Op Ed

Medicaid Helps the Middle Class

And it needs to be protected. Republican Congress could slash coverage.

By - Jul 2nd, 2017 12:10 pm
Donald Trump, Paul Ryan and Mike Pence. Photo from the Office of the Speaker of the House.

Donald Trump, Paul Ryan and Mike Pence. Photo from the Office of the Speaker of the House.

Someone asked me why I thought the deep cuts to Medicaid in the Republican AHCA/BCRA bills have not gotten much attention by the media or legislators until recently. I answered that I thought most people are unaware of the programs that receive Medicaid funding to meet the vast range of needs people have from birth until death or that 2/3 of Medicaid participants are children, frail and poor elderly people, and people with disabilities.

Later, upon self-reflection I realized that I had only given a partial answer. I am part of the reason that Medicaid is not being discussed, because I have been too embarrassed at times to admit that, when we were at our last resort, our family turned to Medicaid. I am going to say it loud and clear now, “My middle class family uses Medicaid.” Medicaid helped my dad receive care in the last few months of his life after we exhausted my parents’ resources caring for him in our home following a debilitating stroke 7 years prior. Medicaid paid the portion of expensive autism treatment that our son needed and we could not afford, even with employer-sponsored health insurance. Medicaid pays for the services my 84 year-old mother needs to remain in our home and out of a nursing home.

There is no shame in accessing care for loved ones or in a society that helps its members. Any of us, in an instant, can find ourselves in difficult circumstances faced with impossible decisions.

However there is shame in…

Callousness: Republicans turning the rose garden into a beer garden in celebration of a bill that would strip $23 million people of their health insurance.

Silence: Governors, local, state, and federal leaders of both parties who have not spoken out against the AHCA/BCRA to say that Medicaid per capita caps and block grants will be devastating for families and negatively impact 1/6 of our economy.

Secrecy: A handful of senators negotiating the BCRA bill behind closed doors, without stakeholder input, without hearings, or opportunities for amendments, when it will have life or death consequences for millions of people and quality of life consequences for us all.

Lying: A president who promises not to cut Medicaid and then proposes in his budget a $610 billion dollar Medicaid cut on top of the $772 – $834 billion Medicaid cut in the Republican AHCA/BCRA bills, thus cutting Medicaid almost in half over the next few years & completely restructuring it.

Manipulation: Masquerading the AHCA/BCRA as “health care” bills when neither address the real cost-drivers in health care or the actual health care needs of the American people.

Complacency: Citizens watching from a distance as our safety net unravels before our eyes.

The AHCA/BCRA will provide huge tax cuts to the wealthiest Americans on the backs of children, elderly people, and people with disabilities. If it passes all of us should be truly ashamed.

Nancy Gapinski is a parent of a child with a disability and part of an informal group “4th District Advocates” of people with disabilities and their families who are working to save Medicaid.

Categories: Health, Op-Ed, Politics

8 thoughts on “Op Ed: Medicaid Helps the Middle Class”

  1. Barbara Beckert says:

    Thanks for this reminder that Medicaid makes a difference for so many Wisconsin families and we must support and sustain this successful program. Medicaid is a safety net that is there for every family, in case of disability, significant medical need, and the long term supports needed by so many elders. Only Medicaid covers long term care – Medicare and private health insurance don’t cover these services, and very few people can afford costly long term care insurance. When you or your loved one spends down their life savings to cover long term care at a cost of $10,000 a month, Medicaid has been there to ensure vital services continue. However, if the Senate or House bill pass, and make extreme cuts and policy changes to Medicaid, there will be huge gaping holes in that safety net. I am glad that my taxes have helped supported access to Medicaid for my fellow citizens, including some of my family members, and oppose the proposed changes in the House and Senate bills.

  2. Debi Guenterberg says:

    Sorry but our tax dollars go for pregnant illegal aliens who get free health insurance and all of their babies births paid for by the government. Young people with minor children aren’t even required to work to get Medicaid for their families. In WI 47% of all births are paid for by Medicaid. In sanctuary cities like CA and IL it’s 75%. Couples with minor children often work for cash so they don’t lose their free Medicaid. They know just how much they can earn before they lose their benefits. In the new Medicaid laws only people with no minor children will be drug tested! I am tired of seeing young healthy people be allowed to abuse Medicaid and the elderly or disabled get very little help! I know people on Medicaid who take family vacations with their tax refunds

  3. Debi Guenterberg says:

    Medicaid is being abused by young healthy people with children!

