureaucracy. Our organization, Put People First PA, assists those affected by our burdening healthcare system. We have assisted with the reversal of medical bills. We helped community members fight insurance denial claims, and had them appealed! We can fight for our right to healthcare so no one will experience the pain of denial.
By Put People First! PA South Central Healthcare Rights Committee
From late February to late March of this year in Lancaster County, PA, the ruling class strategy of deflection through divide and conquer tactics was carried out by City, County and State elected officials.
February 27, 2024, Lancaster City Council Meeting: The County government Homeless Coalition share their “cost saving” proposal for the year to close down the only low barrier shelter in Lancaster City at the end of June 2024
The City Council vote on a resolution that reaffirmed Lancaster City’s standing commitment to be a “Welcoming City” to undocumented immigrants
March 2024, Lancaster County Commissioners, Josh Parsons and Ray D’Agostino, attack the Drag Queen Story Hour organized by Lancaster Pride and the Lancaster Public Library, followed by a right wing bomb threat and protest by hate group Moms for Liberty is permitted
March 20th, 2024, Lancaster County Commissioners vote on a resolution declaring the county a “NON Sanctuary County,” and urge other counties to follow suit.
The community as a whole was unaware that these tactics of divide and conquer were being used. Several community members and organizations took action against the attacks on their communities by only addressing what their sector of the class was experiencing instead of uniting together as one.
Besides those under attack not being in step, some members of the working class fell for the fear tactics and false narratives, which led to the working class fighting each other.
Imagine what we could have accomplished if we had ALL banded together based on our needs and against the ruling class agenda, instead of fighting each other.
The Political Geography of Lancaster County
The political geography of Lancaster County is such that the Democratic Party has in recent decades controlled the Lancaster City Government and the Republican Party has in recent decades controlled the Lancaster County Government. In much the same way state politics pit Philly and Pittsburgh against the more rural and central parts of the state, the politics of Lancaster County pit the residents of Lancaster City against the residents of the rest of Lancaster County. Underneath this divide and conquer narrative and politics is the reality that across Lancaster County people are being hurt by the denial of their human rights to healthcare, housing, jobs at living wages, etc.
Across Lancaster County & City both political parties have been united in and beholden to economic redevelopment that enables profits for the few and gentrifies the poor. And in the lead up to elections, in particular national elections, both parties engage on issues in ways designed to rally “their base” to turn out on election day.
In many ways the use of divide and conquer tactics – either via attack or defense – obscure these underlying economic and party interests.
The Republican Party, under the sway of the distorted moral narrative of White Christian Nationalism, blames and scapegoats various segments of the working class for the ills facing society. They refer to these populations as illegal, sinful and threats to social order.
The Democratic Party, neoliberal at its core, feigns concern for the poor, but mostly offers patronizing sentiments (implicitly blaming the poor for their poverty), and leave the poor in the bleachers while the Democratic Party “fights” on their behalf. This leaves the poor demobilized and divided and blocks real organizing and coming together for the kinds of fundamental change our communities need.
The Democratic Party has also taken to co-opting leaders who emerge in different fights into the Democratic Party as part of renewing their party’s connections to populations that have historically been part of the Democratic Party base. When at times these leaders do not fall in line with the official Democratic Party establishment position on different issues, these leaders are thrown to the curb.
Below we look at three examples of this divide and conquer politics at work…
How Power Holders Divided the Working Class
The Attack on the Unhoused
The attacks on the different sectors of the working class began at the February 27, 2024 Lancaster City Council Meeting. At that meeting, the Homeless Coalition, run by the county government via the Lancaster County Redevelopment Authority, shared their “cost saving” proposal for the year. They proposed a plan that would lead to closing down the only low barrier shelter in Lancaster City at the end of June 2024 and instead invest in outreach workers until the Otterbein Church shelter was ready in December.
During the public comment section of the meeting several community members, who were part of a loose ad-hoc advocates collective, spoke out regarding concerns for the loss of shelter beds. While the several Lancaster City Council members and the Mayor expressed concerns, they did nothing to stop the loss of these beds.
