Cruel Summer

14 million people cut from their insurance coverage with the stroke of a pen.  That probably sounds like an exaggeration designed to grab eyeballs, but it’s not. melting popsicle crop  That’s actually what the experts at the Congressional Budget Office predict will happen over the next ten years if the Medicaid cuts in the GOP’s health care plan go into effect.  That’s just the Medicaid cuts – it doesn’t factor in at all the losses among those on private insurance plans.*

Now, I know there may be people who are tempted to tune out when the topic turns to Medicaid, because they think it doesn’t affect them or their families, and the whole program might just seem foreign to them.  But please, stay tuned.  There’s a good chance someone you know & care about is touched by Medicaid, even if you don’t realize it.   And there’s a good chance too that one day your life will be affected by the program.  That is, assuming the program is still there . . .

Since the Medicaid cuts are such a huge part of the GOP’s “health care” plan, today’s post is a round-up of articles on that topic:

1.  In addition to the unprecedented secrecy the GOP is using to get their health care bill passed, they have another bit of sneakiness up their sleeve: they are using Obamacare repeal to do something that’s long been on their wish list but which they could never pull off directly: slash Medicaid.  Cutting Medicaid by 25% any other time – when it wouldn’t be hidden behind the “Obamacare repeal” label – would be politically untenable.  So they’re seizing this opportunity while they can.

One part of the Medicaid cut in the repeal plan is a roll-back of Obamacare’s Medicaid expansion. But then the Republican bills go beyond that to make cuts to the traditional Medicaid program that existed for decades before Obamacare.  The House bill had $830+ billion in cuts to Medicaid overall, which the CBO said would lead to 14 million people losing Medicaid coverage over the next 10 years.  Rumor has it that the Senate bill makes even more severe cuts to the traditional Medicaid program, i.e. the portion of the Medicaid program that existed before Obamacare, which almost certainly means even more people will lose coverage under that plan:

Senate Republican leaders are reportedly considering lowering the annual increase in state Medicaid funding under a per capita cap below the House bill’s already inadequate rate starting around 2025. That means states would have to absorb even deeper cuts in federal Medicaid funding than under the House bill — which would cut federal Medicaid spending by $834 billion over ten years and slash enrollment by 14 million by 2026, relative to current law, the Congressional Budget Office (CBO) estimates.

2.  But Republicans will try to convince us that their bill is actually a kinder, gentler bill because it phases out the Medicaid expansion more slowly. They’re doing this because there are several Senators whose states have benefited tremendously from the Medicaid expansion, and they’re nervous about voting for a bill that ends the expansion.

So they think they can fool their constituents into believing that cutting the expansion over the course of a few years doesn’t actually mean cutting the expansion.  But this “compromise” would have essentially the same result as the House bill in terms of the coverage losses.  And most states would likely have to end their expansions immediately anyway, due to the way the federal cost matching works.

3.  There is a common misconception that most people who receive Medicaid are able-bodied people who just don’t feel like working. It’s this stereotype that makes it easier for Republicans to target Medicaid. But it’s very far from the truth.  On the Medicaid expansion, specifically, half of the people covered are permanently disabled or have serious physical or mental limitations and . . .

Of the other half, who might be viewed as “able-bodied,” 62 percent are already working or in school and 12 percent are looking for work; only 25 percent are not currently working or in school.

Only 13 percent of adults covered by Medicaid’s expansion are able-bodied and not working, in school, or seeking work. Of that small group, three-quarters report they are not working in order to care for family members and the rest report other reasons, like being laid off.

Many Medicaid recipients are people who work at low wage jobs that don’t offer insurance.  They don’t make enough to at these jobs to pay for private insurance.

And about a fifth of enrollees are disabled or elderly – they account for nearly half of Medicaid spending.

4.  And for the Medicaid program overall, almost half of the enrollees are children.  The Medicaid cuts will be especially damaging to children with special needs.

Nearly three-quarters of children with special health care needs are in families with low or middle incomes.  Medicaid, along with other forms of public insurance, covers 44 percent of children with disabilities and special health care needs, serving as the sole source of coverage for over one-third of these children.  Medicaid also provides supplemental “wrap-around” coverage for many children with special health care needs who have private insurance, providing services not covered by private insurance and making the services they need affordable for their families.

5.  On the topic of how Medicaid assists the elderly, this NY Times op-ed by three health policy analysts makes the point that You’re Probably Going to Need Medicaid.

