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

http://time.com/money/4649499/donald-trump-wants-to-cut-medicaid-heres-what-the-program-actually-does/

Affect of Medicaid Changes

https://www.thebalance.com/how-could-trump-change-health-care-in-america-4111422

Mental Health America

https://mentalhealthsummit.wordpress.com/2017/05/05/repeal-of-the-affordable-care-act-will-be-devastating-for-persons-with-mental-illnesses-in-illinois/

Student describes personal value of SNAP, SSI, and Medicaid

In my opinion, this student offers a convincing personal testimony about the value of SSI, Medicaid, and SNAP as programs that help persons with disabilities enjoy a better standard of living. These programs prevent the sort of desperate poverty and malnutrition we don't want in our society. 

Since I became disabled at the age of sixteen I have received a lot of government assistance, which has helped me survive and get by. The first assistance I can remember receiving was Supplemental Security Income when I turned eighteen. The Supplemental Security Income program was established during the Nixon Administration. It was essentially a restructuring of the Social Security Act’s public assistance programs for blind and older Americans. The program assists poor people aged 65 or older as well as blind people and people with disabilities. People with disabilities, like myself, are the largest group in Supplemental Security Income clients. “Disability” is defined under the Supplemental Security Income guidelines as a “physical or mental impairment that prevents substantial employment activity and has lasted or probably will last for a least a year or may result in death. As I stated before I started receiving Supplemental Security Disability when I was eighteen and I am still receiving it today at the age of twenty-three. I am grateful to be able to have this income because it has helped me be able to support myself while being a full-time student and has also helped be able to provide for my son over the last two years. Although for me it is not an ideal income to survive on forever, it has been an amazing benefit to have over the last seven years of my life since I have been unable to work. 

[Back in the 1990s when I was a graduate student the Social Security Administration published an interesting report authored by Sata Kochhar and Charles G. Scott describing all the different sorts of disabilities among SSI recipients the prevalence of various conditions.  That report is still available online.  For the most recent data (which is not at all detailed like that 1995 report was, you can go to the Statistical Yearbook from Social Security, and see that (in December of 2016) 5.8 million SSI recipients were disabled, 1.2 of these were both blind and disabled, and only 1.2 million were elderly.]

One thing I have been blessed with my entire life is private insurance from my mom. It has been a blessing to never have to worry about going to the doctor or getting my medicine. Before having Medicaid, having private insurance was a huge benefit to me and my family. I was life lighted to a hospital when I had my car accident and my private insurance covered every penny of my twenty plus thousand-dollar helicopter ride. I am explaining the ways that private insurance has benefited me because I also want to explain how it has hindered me in ways since becoming disabled. The situation I am going to use is when I was still doing physical therapy and my private insurance was basically slowly trying to kick me out of physical therapy all together. They began limiting my monthly visits and time to an amount that made it almost pointless to go anymore. At that point my physical therapist and doctor began trying to get my private insurance to cover a ‘sit to stand’ machine that I could have at home since I was not going to be able to use one at therapy for very much longer. The sit to stand was a machine that I could transfer into that would lock my knees into place and let me slowly pump the machine up to a standing position. It was a great way for me to stretch my legs, bare weight on my legs and let my insides breath from a normal body position. This sit to stand machine would provide multiple benefits for my body.  

I went through a couple different companies applying for a sit to stand machine in hopes of getting approved for it. But it wasn’t until I received Medicaid that I finally was approved for the sit to stand. After being denied multiple times by private insurance, I was approved on the first try with Medicaid, and I could not have been happier. Because of Medicaid I was able to continue my therapy from home and not have to worry about getting the proper exercise I needed. Today even when my private insurance won't cover all or part of a bill, Medicaid almost always covers the costs. Medicaid is a major health program and helps millions of people like myself. To explain Medicaid more, it is a federal grant to states that helps finance health care for the poor. Federal regulations specify the basic health services that must be offered under Medicaid. Yet, services are primarily administered by individual states including decisions regarding the duration of services and optional services. Medicaid is a “vendor system” which means payments are made directly to the service and provider. Many recipients of Medicaid are families with Temporary Assist to Needy Families (TANF). However, the most Medicaid dollars go to people who are blind or have other disabilities. Furthermore, most Medicaid spending on older Americans is for nursing home care. 