The Attack on the Undocumented
At that same Lancaster City Council meeting the Council voted on a resolution that reaffirmed Lancaster City’s standing commitment to a policy that allows local police and government officials to cooperate with ICE only when state and federal law requires such cooperation, but generally restricts police and local officials from asking immigrants for documentation. For such policies, Lancaster City has been certified as a “Welcoming City” since 2019.
Immediately following the City Council meeting Lancaster County Commissioner Josh Parsons accused the Lancaster City Administration of making Lancaster City a “Sanctuary City.” He used social media and local mainstream media to spread false narratives and fear mongering tactics to paint immigrants as potentially dangerous and a strain on our local social service programs.
In the subsequent days other local and state elected officials representing Lancaster County joined Parsons in the hateful attack on immigrants. While some in the community raised their voices in defense of immigrants, there was no general outcry against these attacks. And many community residents fell for the hate rhetoric.
On March 20th Lancaster County Commissioners voted on a resolution declaring the county a “NON Sanctuary County,” using the justification of the County’s need to “follow the law.” Now other townships and boroughs throughout Lancaster County are following suit.
The response of Lancaster city government has been to argue that they are not a “Sanctuary City,” rather than putting forward a strong stance in protection of the undocumented.
The Attack on the LGBTQIA
The same County Commissioner, Josh Parsons, then attacked the Drag Queen Story Hour being organized by Lancaster Pride and hosted by the Lancaster Public Library. Parsons criticized the library, targeted the drag queens and expressed “concern” for the safety and wellbeing of the children.
Many in the community at large were taken in by this attack and made their views known at a subsequent County Commissioners meeting and on social media, speaking to homosexuality and queerness as sins against God. They promoted the idea that townships, boroughs and school boards across the county should withhold funds from libraries that promoted pro-LGBTQ books and activities.
The Lancaster Patriot used their media platform to rally their readers and viewers to oppose the LGBTQ community. Moms for Liberty, who have a concentration of chapters in the Southeast and South Central regions in Pennsylvania, organized a counter protest for the day of the Drag Queen Story Hour. On the night before the event, faith leaders and their congregations hosted a prayer rally in Ewell plaza outside the library in opposition.
The City Administration’s granting of Moms for Liberty (a designated hate group by the Southern Poverty Law Center) a permit for a counter protest, stands in stark contrast to their unwillingness to allow the PA Homeless Union, PPF-PA and Food Not Bombs to organize and distribute food to the homeless in the downtown area.
At the same time a sizable uproar began to build in defense of the Drag Queen Story Hour, and broader LGBTQ community. Those standing with the queer community also spoke out at the County Commissioner meetings, on social media, and planned a wall of love to be a buffer between those attending the story hour and the counter protests made up of mostly Christian Nationalists and hate groups.
Ultimately the drag queen story hour was canceled and the wall of love never happened because of a bomb threat which targeted specific people, Lancaster Pride, Lancaster Public Library and Lancaster Newspapers. The day of the scheduled Drag Queen Story Hour a portion of Lancaster downtown was closed off, including Binns Park, Ewell Plaza and the Library. The closing off of these public spaces affected not only the queer community but also others who use the services of the library, including the unhoused who use the library and that area of the downtown as a refuge from the elements. Sad, because it was actually raining that day.
From Scattered Silos to a Unified Front
For the most part these attacks on different sections of our class led to a defensive response that was fairly siloed. Organizations of the homeless, undocumented and LGBTQ (along with their allies) fought back simultaneously, but not in a coordinated way.
This began to shift at the Lancaster County Commissioners meeting on March 20. There, without any prior planning, advocates for all of these constituencies found each other filling the seats and testifying against the attacks. Seeing their own situation in each other’s fights.
Our South Central PA Healthcare Rights Committee (SCPA HRC) was present in all of this. Having established ourselves through organizing and previous moments of struggle (in particular the fight against the closing of St Joseph’s Hospital, against water shutoffs, and for the rights of the unhoused, decarceration and the rights of those held in Lancaster County Prison) we began to make the invisible, visible.
