2020 incomes, poverty, and health insurance coverage; initial reaction

 The Census Bureau’s reports on income, poverty, and health insurance coverage were released today (September 14, 2021).

Usually, journalists who look at these reports get the story wrong.  I’ve just started exploring the reports, but here are some estimates that got my attention.

1. The collapse in real (inflation adjusted) household incomes was big: a 3.2 percentage decline from 2019 to 2020. But this decline was not felt among African-American households (at least to a statistically significant degree).  It was also not experienced on the East Coast.  The Census Bureau divides the country into four zones: Western, Midwestern, Southern, and Eastern, and the household income declines were measured in the three zones west of the Eastern United States.
2. The decline in labor force participation was also massive. 6.2 million fewer women working full-time year-round and 7.5 million fewer men working year-round full-time.  There were that many temporary or permanent lay-offs due to the Pandemic and measures taken to preserve life during waves of infection.
3. For those who did not get laid off, wages zoomed up.  Those who worked full-time year-round in 2020 earned 6.9% more than did such workers in 2019. I sure wish I had received a 6.9% increase in pay from 2019 to 2020.  
4. Poverty didn’t go up as much as I feared: we were up to 11.4 percent poverty in 2020, compared to 10.5% poverty in 2019. Due to growth in population, that’s 37.2 million people living in poverty in 2020, up from 34 million in 2019. 
5. The trends in being uninsured all year were bad, especially for young adults, but not too terrifically horrible. A little over 14% of the population aged 19-34 years old lives without health insurance. For those aged 65 or over, it’s only 1% who are uninsured (Medicare isn’t really universal). For children (aged birth to 18) the uninsured rate is 5.6%, which shows Medicaid isn’t reaching all the low-income children, or else lots of non-poor families aren’t getting health insurance for their children. 
6. We had 8.6% of the population (28 million persons) without health insurance “at any point during the year” of 2020, the year of a pandemic.  No more of that!  (we need Universal health insurance or a single-payer national health care scheme; either would be better than having 28 million people trying to get by without health insurance). 
7. Median household income was $67,521 for 2020. That’s a decline of 2.9% from 2019 ($69,560), but consumption probably didn’t decline at all, because after taxes and benefits (stimulus checks and unemployment insurance, for example) the actual real median income post-tax (after taking account of the benefits from the CARES Act, CRRSA Act, FFCRA, etc.) increased 4.0%.  The post-tax income index of inequality fell (we became more equal) 3.1% from .442 to .428 (I would like to live in a society as wealthy as ours with a Gini of .33 or slightly lower, so we’re not near that). 
8. The median earning of a year-round full-time worker was $56,287. 
9. There is a helpful chart (figure 7) comparing the start of the Great Recession 2007-2009 to the Pandemic recession 2019-2020. The pandemic had a larger decrease in year-round full-time workers (down 11.5% compared to the great recession of 8.6%), but less of a decline in all workers (down 1.7% compared to 2.4% down in the great recession).  During the Great Recession even full-time year-round workers saw median income declines of 0.6%, whereas during the Pandemic Year, full-time year-round workers saw median incomes increase 6.9%.

A couple charts from the report (like all Federal reports, it is in the public domain):

The post-tax Gini may have declined, but ignoring taxes and income transfers (benefits), inequality was getting worse. Look at that huge loss in shares of aggregate income suffered by the lowest 20% of households.

The decline in poverty enjoyed since 2010-2011 ended in 2020.

Health insurance ought to cover mental illness

Mental health 

Mental health care should be covered on all health insurance policies just as specific medical care is. Mental health can be more devastating than many physical ailments, but many people are not able to seek help for these problems because services cost too much money and are rarely available, with many health insurance providers making it nearly impossible for many families to seek help.

 Having acute mental health problems can affect a person’s life in many ways. First it can make them have internal problems and negative cognitions that make them feel horrible about themselves. This will continue to bring them down farther and farther until they are able to seek treatment. Mental health can also have a huge impact with school work or in the job force. The person enduring a mental illness may not do as well in these environments if they are silently suffering with their mental health. Having stress and bad mental health can also lower your immune system and cause a person to get physically sick more easily. 

Without affordable treatment they may feel alone and helpless, and they may develop worse relationships with their loved ones because of what they are experiencing. These things can lead to hopelessness, suicidal ideations, drug abuse, or other escapes from the pain sought out by the person with the mental illness.  Mental health is a very serious problem that many people have experience with, either by knowing someone with these problems or they themselves have experienced mental health problems. 

I personally believe mental health is more debilitative than some of the sicknesses that are covered on insurances. For example, many insurances will either cover prompt care completely or only have the patient pay a small cover fee if they have a cold, or any other small ailments that the patient is seeking medicine for. Having a mental illness, however, is not seen as important to many individuals. I believe this is because many people do not see the person suffering as much as they do with a physical illness, and they understand the physical illness better than they might understand the torments of mental illness. 

Some people also think that the mentally ill just need to be happy, or stop worrying etc. and think it is an easy fix, which it is not. Mental illness can affect a person for the entirety of their lives if not treated, and many people do not understand this, which makes them feel more alone and causes them to experience a lower quality of life satisfaction. 