Another program that has been a big help in my life since becoming disabled is food stamps. The Food Stamp Program (now called the Supplemental Nutritional Assistance Program) was designed to help end hunger and improve nutrition and health. It helps low-income households buy the food they need for a nutritionally adequate diet. The Illinois Department of Human Services administers the program in our state, but at the federal level the program is administered by the Department of Agriculture. Food stamp benefits can be used to buy any food or food product for human consumption, plus seeds and plants for use in home gardens to produce food. Benefits are provided through The Illinois Link System, an electronic system that allows someone to use a plastic card, like a bank card, at grocery store check-outs. Most households with low income can get food stamp benefits. I started receiving food stamps when I moved out of my mom’s house at the age of nineteen. When I first moved out I moved into an income-based apartment complex by myself, so I only received around $65 when I lived there. After I moved out of my apartment and into a house I was renting for quite a bit more money, they increased my monthly amount to around $195, which was awesome. I was always able to keep my house stocked with food throughout the entire month. Once I had my son, my monthly amount increased to around $320 and it has been an absolute blessing for my son and me. My son has been blessed to be able to have all the food he has ever needed in his two years. Without the help of my food stamps, I would not have been able to keep food in my refrigerator and cabinets a lot of the time. 

I know one of the articles I came across had some older information, but the key points of these programs were still clear. In my opinion, although some of these programs may be flawed in certain ways, they are none the less beneficial to those truly in need. Without federal and state programs like I mentioned, among many other assistance programs, people like myself would not be able to survive or provide for themselves and/or their families.

References

Current Issues and Programs in Social Welfare. (2017, October 30). Retrieved February 24,

2018, from https://socialwelfare.library.vcu.edu/recollections/current-issues-and-programs-in-social-welfare/

Illinois Food Stamp Program. (n.d.). Retrieved February 24, 2018, from

https://www.benefits.gov/benefits/benefit-details/1260

Student considers public funding for abortion in Illinois

Abortion Coverage

In recent news, Illinois lawmakers have passed the law that abortions can be paid with medical insurance. This topic has been a big thing recently since many people do not think that medical insurance should cover abortions because it promotes killing a child. However, others believe it allows all women to be in control of their body.

As stated earlier, many people feel that this law promotes the killing of a human being. Some critics of this newly passed law state how people will now try to use this as a new form of birth control and that this might be taken advantage of. Nonetheless, many people have been asking the question “where will funding for this come from?”. This is an issue because higher education cannot be funded but the state has money to cover the harming of children.

However, people who support the new law states that since this has now passed it will allow people who accidentally got pregnant and cannot afford to get an abortion to do so. Many say this will reduce harm towards unwanted children.

In my opinion, I think that abortions should not be covered under Medicaid because that extra money can be used to better the state. I do, however, think that abortions should be cheaper so people want have to stress about the payment of an abortion. 

SEPEDA-MILLER, KIANNAH. "Democratic Illinois House OKs Public Funding for Abortions."U.S. News & World Report. U.S. News & World Report, 25 Apr. 2017. Web. 27 Apr. 2017.

It's interesting to note that poor women are more likely to have abortions.  Poor women are more likely to have their health insurance with Medicaid.  So, when poor women who use Medicaid want abortions, should their Medicaid cover the termination of their pregnancy. 

