What politicians don't say about Medicaid and human trafficking victims

Ask members of Congress about human trafficking.

They may describe victims exploited for labor or forced to sell sex right here in the United States. They may reference last month's unveiling of the State Department Report on Human Trafficking touted by first daughter Ivanka Trump.  Some may proudly tell you that they sit on the bipartisan Senate Caucus to End Human Trafficking.

Then ask them how the Better Care Reconciliation Act, the Senate GOP's plan to dismantle the Affordable Care Act, will help trafficking victims.

And they may remain silent.

I am a family medicine physician who has worked in Philadelphia and New York City for three years, and I know how the BCRA will affect trafficked people: It will unequivocally harm them. I know this because I run the Institute for Family Health's PurpLE Clinic (Purpose: Listen and Engage) in New York City, which provides health care for human trafficking survivors. The survivors I work with are of all genders, ethnicities, ages. Some have been without necessary health care for years, facing complications from untreated infections, undiagnosed diseases, addictions and complex trauma. And every single survivor is uninsured or on Medicaid.

Before starting the clinic, I met with women who had experienced sex trafficking in the U.S. and asked them about their health-care experiences in order to design a survivor-informed primary care clinic. To my surprise, unprompted, Medicaid kept coming up:

"Skylin" was sold for sex by three different traffickers in at least 10 different states since the age of 15. When asked about seeing a doctor during and after being trafficked, she said:

"You know what?  I never, never, ever, ever … even to this day, not that I don't want to … but I lost my Medicaid … my Medicaid was taken away.  Ever since then, I never pushed the issue to go to a doctor. … And that's not good. … I don't have a doctor or anything like that."

"Alice" gave advice based on her attempts to connect with health-care services when she was no longer being trafficked:

"I've never had therapy because I've never had the health insurance to be able to do therapy.  Now that Obamacare is in effect … it's cheaper and more affordable for people my age."

Because her mother had an addiction, "Em" was sold for sex to pay for drugs:

"I didn't have Medicaid.  I was homeless … the hospitals … they have to take you because you're going to try to kill yourself. … I wound up getting a bill in the mail."

This clinic forces me to reckon with the gravity of what out-of-pocket costs can mean for my patients: being exploited for longer hours or sold to more buyers to pay for the medical visit and compensate for taking time off.  Block grants and special victims funds are insufficient to address the insidious nature of trafficking, and fall short of reaching the broad numbers of victims needing access to care. Traffickers certainly do not consider which states have expanded Medicaid benefits when deciding where to exploit their victims.

I have watched Republicans and Democrats come together to combat human trafficking as a domestic concern that transcends party.  But the mantle of fighting human trafficking does not belong to those who find it politically fashionable. It requires champions who recognize the social determinants of health that make one vulnerable to being trafficked, and the medical needs of those who are experiencing or have survived this abuse.

Senators who tout the horrors of human trafficking must choose between supporting survivors or supporting the BCRA.

Anita Ravi, MD, MPH, MSHP, is the founder and clinical director of the Institute for Family Health's PurpLE Clinic