This could change if insurance could help cover mental health problems along with physical ones, because mental health is just as—or even more important than—physical health in its power to ruin life satisfaction and stability. Adding mental health coverage to all health insurance policies could dramatically lower suicide rates, and would help people who choose to use their insurance to seek help with finding healthy coping skills to better handle their life problems. After seeking help, they would more likely better provide for our community because they will be able to work more productively.

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/

Some of the shortcomings of the Affordable Care Act

In the following reaction paper, the student identifies some of the successes of the Patient Protection and Affordable Care Act (Obamacare).  Basing her thoughts on some points made by Elizabeth Rosenthal, the student also reviews some of the limitations or shortcomings of the act. 

The United States is one of the wealthiest countries in the whole world. This would lead you to believe that nearly all its citizens would be well taken care of and not forced to suffer a lack of health coverage. This has been far from true. However, on March 23^rd, 2010 the Patient Protection and Affordable Care Act (PPACA) came into effect under President Barack Obama, who believed that healthcare should be a right for the American people, not a luxury. This act was designed to increase health insurance quality and affordability while lowering the number of uninsured people. The law required insurers to accept all applicants, cover specific conditions, and charge the same rates regardless of pre-existing conditions or sex. 

The PPACA did great things statistically for uninsured Americans. The percentage of uninsured Americans went from 16% in 2010 to 8.9% in 2016 and 24 million more Americans were covered with health insurance in the year 2016 than would have been without the PPACA. It’s estimated that this healthcare act has saved nearly 50,000 lives that would have been lost had those people not had health insurance. 

Having said that, I found a very interesting article called “Sorry, We Don’t Take Obamacare” on the New York Times website, outlining some of the shortcomings of the Affordable Care Act. The author, Elizabeth Rosenthal, discusses how the healthcare plans offered by insurers like Anthem and United Health were very different from those being offered by employers. These plans provided less coverage away from patients’ home states, required higher patient outlays for medicines, and included a very limited number of doctors and hospitals. Rosenthal contributes many of these problems to the broad standards for PPACA plans, which allow insurers considerable leeway in designing their exact offerings. For-profit insurers naturally tend to exclude high-cost, high-end hospitals and physicians. 

All in all, I see both sides of the coin. Unfortunately, no system, especially one as large as one that is trying to provide universal healthcare, is perfect. There are risks when you must collaborate with big business insurance companies who only want to turn a profit. However, I do believe the PPACA is doing more good than harm. Saving lives and increasing healthcare is my number one concern for this issue. Having said that, I would like to see stricter guidelines in place for insurers to further cut costs on premiums and medications while providing access to a wider variety of hospitals and doctors. 

Source: https://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html?_r=0

The Affordable Care Act was written partly by the hospitals (including the for-profit hospitals) and the health insurance companies, and other associated profit-making industries involved in providing health care. To gain sufficient support from these powerful interests in the medical industry, the people creating this law had to figure a way to allow these corporations to continue profiting under the new regulations and rules.  Most of the rules were going to reduce the profits of health care, so other rules had to be introduced (or prevented) so that profits could increase or at least be preserved at a level that would be acceptable to the profit-takers.  If you remove life-time limits, so that insurers can be responsible for unlimited lifetime health care costs, you have to give something.  If you take away the insurance company abilities to exclude persons with pre-existing conditions, or kick people off their insurance if they get sick; then again, you must give something.  If you mandate that the minimum standards of insurance include certain things that the insurance companies sometimes exclude, as a consequences you have to find something else you can give to the companies to compensate for that. 

One way for the insurance companies and health care provision companies to keep costs under control is to limit and restrict the choices of health care consumers. If consumers have total freedom of choice, then they can go anywhere, and see anyone, and get any sort of service, and costs become less predictable, and consumers tend to spend more.  In other words, the freedom of the healthcare consumer and the doctors and nurses who see them is opposed by those who want to control costs, whether they are for-profit health care providers and insurers trying to keep down costs so that profits will remain for their investors or whether they are government bureaucrats trying to reduce the spending of public tax revenue in a public medical insurance policy.  

The higher patient co-pays or personal spending on health care will be sought in a “free market” system in which only a handful of fairly non-competitive health care providers compete in markets that are geographically limited (there are limits to how far people will go to get a bargain in the prices they pay for medicines and doctors services).  The same increases in costs will occur in a public system in which the public administration of the health care system seeks to get maximum efficiency, reducing “wasteful” spending on unnecessary or possibly ineffective services and treatments. 

The thing that continues to amaze me is how timid the government has been in applying its coercive regulatory authority over professions and corporations.  Why not simply dictate that as a requirement for licensing and authorization to practice medicine, or nursing, or insurance, or dentistry, or hospital administration, that doctors, dentists, nurses, hospitals, and insurance companies must do… and then dictate terms? If there is a problem that a doctor or hospital “won’t take Medicare” or won’t participate in some part of the PPACA, why not simply make it a law that doctors and hospitals have no right to turn away Medicare patients (perhaps they only will be allowed to turn away Medicare patients when the percentage of their case-load of patients using Medicare to pay exceeds the percentage of all persons in their geographical area who are using Medicare by 10%)?  If medical care costs when traveling are too high, why not have the government dictate that such costs cannot be higher than costs of using local providers by more than some percentage amount? 