The critical question with abortion is the issue of when a zygote or embryo or fetus becomes a child.  At some point in the pregnancy, the baby is a human child, and should be protected, unless there are complications that endanger the mother’s life or possibly defects that mean the child will die within seconds or hours of birth.  But, when does this point stand?  Is it within minutes of fertilization of the egg, or the zygote's implantation into the wall of the uterus?  Is it in the eighth week of development, the 10th week, the 12th week, the 15th week, the 20th week, the 22nd week, or when?  So long as the thing in the woman is not a human child, abortions seem morally neutral, or possibly beneficial.  A person who doesn't want a child, is too young or too poor to rear the child, and wants to terminate a pregnancy before the embryo has become a child is possibly doing something meritorious.  But, when an abortion is performed after the threshold has been crossed, then an abortion is essentially the killing of a child, and it is morally objectionable. 

Very few Americans think that the embryo is a human child in the first week or two of development, and most people are not opposed to abortions performed in the first month or first six weeks of a pregnancy.  Those who do oppose abortions even in the first hours or weeks of a pregnancy almost always base their opposition on religious beliefs, and our government is supposed to stay out of theological and religious disputes.  

Opposing public spending on abortions on the basis of cost seems odd to me.  The costs of allowing a poor and unwilling mother bear a child are potentially far higher to that mother and society in general than the relatively modest cost of an abortion.  The main objection to public-funded abortions that appeals to me is the idea that some people take such a strong and deeply-held objection to abortions that we ought to respect their strong feelings and refrain from using public expenditure on such a controversial procedure.  Let abortions be funded by private charities and non-profit corporations.  I say this argument has some appeal to me, but I do not say it is persuasive.  I actually hold no firm opinion on this matter; I'm inclined to desire that abortions are legal and affordable and accessible, but I'm also inclined to oppose abortions and desire a society in which no woman chooses to have an abortion. 

I recommend the ACLU fact sheet about public funding for abortions. 

A television station in Chicago covered this issue. 

Public broadcasting in Urbana-Champaign covered this bill as well. 

A Pro-Life student urges politicians to protect funding for Planned Parenthood

To The Honorable Senators of Illinois, Dick Durbin and Tammy Duckworth,

Greetings, today I am writing to you to express my concern for the funding of Planned Parenthood. Over the years there has been many a debate about the morality of Planned Parenthood and whether their services are right or wrong. Even though I myself am an avid pro-lifer and have participated in several pro-life events such as the March for Life in Washington D.C., this is not what I want my letter to be about. I simply aim to address the issue of the allocation of funds for the Planned Parenthood program.

Despite the bad reputation among many of us who are pro-Life, which Planned Parenthood has earned itself over the years with many scandals, the program does have many good things to offer to our community. These good things include STD testing, birth control, cancer screenings, and their sex ed program. In 2014 Planned Parenthood helped 4,218,149 with STI/STD treatment and testing alone (PPFA pg. 2). In that same year they provided contraception to 2,945,059 people (PPFA pg. 2). These statistics alone prove that Planned Parenthood does more than just terminate pregnancies. 

Few would argue that Planned Parenthood is all bad and that their work in treating STDs and cancer screenings is not a valued asset to our society. However, there are people like myself who are deeply troubled by the idea of our tax money funding procedures that we so vehemently oppose. In 2014 Planned Parenthood received $528 million dollars from the government alone (Kurtzleben np).  That money counts as 40% of their total revenue (Kurzleben np).  Realistically it makes sense that not all of the tax money goes to abortions; however, people who stand on the side of pro-life do not wish for a single penny of their hard earned money to go to abortion. However, many would agree that the money the government allocates to Planned Parenthood is still useful and necessary.

Therefore, I propose that there be a policy that dictates where and how the money the government gives to Planned Parenthood is used. This policy would also require Planned Parenthood to provide the public with financial statements for every penny of their $528 million dollar revenue. The government could make it simple for Planned Parenthood by giving out their funds in the form of grants that can only be used for a certain aspect of Planned Parenthoods programing. For instance say the government only allow 100 of the 528 million to be used for the distribution of condoms overseas in impoverished nations. 

Despite how people feel towards Planned Parenthood, they are the “leading providers of high-quality, affordable health care for women, men, and young people, and the nation's largest provider of sex education” (Parenthood np).  I think that having a policy like the one I proposed would be an excellent compromise to the pro-life, pro-choice battle that all too often places Planned Parenthood in the crossfires. 