  4. fightingbobfan says:

    Let me get this straight. You want to deprive millions of people of health care and nursing home care and given billions to the obscenely uberrich because a few people have abused the program, and you have no idea how many or if this even happened?

    And the usual “I know a few people nonsense.”

    We should make policy based on this?

  5. Mary Kay Wagner says:

    Actually Debi, Medicaid is not available to illegal aliens. This country is not as generous as many others that provide care regardless of your immigration status. Medicaid is being used by many rural family because it is the only health care coverage available to them. So in a sense, it is being used by young people with children. I would hardly call that abuse, however. Something to consider, all those people who receive care for which hospitals and care providers do not receive compensation, you, Debi, eventually end up paying for. Care providers pass on those uncompensated costs to the rest of us in the form of higher bills. So we have 2 options, we can pay for programs like Medicaid upfront, and work to keep people as healthy as possible or we can pay for their catastrophic uncompensated care in the form of higher cost on our own bills after the fact. As health care costs continue to rise exponentially, there will come a time, Debi when you won’t be able to afford the healthcare you need. What will you do then?

  6. Jason Troll says:

    It always amazes me how the left answer all problems with making the one percent pay for everything. If we can only stack the ninety-nine on the one. Who is the one percent. It certainly isn’t Democratic donor Chris Abele, or Democratic Donor Herb Kohl, or Amazon owner Jeff Bezos(another Democrat), how about the owners of Google, Face Book or Netflix all Democrats. They pay near nothing in federal income taxes and yet the Democratic party protects them from the countries problems. Medicaid, Medicare and Social security. I f you side with the Democrats and give them billions you need not worry about America’s issues.

  7. JUDY koz says:

    How Undocumented Immigrants Sometimes Receive Medicaid Treatment


    Photo by Adam Berry/Getty Images.

    During the debate over the 2010 federal health care overhaul, Democrats promised that illegal immigrants wouldn’t be among the 27 million people who’d gain coverage. President Barack Obama repeated that pledge last month when he outlined his immigration plan.

    But while federal law generally bars illegal immigrants from being covered by Medicaid, a little-known part of the state-federal health insurance program for the poor pays about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants. Most of it goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.

    The funding — which has been around since the late 1980″s and is less than 1 percent of the cost of Medicaid — underscores the political and practical challenges of refusing to cover an entire class of people. Congress approved the program after lawmakers required hospitals to screen and stabilize all emergency patients regardless of their insurance or citizenship status.

    Some groups say the services encourage people to cross the border for care, while advocates for immigrants say the funding is inadequate because it doesn’t pay for prenatal care and other vital services.

    “We can’t turn them away,” said Joanne Aquilina, the chief financial officer of Bethesda Healthcare System in Boynton Beach, Fla., which sees many illegal immigrants because of its proximity to farms where they harvest sugarcane and other seasonal crops.

    Nearly one-third of Bethesda Hospital East’s 2,900 births each year are paid for by Emergency Medicaid, the category that covers mainly illegal immigrants. The category includes a small proportion of homeless people and legal immigrants who’ve been in the country less than five years.

    Hospitals can’t ask patients whether they’re illegal immigrants, but instead determine that after checking whether they have Social Security numbers, birth certificates or other documents.

    “We gather information to qualify patients for something and through that process, if you really hit a dead end, you know they are illegal,” said Steve Short, the chief financial officer at Tampa General Hospital.

    A 2007 medical article in the Journal of the American Medical Association reported that 99 percent of those who used Emergency Medicaid during a four-year period in North Carolina were thought to be illegal immigrants.

    The Federation for American Immigration Reform, which seeks to limit immigration, said the funding led more women to give birth in the United States, especially since they knew that children born here would be American citizens. The group believes that tens of thousands of “anchor babies” are born each year to illegal immigrants who hope that giving birth to children recognized as citizens will help the women gain legal status themselves.

    Anyone born in the United States is a U.S. citizen. It’s unclear how many mothers later get green cards or become citizens.