Is there something wrong with limiting choice of doctors and hospitals?  There may be a problem if such limits impose harm on people’s health, or cause significant inconvenience.  But, suppose records show that three hospitals meet standards of care, and two don’t, then in such a circumstance, why not encourage patients to use the three hospitals that meet standards by allowing them to pay the least to get care in those hospitals, and discourage patients from seeking care in the two hospitals that fall short in standards of care by imposing larger costs on the patients if they use those inferior hospitals?  

Let’s say there is a procedure that costs between $20,000 and $120,000 to perform, and on average costs $70,000.  Let’s say that the average “success” rate of the procedure is 80%, and the average 5-year relapse or reoccurrence of the problem the procedure addresses is 40%.  I would make a scale for this procedure like this:

Level 5:  Success rate over 80%, 5-year reoccurrence under 40%, cost less than $50,000.
Level 4:  Success rate over 80%, 5-year reoccurrence under 40%, cost between $50,000-$70,000.
Level 3:  Success rate over 80%, 5-year reoccurrence under 40%, cost over $70,000.
Level 2:  Either success rate over 80% or 5-year reoccurrence rate under 40%, but only one, and not both, are better than the average.  Cost is below average ($6,000-70,000).
Level 2:  Either success rate over 80% or 5-year reoccurrence rate under 40%, but only one, and not both, are better than the average.  Cost is above average ($70,001-$120,000).
Level 1:  Success rate under 80% and 5-year reoccurrence rate over 40%, but cost is low ($6,000 to $50,000)
Level 0: Success rate under 80% and 5-year reoccurrence rate over 40%, and cost is average or high ($50,001 to $120,000)

I would then restrict the freedom of my patients or the persons I was insuring by letting them pay the least out-of-pocket if they would go to a provider that was rated as a level-5 provider of that procedure.  They would pay a bit more to go to a level-4 provider of the same procedure, and a bit more than that to go to a level-3 provider of that service, and so on and so forth to the highest out-of-pocket fees for choosing to get the services from a level-0 provider.  

The PPACA goes in this direction to some degree by having health care providers keep records in a certain way and report things related to costs and outcomes to the government, so that care providers get feedback on how they are doing in terms of delivering services that are meeting quality standards and doing so at prices that are relatively lower or higher than average. There are consequences and incentives to push providers to try to be both more effective and more efficient in service provision.  It makes no sense for the information about “effectiveness” and “efficiency” to be collected by a host of competing private organizations; it all ought to be collected and shared by one central disinterested professional organization (a public entity). The information ought to be used to reward the most effective and efficient providers of services (by allowing private insurers and public health provision programs to guide patients toward the best services).  The same information can be used to intervene with the least effective or least efficient service providers, determining why their ratings are low, and helping them improve. For example, local customs may be causing a decline for regional ratings on effectiveness, and a public health intervention is needed to change local customs.  

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). 

Letter supporting the Hospital Uninsured Patient Discount Act

This is an example of a letter to an elected representative or executive on a social welfare topic.  This student has written about a proposed law to force hospitals to lower prices for uninsured patients. The law was, as I understand it, proposed because many hospitals have a policy of raising prices for the uninsured.

I am writing to support the Hospital Uninsured Patient Discount Act SB1881. I am a junior at the University of Illinois- Springfield studying in the Social Work Program. I am urging you to lobby for this bill because it provides a discount to hospital bills of uninsured people in Illinois. Most people who do not have health insurance simply cannot afford health insurance. Obviously, if that person cannot afford insurance, it will be very hard to them to afford a monumental bill for services provided at a hospital. Most people, because they lack the funds, will not pay the bill that they did accrue because they are being charged a very high price for services that they needed, most likely in an emergency situation. By applying a discount to uninsured persons’ hospital bill, the patients will be more likely to pay their bill. By discounting the hospital bill, hospitals will be more likely to receive money for their services because fewer bills would have to be sent to collection agencies (where they would settle for far less than even the discounted price).

You may be concerned that by discounting the prices for procedures performed by healthcare professionals, those professionals would not get paid enough for their services. But, that’s not really the case because healthcare services are already so overpriced that cutting the cost of treatment won’t be unfair.

Every person who is uninsured and qualifies for the discount, should receive the discount, even residents who are undocumented. It’s a shame that there is anyone in this country that has to go without health insurance; it’s the least we could do as a state to give those people, who can’t afford health insurance, a discounted price. Just think about people you know, I’m sure you know someone right around you, who does not have health insurance. You would hate for them to lose their house or mode of transportation because they couldn’t afford their hospital bills they accrued during an emergency. I don’t think anyone would want that, that’s why it’s vital for you to support this bill.

Thank you so much for your time and I hope you will support the Hospital Uninsured Patient Discount Act SB1881.