Thank you for your time and attention.

Sincerely, 

[Student's Name]

References

Kurtzleben, Danielle. “Fact Check: How Does Planned Parenthood Spend That Government Money?”. NPR it’s all politics. August 5, 2015.

PPFA — Planned Parenthood Federation of America. (2015a). 2014 Annual Affiliate Service Census Executive Summary. New York: Planned Parenthood Federation of America, Inc. (An internal report). _____. (2015b). 2014-2015 Annual Report. New York: Planned Parenthood Federation of America, Inc. 

Parenthood, Planned. "Planned Parenthood at a Glance." Planned Parenthood. N.p., 17 Feb. 2017. Web. 22 Feb. 2017. 

This is an interesting example of allowing a political leader to know that although you are representing a particular camp in some controversial issue, you do not necessarily support all the opinions associated with your camp.  You are pro-life, and against abortions, and you especially do not want money spent on abortions.  Many who agree with you on that issue want to defund Planned Parenthood.  You are suggesting that despite your pro-life stance, you still want to protect Planned Parenthood and ensure that it receives government payment for the services other than abortion that is delivers.

As another aside, Planned Parenthood is already prevented from using federal dollars on abortions.  See the Fact Check story from several years ago about this. Planned Parenthood describes how it gets federal dollars mainly through Medicaid and Title X for preventive health services (never abortion, which cannot be paid for with federal dollars).  So, to some extent, the policy you are advocating for here is already one that exists. 

Medicaid as Part of the War on Poverty.

This is a student paper about Medicaid.

“This administration today, here and now, declares unconditional war on poverty in America.” these words spoken by President Lyndon B. Johnson began an era of change for our country. It was during his first State of the Union address that he spoke them and started the War on Poverty. This war would continue to rage on for years. New programs would be formed such as Head Start, which would make sure that some children of poor families had access to early education, and the Food Stamps Program, whose goal was to provide nourishment for those who could not afford it. Another of these programs was the Medicaid program. This program would provide healthcare at no cost to those that desperately needed it. Children of poor families, the elderly, and the disabled would all be covered under this new program. 

It was in 1964, after the assassination of President John F. Kennedy, that Lyndon B. Johnson was sworn into office. During the time of Johnson’s presidency, the war in Vietnam was in full swing. Soldiers were dying in record numbers and Johnson signed a bill to send more soldiers to fight. These soldiers would often return from war and need medical care. Also, the Civil Rights Movement was gaining momentum. Martin Luther King Jr. was becoming a well known name, and in 1965 he led the now famous march from Selma to Montgomery, Alabama. It was that year Johnson signed bills that would help change American history forever. One of those was the Voting Rights Act, which gave African Americans the (practical) right to vote (which they had had in theory since the passage of the 15th Amendment in 1870). Another was the bill that amended the Social Security Act of 1935 and created the Medicaid program. This program was designed to ensure that with the help of the federal government, individuals that lived below the federal poverty line would be given free healthcare by their state. After this legislation was passed, Illinois, along with many other states, accepted the program. 

While the original purpose of the program was only to provide healthcare for the children of poor families, the elderly, and the disabled living in poverty, many reforms were made over the years to increase the number of people that receive the benefits of the program. Over the years, many changes to the program have been made at the federal level and the states have had the opportunity to expand on those changes and cover more people than the federal government requires. Many times, Illinois has been one of the states that has gone above and beyond by opening the program to more people. For example, the federal requirement for eligibility states that: 

"The minimum income level of 133% of the federal poverty level for nearly all people under 65" qualifies a person for medicaid. In Illinois, those percentages go as high as 208% of the federal poverty level." (medicaid.gov)

In fact, as of 2016, the eligibility requirements for Medicaid in the state of Illinois are as follows: 

     "Children ages 0-18 with family income levels up to 142% of the Federal Poverty Level (FPL). 

      Pregnant women with family income up to 208% of the FPL. 