In county and city meeting rooms, in one on one conversations, signal group communications, and on social media – and then in press conferences and major gatherings like the Poor People’s Campaign: A National Call for Moral Revival’s March 2nd convening in Harrisburg – we called attention to how the attack on these three sections of the working class (and others) was meant to divide us, pit us against each other, leaving us less able to resist both the onslaught of divisive attacks (and siloed responses) and the forward march of the redevelopment machine.
We moved to shift the narrative from the prevailing left vs right frame, to a rich vs poor frame. We engaged in the battle for the Bible, suggesting the hypocrisy of worshiping a homeless man on Sunday and then stepping over, vilifying and criminalizing him — and the refugee and LGBTQ — on Monday.
As we have in the past, we continue to fight for the unity of the leaders who emerged out of these different fronts of struggle.
Combat Divide & Conquer Tactics by Uniting the Poor and Dispossessed: Lessons Learned
In Lancaster, power holders (or elected officials), both DP and RP, both City and County, and on all levels of government, engage and use divide and conquer tactics. These tactics are being used in heightened ways in the lead up to the 2024 presidential election. This is particularly so when it comes to potentially highly controversial issues that can be used by both parties to rally their bases. Of late, the RP has led with divisive attacks and the DP has responded with divisive defenses. This same phenomena is playing out across all of South Central PA. We need to be prepared to understand this and not be diverted from our fundamental mission of uniting and organizing the poor.
We need to see projects of survival (like our people’s clinics) and other basebuilding activities on the right to healthcare / medicaid for all just as vital now as we did when we took on UPMC and power holders over the closure of St. Joseph’s Hospital. We need the rallying energy of a campaign that goes on the offense for our common needs and in doing so organizes and unites our class across lines of division.
We need to work hard in developing our 4 Cs of leadership and see our campaign plan through!
There’s a war on the poor and dispossessed and we must unite, study together, and develop leaders across all lines of division. There’s potential in the South Central PA region for many different community based and statewide organizations to organize together, i.e there’s potential in forming and developing the “new and unsettling force” Martin Luther King Jr spoke of. We need to focus on and deepen our relationships with contacts we have already made.
We must expand our work around the “Battle for the Bible” in the South Central PA region (known as the Bible belt of PA) and deepen our relationships with faith leaders that we’ve connected with over the years and more recently. We need to bring faith leaders and their congregations directly into the work of the PPF-PA SCPA Healthcare Rights Committee and or the PA Poor People’s Campaign.
The attacks on our class, and the rallying of different sections of our class to either the MAGA RP or a “progressive” unrepentant liberal/neoliberal DP, will continue in a vicious cycle. We must organize our class for the long haul to fight for fundamental systemic change, revolutionary change, not reform. We need to kill the system before it kills us.
We need to be very vocal and relentlessly declare ourselves Poverty Abolitionists, especially in this region (our fight to abolish poverty is deeply connected to abolitionist fight to abolish slavery which was strong in this region).
By Rebecca, Northeast PA Healthcare Rights Committee Co-coordinator
My father taught me so much about how to survive under poverty. He would be gone all week, driving day in and day out as a truck driver, but still made time to help our neighbors on the weekends. Sometimes it just so happened that when we were hungry, the exact food that we needed would “fall off” the back of the truck while it was being unloaded. Daddy would say it was an “act of God”.
One summer night in 1998, he called home to talk to us kids. He did that every night, which was quite a feat back then before cell phones became commonplace. His only words were, “Put Alice on the phone.” He never called my mom Alice. The doctors said it was a heart attack, but a month later my Dad went back to work – “AMA”, or Against Medical Advice. The day that my dad left, we were served an eviction notice.
My family was homeless for several months. No matter how hard or how long my dad worked, we couldn’t seem to climb out of poverty. The health insurance cost $120/month because his heart attack was considered a pre-existing condition. The meds cost $60/month out of pocket. He dropped the health insurance and we stopped going to the doctor.
