Happy 53rd Birthday Medicaid and Medicare!
If you don't have health insurance through your employer, you need the Affordable Care Act, also known as the ACA or Obamacare. In New Jersey for over 1.74 million people, that often means Medicaid, the federal/state health care program that covers among others, children, those with disabilities, working families, people struggling with addiction, and those in skilled care facilities (nursing homes.) Yes, there are lots of other plans to choose from under Obamacare, but they often can be costly and next year they may be even costlier.
Consider the plight of one Texas couple, Maria and Jake Grey, who are considering a divorce to pay for health expenses for their daughter who has a rare chromosomal disorder. The Greys spend at least $15,000 per year out of pocket from Jake's $40,000 a year salary. However, if Maria, through divorce, becomes an unemployed single mom with custody of her daughter, she qualifies for Medicaid. Why in one of the richest countries on the planet should this situation exist?
However, instead of offering real fixes to our health care system, the Trump administration has gone out of its way to undermine it. After Congress’s attempts to legislatively repeal the ACA, the administration has engaged in administrative actions affecting the ACA, including the Medicaid program, which will make it harder for people to get quality, affordable care.
Likewise, Congress, particularly the House of Representatives, in an attempt to reduce spending, is targeting the Medicaid program as well, now that we face massive deficits after the tax legislation that passed in December.
Some of these efforts attempt to convert Medicaid into what is called a block grant program in which the federal government gives the states a chunk of money to allocate among the Medicaid enrollees. Right now, we have an open system, you qualify, you enroll, we get a certain amount of federal dollars per person (more or less) and there’s no limit. Block grants can sound totally harmless. You’ll hear elected officials say things like, “we’ll let the states decide.” But that’s code for, "we’re going to cut the amount of money available to states and give it to them in a big chunk." Remember what Governor Christie did with his big chunk of Sandy money? Until laws were passed requiring both transparency and focusing funding in impacted counties, he used the money to fund a development in Belleville that was not impacted by Sandy but did forward his political agenda. Do we really want to give any future New Jersey Governor the ability to do that with money we need for New Jersey’s children to have health care? Or people to access rehab or medically assisted treatment in recovering from opioid addiction? Or our elderly to have the care they need? We think the answer to that is heck, no!
There is also an initiative from the Trump Administration to require Medicaid recipients to work. On its face, that sounds like a reasonable request. Let's look a little closer though. According to the Henry Kaiser Family Foundation, a non-partisan research organization, most Medicaid recipients are already working, more than six in ten. That's right, these folks are working and still have annual incomes low enough to qualify for Medicaid. If you're on Medicaid and you're already working, you’d need to prove you're working by complying with online reporting requirements. But did you know that many folks either do not know how to use a computer or have ready access to one?
Those who are not working are likely exempt, for example, the disabled, grandparents in nursing homes, full-time students, or full-time caregivers. BUT they still must comply with reporting requirements. So we're right back in the situation of requiring people who may or may not have access to a computer, to navigate a complex online reporting system. And how much money would we spend trying to even implement this reporting system? For, wait for it... 6% of the people who currently are on Medicaid. When you factor in all the people who are exempt, we're only talking about six percent of Medicaid recipients who fall into the work requirements. Within this six percent, there are often barriers to finding work, such as a lack of transportation, lack of childcare, lack of training, and lack of available jobs, and those of us who live in rural areas where work is seasonal can appreciate some of these dilemmas.
All these proposals have the potential to hurt and shrink funding to NJ and other states and move more money to unnecessary bureaucracy and oversight and less to care for families! If we got a chunk of money, or block grant, here in NJ, it’s hard to imagine it wouldn’t force cuts in care to those with disabilities, children, seniors, low income families, or put greater pressure on NJ's already tight budgets.
The Budget Committee in the House of Representatives came up with a budget plan in June called ironically, "A Brighter American Future." The plan attempts to balance the budget over the next nine years by gutting both Medicare, health insurance for Americans 65 and older, and Medicaid, supposedly saving $7.5 trillion, with cuts of $537 million for Medicare and $1.4 trillion in Medicaid among other programs.
And why does Congress even have to think about cutting all these safety net programs? One of the main reasons is the tax plan which Congress passed and the President signed into law last year, which cut taxes all right although mostly to help the top tier again, the 1%. The deficit soared. Congress said, "well, we have to make up that shortfall in revenue from somewhere, so we think it's a great idea to take from the neediest and most vulnerable, children, disabled people, the elderly.” Well, even if they didn’t say that exactly, seems like that’s what they mean and what the impact may be.
We've had some real surprises over the last year and a half with regards to health care. We need to continue to work together for more affordable, more accessible, and even better health care for us all.