      Adults with family income up to 133% of the FPL." (healthinsurance.org)

As long as a person meets the income requirements put forth by the state and is under the age of 65, he or she is eligible for enrollment in the Medicaid program. 

Once a person is enrolled in the Medicaid program he or she will begin receiving a wide range of benefits. These benefits may include, but are not limited to: necessary doctors visits, prescriptions for both drugs and medical devices, yearly check-ups, required immunizations, preventative health screenings and family planning. All of these services and more, such as dental work, are all offered to the Medicaid client at no cost to him or her. Each states' medicaid program is funded by the state and federal government. While it varies by state the federal government funds, on average, a little more than half of the program and the state covers the rest. A bill to fund the Medicaid program through the use of block grants was vetoed by President Bill Clinton in 1995. 

Illinois Medicaid has issues with their program. One of these is that it is hard to find providers that take the insurance provided by the Medicaid program. Clients that use the program are having to sometimes travel an upwards of 100 miles away from their homes in order to find a doctor. Another issue is the limited coverage. While Illinois allows more people to be eligible for the program, the services that are offered, such as dental, are the bare minimum. For instance; the dental plan in Illinois only covers preventative care and cleaning. If the client is in need of any type of orthodontic services or dentures, he or she is unable to receive them under the current Medicaid plan. This is also true of their general health plan. Anything that the state deems as cosmetic or unnecessary, is not covered.

There are many good things and a few bad things about the current Illinois Medicaid plans. Since it was implemented in the 60s, the program has helped thousands of people receive health care coverage. While the plan may need to be overhauled and coverage expanded, it is still a much needed program that helps ensure that all those in Illinois that were previously unable to afford health care are covered. 

  Here are some more details about the relative size of Medicaid nationally and in Illinois:

Nationally, I think about 72 million people are getting health insurance through Medicaid (The figure of 72 million comes from the Henry J. Kaiser Family Foundation http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/ ). 

Some older numbers from back before the ACA boosted enrollment by so many millions in states where the program expanded, when the enrollment was merely 59 million, showed a break-down of enrollments like this: 

31 million children
11 million non-elderly non-disabled adults
8.8 million non-elderly individuals with disabilities
3.7 million people with disabilities who are enrolled in Medicare (elderly)
4.6 million low-income seniors   (see https://www.medicaid.gov/medicaid-chip-program-information/by-population/by-population.html )

The expansion of Medicaid will have increased the proportion of recipients who are adults; this is because before the Patient Protection and Affordable Care Act, poor families with children or disabled persons could often benefit from Medicaid, but poor households in which no one was disabled and no children were living could usually not qualify for Medicaid.  Medicaid expansion allowed many of these low-income non-disabled adults who have no dependent children to qualify for Medicaid. 

Federal Medicaid expenditure in 2015 were about $332 billion (http://www.hhs.gov/about/budget/fy2015/budget-in-brief/cms/medicaid/index.html#) 

There are about 3.2 million people in Illinois who receive health insurance through Medicaid.

I believe in Illinois about $8 billion (or perhaps it's up to $8.5 billion now) gets allocated for health care expenditures, and the vast majority of that goes to Medicaid or the Health Care Management Organizations that handle health insurance for nearly two-thirds of Illinois persons receiving Medicaid.  That is about a quarter of the state budget. Even so, the last I heard, the state has debts approaching $600 million that it owes to health care providers who have accepted Medicaid payments for services.  

Websites with good information about Medicaid.  These were sources for this article.

http://govthub.com/illinois-benefits-guide

http://kff.org/medicaid/timeline/medicaid-timeline/

http://www.benefits.gov/benefits/benefit-details/1628

https://www.cms.gov/About-CMS/Agency-Information/History/index.html

https://www.healthinsurance.org/illinois-medicaid/

https://www.medicaid.gov/medicaid-chip-program-information/by/state/illinois.html

http://www.thepeoplehistory.com/1965.html

http://www.theshriverbrief.org/tags/medicaid/

Student believes the expansion of Medicaid makes sense for all states

A student's musing on the Affordable Care Act for a reaction paper.