Eventually my dad worked hard to improve our credit and bought a house, and my brother came back from California. When my mom had a stroke, Geisinger sent my dad a bill for almost a million dollars – he had a good laugh about it and threw it in the trash. When my mom died, my dad used her last social security check to pay for her cremation. After my brother lost his job, I gave my dad whatever I could, but they still kept coming up short. My dad and then my brother took out payday loans in order to make up the shortfall.
In the summer of 2022 my dad got a hernia. Fluid was emptying into his groin; his family doctor referred him to a liver specialist in Harrisburg. The night after the surgery my dad complained of chest pain, but it was dismissed as heartburn. In December of 2022, I rushed him to the ER three times. As soon as they got him to a real room, they wanted to discharge him as soon as possible. Repeating this cycle over and over again was torture.
The fourth time that I rushed him to the hospital was in January of 2023. They ran tests and found out that he was having another heart attack, and one of the tests they did showed that he had calcification on his heart. They said any surgery was too risky with the calcification, that he never should have been approved for the liver surgery. I cried and protested that they said he would die without the surgery. They said yes, it was only a matter of time. They gave my dad a prescription for nitroglycerin and discharged him. He only made it another three weeks before we lost him forever.
Poverty sentenced my dad to death over and over again. It sentenced my dad to death when the threat of homelessness forced him to work himself into multiple heart attacks. It sentenced my dad to death when he chose to drink to cope with the stress, which developed into liver disease. It sentenced my dad to death when he decided to forgo doctor visits because health insurance was too expensive. A lifetime of poverty and insufficient healthcare culminated in his death.
Through the Nonviolent Medicaid Army, I learned about a place where healthcare is guaranteed as a human right. In Cuba, every person has a family doctor who cares for you your whole life, and that family doctor talks directly to your specialists in the same building. My father deserved the kind of healthcare where your liver specialist meets and talks with your cardiologist before surgery. Where your whole healthcare team works together. Not some disjointed, fragmented system that runs off of profit. Whose miscommunications result in two months of pain, suffering and untimely death.
By Put People First! PA Base-building Team Coordinators Kristin and Harrison
What are Projects of Survival?
In September 1968, FBI Director J. Edgar Hoover described the Black Panthers (BPP) as “the greatest threat to the internal security of the country”. For many it was thought that this statement was made due to their militant presence and guns but in actuality it was due to the work they did to organize in their communities through what they came to call Projects of Survival (PROS).
Projects of Survival are a form of base-building that help our base meet our immediate needs while strengthening the organization and coordination of our class. The BPP organized within their own communities, met the needs they witnessed and used such opportunities to connect with and organize their base through ongoing political education activities. It is this organizing of the most impacted segment of society as well as their work to connect across otherwise uncrossable lines through the Rainbow Coalition, organizing the bottom, that made them “the greatest threat….”. This led to their ultimate infiltration, leader assassination and incarceration and demise.
In the late 1980s-1990s the National Union of the Homeless took up the practice of carrying out Projects of Survival (PROS) through their nationally synchronized housing takeovers in over 25 cities across the nation building a membership of close to 35,000 members at its height. Although they were able to win concessions in the name of multi-million dollar housing programs in a number of major cities across that nation, they too were infiltrated, undercut and by the late 1990 were in demise.
What makes this type of organizing so dangerous to the power holders we are working to hold accountable? As PPF-PA works to carry out our Theory of Change and the Poor Organizing the Poor Model of Organizing it is our practice of moving beyond charity and mutual aid to carry out these PROS as a form of base-building that helps to meet our base’s immediate needs while strengthening the organization and coordination of our class. This is what makes our base-building centered around our practice of carrying our PROS across the state just as powerful, effective and dangerous.
Why are we committed as an organization to PROS?
