Friday, December 26, 2008

Dumping The Poor

As the individual states come to grips with the economic disasters the nation is facing, state, and consequently local budgets, get slashed. Among the earliest programs cut are public services, things that directly affect the poor. An article in today's Washington Post points out that one program currently being gutted at the state level is Medicaid, the program that provides health care coverage for the poor.

With revenue falling at the same time that more people are losing their jobs and private health coverage, states already have pared their programs and many are looking at deeper cuts for the coming year. Already, 19 states ... have lowered payments to hospitals and nursing homes, eliminated coverage for some treatments, and forced some recipients out of the insurance program completely.

Many are halting payments for health-care services not required by the federal government, such as physical therapy, eyeglasses, hearing aids and hospice care. A few states are requiring poor patients to chip in more toward their care.


It's not just the "frills" like hospice care that are getting the ax. People are being completely dropped from the program at a time when even more people are without health care coverage. How's this for an ugly example:

...Florida's Medicaid officials have just handed the governor and legislature a blueprint for a 10 percent reduction; it would eliminate coverage for 7,800 18- and 19-year-olds and 6,800 pregnant women.

California, still without a viable plan to cut its own red ink, is making the same kind of Draconian cuts, because the legislature is unable to come up with a budget that would actually increase revenue by raising taxes on those who could afford it, something Republican legislators continue to block because they can.

All of the states are looking to the federal government for assistance, and the incoming Obama administration acknowledges that health care, especially for the poor, has to be configured into any recovery package. Congress is considering boosting the federal share of Medicaid by close to $100 billion over the next two years, which would in fact take some of the pressure off the states.

Such moves, however, are nothing more than bandaids hiding symptoms. A single-payer national health plan looks to be the only answer at this point, but few in Congress seem to have the courage to admit that.

And that's a shame, a real shame. Our founding document, the US Constitution, opens with these words:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America. [Emphasis added]

Perhaps we should forward these words to the President Elect and to members of Congress, reminding them that their power stems from that document, the purpose of which was laid out clearly in those words.

It couldn't hurt.

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3 Comments:

Blogger Mithras said...

Rhode Island is making the biggest change:

Rhode Island's approach has been the most far-reaching to date. This week, it announced an agreement with U.S. health officials that would, if the state legislature consents, change the entire financial basis of the program. The state would forfeit its Medicaid entitlement and accept a total of $12 billion in federal money over the next five years. In exchange, Rhode Island would win uncommon freedom from federal rules, allowing it to enroll all its Medicaid patients in managed care, cover less treatment and expand care for elderly patients at home, instead of in more-expensive nursing homes.

I have a good friend near Providence who this affects. We just got off the phone trying to figure out what it means for her prescription coverage. There's no real clear answer.

The Rhode Island thing is important because it's a "demonstration". (Actually what they call it.) If it goes through, it might become a model for other states, so it might be nice to know what it's all about before the RI legislature approves it.

6:34 AM  
Blogger Diane said...

For God's sake, Mithras, let's get this out into the discourse however we can.

My dream of universal health care access is going to take years, if it even happens. In the mean time, thousands, perhaps millions of people are going to be directly impacted.

If you blog on it, please let me know via email and I will pimp the hell out of it. If you come across other bloggers dealing with the issue in their states, let me know, and I will put together a post that lists the congress critters on the appropriate committees so that we can put the pressure on.

Thanks for stopping by with your insightful comments.

8:33 AM  
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