Monday, April 30, 2018

Student wants to preserve Medicaid and the ACA’s Medicaid Expansion


The Honorable Senator Richard Durbin
525 S. 8th Street
Springfield, IL 62703
https://www.durbin.senate.gov/contact/email

Dear U.S. Senator Richard Durbin, February 25, 2018

I have never written to or voiced my opinion to any politicians before this letter. I have been learning many things about politics and policy lately as I feel it is my duty to become informed. I suppose that I sway more to the liberal side, but I feel it is important to have an open mind about everything. I have lived in Christian County for about eight years, but have lived in Illinois my entire life. I have two children who I want to grow up financially secure and not ever need the governments assistance. I have used programs such as Medicaid when I had my first daughter. It helped us through a tough time financially, and we fought hard to get to a place where we no longer needed it. So, I am not writing this because I depend on government assistance and want to keep my benefits. Nor am I writing this to convince you to take benefits away from those who need them. I am writing this as a worried middle-class family.
I feel that healthcare is extremely important, but I fear that President Trump’s changes are going to hurt more people than it will help. President Trump does not like the ideals of the Affordable Care Act; he has made that extremely obvious. Healthcare is a major expense for the federal and state budgets. The cuts that Presidents Trump wants to make to Medicaid will, I believe, hurt more than it will help. 
The plans that President Trump has started to enact this year are to eventually save the American taxpayers money. Everyone wants to save money. No one is objecting to that. With every budget cut something will suffer. Not only will it hurt some of the people currently using Medicaid, but it will also hurt the middle class.
Trump wants to make major changes to Medicaid that will undo some aspects of The Affordable Care Act. By giving states a block grant, no more and no less, he is jeopardizing the ability for coverage for many people not only in Illinois but also in all states. If the states can not keep up with healthcare costs then they must either reduce coverage, make the poor pay some of their health insurance, or decrease the amount of people eligible. 
How will this affect people that were covered under The Affordable Care Act under Obama’s push to increase eligibility? Some of the people who fit into that increased eligibility are at risk of losing coverage if President Trump decides to repeal the increased eligibility. The Mental Health Summit website posted an article in December of 2016 about what would happen if President Trump did repeal the Medicaid Expansion. This article goes on to explain that 650,000 people in Illinois are covered under this expansion. The Federal government was footing almost all the bill for these newly eligible persons. So, it was not a price that the State’s had to pay.
These changes will also affect the middle class in several ways. An article in Time.com outlined this and I believe it was very insightful.
First, the article says, 42% of Medicaid spending goes to the disabled. This group includes the mentally ill, people with physical disabilities, and people with developmental delays. Any cuts will greatly affect them and their families. Families will have to dig into their own pockets to pay for care.
Mental Health America of Illinois reports that under The Affordable Care Act, mental health care was covered as an essential health benefit. The repeal of this will mean that mental health care is no longer mandated to be covered. This Republican repeal will also undo the requirement that pre-existing conditions be covered without huge additional costs. 
Second, the elderly makes up about 21% of Medicaid spending. Baby boomers are making up a huge part of our population in the US. Any decrease in Medicaid funding will affect their level of care. The elderly will have to depend on help from family to maintain their healthcare needs.  For example, Medicaid covers the long-term care of the elderly, who often get long-term care when their functioning is severely diminished by health problems such as dementia.  Yes, it is expensive to care for such people, but surely one of our priorities ought to be that we care for persons with significant disabilities, so I want Medicaid’s assistance to elderly persons in long-term care and their families to be maintained; not diminished at all.
Third, children make up about half of all people covered under Medicaid. These are the people that President Trump says are the focus of the changes. Medicaid also covers about 75% of births to poor mothers.
Without the coverage of The Affordable Act, I fear, that insurance prices will rise for the middle class. Medicaid helps to cover the costly healthcare for children, the elderly, and disabled. If these are moved to private insurance rates will go up to help the insurance companies cover those costly healthcare issues.
President Trump also signed the Tax Cuts and Job Act, which removes the penalty for not having health insurance. This is also a major concern for the middle class with private insurance. Now, young and healthy adults will forgo the expensive insurance premiums and not have to pay a penalty. For them, if they are healthy, it is perhaps not a bad thing. For middle class families it could greatly affect insurance premiums. Insurance companies will be losing out on income from these healthy individuals and could raise premiums for everyone else. 
Charging people for not having insurance was never the greatest idea. It is a form of punishment. If you can’t afford to have insurance how could you afford the penalty at the end of the year? But, there were subsidies for families earning up to 400% the poverty level, and the tax penalty was never particularly onerous.  Perhaps a small tax break or some incentive to maintain your insurance throughout the year would work better than the penalty fee tax. Our family pays just under $10,000 a year in insurance. And that is the cheapest option. Our deductible (which was $5,000) went up to $5,500. Premiums have not risen yet, but I fear they will. 
I am urging you to not repeal the Medicaid Expansion Program. It is providing much needed services to those who would otherwise not be eligible for Medicaid. I do, however, agree with the proposed work requirements to those who are able bodied. Perhaps this will cut some of the costs to both state and federal budgets.
If Trump truly is worried about pulling people out of debt and not having them depend on government assistance, I fear, this will pull more middle-class people into debt and in need of government assistance.
My suggestion would be to keep the people enrolled in Medicaid that fit into the Expansion Program. To make it fair, split the cost between federal and state government. I realize payment for this would increase taxes, but it is a small price to pay in the long run.
People who would lose coverage could end up costing the taxpayers more money. Uninsured people who can’t pay their emergency room bills or pay any out-of-pocket healthcare bills will eventually be paid for by tax payers and people with private insurance. 


Thank you for taking the time to listen to my concerns,
[Student in the SWK-355 Social Welfare Policies and Services course]
Here is a list of where I got my information:
Time.com
Affect of Medicaid Changes
Mental Health America


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