PROS take a more common response to need, such as charity or mutual aid, and builds them into organizing opportunities that protest the current conditions causing the ever rising need in our communities, provide us opportunities to base-build among those connecting with our PROS in the most need, provide leadership development for our existing and emerging leaders as they plan, execute and evaluate the effectiveness of each PROS and of course provides a means for us and our base to meet our needs in and call attention to the conditions and crises that exist today in an ever-growing environment of abandonment in the midst of great resource abundance! We engage with, agitate and organize our class, our base, into organization within Put People First! PA (PPF-PA) and the Nonviolent Medicaid Army (NVMA) to find other leaders amongst our base to join us while we build our organization and power to fight back against this “profit over people” society and win a society that PUTS PEOPLE FIRST.
How do we carry out PROS?
There are three main components to carrying out a powerful PROS:
Go where our base is, where they get their needs met
Create a space for such needs to be met
Conduct organizing conversations to engage with, agitate and build relationships with our base across all lines of division, need and location (urban and rural).
There are also three important phases of a powerful PROS:
Plan – where do we go to meet our base? What need do we meet to strengthen engagement? What training does our membership need to fully engage in a PROS? What roles does each member play to ensure a successful PROS? How do we create space for leadership development throughout the process?
Execute – Ensure folks have what they need to carry out their roles. Be flexible in adapting to the needs of the day. Ensure all needed materials are on-site.
Debrief and follow-up – was our location sufficient to connect with our base? Did folks carry out their roles? Who did we meet and how were we developed? Were our organizing conversations effective? Did they encompass all components of an organizing conversation? Who did we connect to? Who will capture contact information for follow-ups? Who will follow up with each new contact? We have a rule in PPF-PA – no PROS is done until the follow up is completed.
In its heyday, the Black Panther Party had many survival programs – from pediatric clinics, to nutrition classes, to martial arts programs. Today, we have to be creative about all of the opportunities to organize our base around their basic needs.
Most recently, we have turned Medicaid appeals into a Project of Survival. For years, we have been signing people up for state benefits like Medicaid and food stamps as a Project of Survival, developing trainings for our members and incorporating this practice as part of our People’s Clinics. Medicaid appeals are simply an extension of this practice of organizing around welfare benefits.
Why Medicaid appeals?
We know that people are still being systematically and brutally cut-off Medicaid en masse. This is an opportunity for us to reveal our class-based healthcare system that is denying us healthcare and killing us every day.
90 million people in this country are enrolled in Medicaid. That is a huge portion of the 140 million! When we are base building, bringing up the Medicaid cuts is a huge advantage in being able to connect with our base. Many people will have direct experience with being cut-off, and this is a great segway to invite them to take action with us.
Appeals give us concrete action to take in response to the Medicaid cuts. By organizing around these cuts through tactics like appeals, we are making the invisible visible. The ruling class is spending millions on cover-up campaigns to make it seem like the Medicaid cuts are over, touting false solutions like marketplace plans as an option for the millions of people who were cut.
Every day we meet another person who was cut off Medicaid. We know that this is going to keep happening to our people, and when it does, they will not know where to turn. That’s where we come in: we can organize people through these crises, showing how their personal healthcare struggle is connected to the class struggle.
Everyone has a legal right to appeal. We can take advantage of this as a base building tactic. Because people are going to continue systematically losing their healthcare, it is extremely useful to have a way to take immediate action that is also a means to build and deepen a relationship with someone.
When someone tells us they have been cut-off Medicaid, we tell them about their right to appeal and encourage them to let PPF-PA help them file. If they agree, we give them a 1-page document about what to expect. After someone gets a notice from the welfare office saying that they no longer qualify for Medicaid, we help them fill out a Fair Hearing Request form and submit it to their County Assistance (welfare) Office. The welfare office will process their appeal and eventually give us a hearing date. During the hearing, a member of PPF-PA can go to support someone as they talk with a judge and caseworker to explain why they think they should still have Medicaid. Regardless of the judges decision, we continue to fight for this person to get healthcare!
So far, we helped 9 people file appeals – all of whom had a favorable ruling out of the 55 favorable rulings statewide. That is a big impact!