For reflection, I’ve chosen to give more thought about the Affordable Care Act and the Supreme Court’s ruling that Medicaid expansion be considered optional. I’ve read a few articles that both support and oppose this ruling, but I always come back to the same opinion. It should be required. When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, he stated it was to “improve a wide range of health and medical services for Americans of all ages” (2012, LBJLibrary.org). He didn’t say it was only for the elderly, or for single pregnant women, or just for children. He said Americans of all ages. Yet somehow, there has been a huge disparity between the ages these programs serve.

Medicare provides free hospital coverage to people who are over age 65, permanently disabled, or dying of a terminal illness. Medicare Part A, the free coverage, only covers in-hospital services. So you have to be so sick that you have to be admitted to the hospital for Medicare to kick in. Medicare Part B is only available to the same populations for a monthly cost, averaging $100-120 per month (Lankford, 2015), but will cover some outpatient services with a deductible and co-shares on payments. Medicare Part D is for prescriptions and also carries a fee. Another interesting note many people don’t know is people who are disabled are not eligible to receive Medicare until they have been on Social Security Disability for two years. Two years is a long time for someone the government has found to be permanently disabled to wait for insurance.

Then there is Medicaid. If not expanded under the Affordable Care Act, most states have very stringent guidelines on who is eligible to receive Medicaid. In the state of Missouri, it’s for children, single pregnant women, and single parents with an income of 18% or less of the federal poverty level (Healthinsurance.org, 2016). This means a single parent can only have an income of 18% of $11,880, or $2,138.40 (2016, Healthcare.org). In Florida, when I was found disabled by the Social Security Administration, my monthly payment was only $650 per month. I was single, disabled, and still ineligible for Medicare, so I sought help through the state Medicaid office. I was ineligible for the regular program, but they had Medicaid for the “medically needy” as a different program. I could get it if I paid them $400 per month out of my $650. People can’t live on $250 per month. This was long before the Affordable Care Act, and I was denied private insurance automatically because of my pre-existing condition, so I had no insurance and no way to receive treatment for a chronic, debilitating, and painful disease. 

I look at the states which immediately opted to expand their Medicaid coverage and think “Bravo! There’s a state that cares about the health of its residents!” Other states claim the costs to expand coverage are too high, despite the additional federal funding they would receive for expansion. But have they not considered the increase in productivity of their workers when they can actually visit a doctor when they are ill? Have they considered the increased revenue in sales tax from those workers, who would have less unpaid sick days, who now have higher earnings to spend in the economy? I believe finding the funds to keep people healthy should take a major priority in state budget plans.

References

Lankford, K. (2015). How Much Will Your Medicare Part B Premiums Cost in 2016? Kiplinger

Today.Retrieved on September 19, 2016 from http://www.kiplinger.com/article/ retirement/T039-C001-S003-medicare-part-b-premiums-in-2016.html.

Healthcare.org. (2016). Federal Poverty Level. Retrieved on September 19, 2016 from

https://www.healthcare.gov/glossary/federal-poverty-level-FPL/

Healthinsurance.org, LLC. (2016). Missouri Medicaid. Retrieved on September 19, 2016 from

https://www.healthinsurance.org/missouri-medicaid/

LBJ Presidential Library. (2012). The 1965 Medicare Amendment to the Social Security Act.

Retrieved on September 19, 2016 from http://www.lbjlibrary.org/press/the-1965-medicare-amendment-to-the-social-security-act

My understanding is that government officials in the states that have refused to expand Medicaid have an ideological opposition to the expansion of government responsibility for health care.  They do not think the government should become larger.  In the long-term, the ACA hopes to cut public health care costs, but these people who oppose the ACA think that this will fail.  Their moral reasoning is that if they allow Medicaid to expand in their states, they will be enabling the government to expand in a way that is unsustainable.  In the long-run, it is correct to point out that running large federal deficits every year, even when we aren't in a recession or recovery from a recession, will increase the portion of tax revenue that must go to pay off interest on the nation debt, and that will reduce money we have available for other discretionary spending.  So, if you disagree with the forecasts that the ACA saves the government money in the long run, or that its overall cost is relatively low, and the benefits it provides are relatively high, then you have a different perspective of reality, and it is possible to make a moral argument in opposition to the ACA's expansion of Medicaid.