    The Federation for American Immigration Reform doesn’t dispute hospitals’ right to be reimbursed for care they’re required to provide.

    “Our focus should be that you could save this money if you prevent the illegal immigration from happening in the first place. You can’t do it after the fact,” said Jack Martin, the special projects director for the organization.

    Groups that advocate for immigrants say it’s foolish for Medicaid to pay only for the births and not for the prenatal care that might prevent costly and long-term complications for American children.

    “It’s a lose, lose, lose,” said Sonal Ambegaokar, a health policy lawyer at the National Immigration Law Center, which advocates for low-income immigrants. She said denying broad insurance coverage to legal immigrants hurt doctors and hospitals financially, prevented patients from getting needed care and increased costs for the health system.

    “There is no evidence that Emergency Medicaid is the cause of migration,” Ambegaokar said. “Immigrants migrate to the U.S. for job opportunities and reunifying with family members.”

    Data that Kaiser Health News collected from seven states that are thought to have the highest numbers of illegal immigrants show that the funding pays for emergency services delivered to more than 100,000 people a year.

    California hospitals get about half the $2 billion spent annually on Emergency Medicaid. The rest is spread mainly among a handful of states.

    In 2011, for example:

    New York spent $528 million on Emergency Medicaid for nearly 30,000 people.
    Texas reported 240,000 claims costing $331 million. (One person could be responsible for multiple claims.)
    Florida spent $214 million on 31,000 patients.
    North Carolina spent $48 million on about 19,000 people.
    Arizona spent $115 million. It couldn’t break out the number of people.
    Illinois spent $25 million on the cost of care to nearly 2,000 people.
    The federal government doesn’t require states to report how many people receive services through Emergency Medicaid payments to hospitals.
    Legal immigrants who’ve been in the United States less than five years aren’t eligible for regular Medicaid coverage, though states have the option of extending it to children and pregnant women.

    Despite the surge in overall Medicaid spending in the past decade, Emergency Medicaid costs have been remarkably stable. A 2004 study by the Government Accountability Office that looked at data from the 10 states with the highest expected Emergency Medicaid costs, reported $2 billion in spending. State officials say spending varies depending on immigration patterns and that during the economic slowdown, the number of illegal immigrants dropped.

    The definition of emergency care and the scope of services available through the Medicaid programs vary by state. For example, in New York, Emergency Medicaid may be used to provide chemotherapy and radiation therapy to illegal immigrants. In New York, California and North Carolina, it may be used to provide outpatient dialysis to undocumented patients.

    Other states have tried to narrow the definition of “emergency” to limit what’s covered. “Each state has its own interpretation,” said Jane Perkins, the legal director of the National Health Law Program, which advocates for the working poor.

    Last year, for instance, Florida changed its policy to pay for emergency services for eligible undocumented immigrants only until their conditions had been “stabilized.” Previously, its policy was to pay for care that was “medically necessary to relieve or eliminate the emergency medical condition.”

    Many hospitals — particularly those in the immigrant areas of Miami and Tampa — feared the change would cut millions of dollars in funding. An administrative law judge ruled in December that Florida had enacted the change improperly because it didn’t go through a public hearing process; the state is appealing.

    Short, the chief financial officer at Tampa General Hospital, said the $10 million the hospital collected each year to treat illegal immigrants was “very important to us.” He noted that Medicaid pays the hospital about $1,500 for each day a Medicaid patient is in the hospital.

    Jackson Memorial Hospital in Miami collects about $50 million a year in Emergency Medicaid funding, according to the state Agency for Health Care Administration.

  8. JPKMKE says:

    Hospitals operate on very small or no profit margin. Almost all of the huge mark-up people pay for their services goes to fund uninsured and unemployed patients. The answer is NOT to tell people to “get a job” and will most likely require an increase in taxes and a shift of funding from other discretionary programs. The fact is that a consistent and predictable segment of the available workforce is not employable or underemployable (due to cognitive or physical disability or both) and those who do pay taxes and pay for healthcare are funding uninsured today through the cost of care. These are not new issues and cannot be solved by simply passing on responsibility to the states as the republican plan appears to do. We need real solutions to control the costs of care while funding those who cannot pay for services. I don’t see this as a partisan issue…Obamacare did not solve the problem and we have yet to see a real solution from the Republicans.

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