Roughly one in three people now turning 65 will require nursing home care at some point during his or her life. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren’t “like them.” But Medicaid is not “somebody else’s” insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves . . .

Medicaid pays nearly half of nursing home costs for those who need assistance because of medical conditions like Alzheimer’s or stroke. In some states, overall spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending . . .

AARP tweet crop

6.  And this excellent piece by Jonathan Cohn of HuffPo has been making the rounds on social media. It’s an eye opening look at how big a role Medicaid can play in the life of the disabled.  Justin Martin, a college student with cerebral palsy, opened up and shared his daily life with Cohn in order to help all of us understand what a positive impact Medicaid has made for him by allowing him to go away to school and live independently:

Martin’s father, who lost his factory job several years ago, drives trucks for a living. His mother, who used to work in state government, now has a job at a university. That position provides health insurance, but the plan, like most commercial insurance policies, wouldn’t cover the array of equipment and services Martin needs ― especially the ones that allow him to live independently. Medicaid, in combination with some other government programs, does. And now some of that coverage is at risk because of Republican efforts to repeal the Affordable Care Act.

If you have time, please read the whole article.  The excerpt doesn’t do it justice.

7.  VoteVets.org, a progressive leaning veterans advocacy group, wants people to know that approximately 1.75 million veterans get health coverage through Medicaid. It’s unclear exactly how many of those would lose coverage under whatever GOP plan ultimately emerges as the final plan, but the 340,000 veterans who are covered under the Medicaid expansion would almost certainly all lose that coverage.

Not all veterans qualify to receive health insurance through the Department of Veterans Affairs (VA). Eligibility relates to a variety of factors, including minimum service requirements as well as disability and discharge status. According to the Veterans Administration, in 2014 only 40 percent of all veterans were enrolled in the VA health care system. Furthermore, veterans’ family members rarely qualify for VA assistance.

8.  And here’s an indication of just how reckless and senseless the GOP plan is: the group hardest hit by the rollback of the Medicaid expansion would be rural Americans, a.k.a. Trump’s base. A new study shows that in rural America, Obamacare led to an 11 percent decrease in the uninsured rate, compared to a 9 percent drop in urban areas.

Rural areas have larger Medicaid populations because more people with disabilities live there, household incomes tend to be lower, unemployment rates higher and jobs with employer-paid insurance less common, the Georgetown report said.

9.  It’s been really stunning how the GOP has been able to get this close to pulling off this drastic reduction in the safety net – entirely behind closed doors, with no hearings or consultation from experts – with barely a batted eyelash from the media.**

My Monday roundup of health care news attempted to convey just how outrageous the GOP’s secretive process has been, and last week I posted about how shockingly unprepared the Democrats and the media have been to respond to it.

Well, Brian Beutler warned us all the way back in December that this would be coming.  In an article titled, Trump’s Distractions Will Provide Republican Cover to Rip Apart the Safety Net, Beutler predicted:

Covering major legislation is grueling, complicated work that doesn’t generate a return-to-clicks in the way a Trump rally or a Trump tweet does. Many dedicated, hardworking reporters will work insane hours covering the GOP’s decision-making and legislative maneuvers, but much of that hard work will end up below the fold, where much of the public won’t see it. This will insulate the party from blowback while the process is underway, which is precisely when blowback is most needed.

Substitute “Trump Russia story” for “Trump rally” in that first line, and Beutler was, unfortunately, dead on.

10.  And lastly, speaking of ripping apart the safety net, during the presidential campaign, Trump explicitly promised he would not do that.

This was one of the ways he distinguished himself from his GOP rivals during the primary.  Now we see him breaking that promise on Medicaid (in addition to the cuts in the health care bill, Trump’s budget proposal cuts another $600 billion from the program).  Why should we trust that Social Security & Medicare won’t be next on the chopping block??

*****

Notes: 

*And of course, this is also setting aside the damage to the people who manage to keep insurance, yet find it’s virtually worthless to them because it no longer covers the services they need.

** Over the last few days, there have finally been stories on tv, and the print coverage has grown, but it’s still getting very scant coverage for something that should be an enormous scandal (the tv news is still disproportionately filled with stories about the Russia investigation, Trump’s nutty tweets, and other more titillating scandals).

***Photo Credit: Creative Commons Pop Life by Alex Cherry is licensed under CC BY-NC-SA 2.0.

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