Many of us have no ideological opposition to allowing the government to expand a bit more, and raising taxes by a few percentage points doesn't really frighten us.  Others are ideologically opposed to any expansion of government or any increase in taxes.  For them, this value is a priority, and the arguments based on benefits to society or justice for the poor or care for the ill do not persuade, because the value of "keep government small and remove the government from the free market" is considered more important.  This is difficult sometimes for me to understand, because it seems to me that this dedication to the principle of "small government and unconstrained free market" only makes sense if it provides better long-term outcomes: a more prosperous society with greater freedom and less poverty and injustice and misery, and I don't see the evidence for this being general and universal (in certain contexts, within certain limits, yes, of course free markets give us better outcomes than certain types of government intervention, but I don't see this always being true in every situation). 

Student essay about HB-1685 and Medicaid Reform

 Here is a student paper about health care reform and a bill to establish a Basic Health Program within Medicaid, in preparation for the changes to Medicaid that will begin on January 1^st, 2014.

Lack of health care coverage is a serious problem for many Americans. The Census Bureau estimates that 50.7 million Americans and 14.89 percent of Illinois residents are uninsured. It is estimated that 25 million Americans are underinsured. A study performed by Harvard Medical School linked the lack of health insurance to 45,000 Americans deaths annually. This subject has been the root of heated debates within our society and our government for many years. On March 22, 2010 President Barack Obama signed health care insurance reform legislation.

     HB 1685 proposes to amend the Medicaid Revenue Act. This bill will require the Department of Healthcare and Family Services to establish a Basic Health Program within the existing Medicaid Managed Care and Care Coordination programs. This program must be established within the guidelines of the Federal Patient Protection and Affordable Care Act. The Federal Patient Protection and Affordable Care Act along with the Health Care and Education Reconciliation Act of 2010 make up President Barack Obama’s Health Care Reform 2010. The development and implementation of a Basic Health Program will provide services to individuals earning between 133% and 200% of the federal poverty level. This program must be operational by January 1, 2014. This program will also ensure that the State of Illinois will be eligible for the enhanced federal matching funds. HB 1685 will make the Department of Healthcare and Family Services responsible for ensuring that Illinois is eligible for, and receives, the enhanced federal matching funds.

     It is estimated that an additional 500,000 to 800,000 people will be eligible for Medicaid in the state of Illinois on January 1, 2014. Currently the Federal government matches Medicaid dollars at 61.9 percent for the state of Illinois. With the implementation of HB 1685 the Federal government will cover 100 percent of the state’s initial costs to cover the newly eligible enrollees for the years 2014 through 2016. In 2017 the matching federal funds will begin to gradually decrease. By the year 2020 the matching federal funds will decrease to 90 percent. The Department of Healthcare and Family Services estimates that the state of Illinois could spend between $200 million and $9.1 billion dollars annually to accommodate the addition of the estimated 500,000 to 800,000 participants.

     While most people agree that uninsured Americans is a serious problem, no one seems to be able to agree on a solution. What type of coverage and who will pay for it seem to be the biggest questions. Many argue that opening the Medicaid program to more participants will only increase the number of underinsured Americans. 

          It will be a few years into the future before we know how well HB 1685 has performed. Maybe then society and our government will be able to decide what is more costly, to provide health insurance coverage for all Americans or to allow thousands to go uninsured.

 On February 15, 2011 Illinois House Bill 1685 was filed with the clerk by Representative Edward J. Acevedo. The first reading was held on February 16, 2011 and the bill was referred to the Rules Committee. On February 22, 2011 HB 1685 was assigned to the Executive Committee.  On March 17, 2011 HB 1685 was sent back to the Rules Committee.