When the COVID-19/pandemic-era ‘continuous coverage’ Federal requirement ended recently, states could resume eligibility checks that can purge people from Medicaid rolls. Many states are currently doing this, with coverage being lost for hundreds of thousands of individuals/families. These cuts are mostly occurring for procedural reasons, not because enrollees actually lack eligibility.
Reports show that states like Florida, for example, have made it almost impossible to keep up with the paperwork and remain on Medicaid. So far, over 250,000 Floridians have lost coverage. Some states aren’t interested in paying for poor people’s health care. Gov. Sarah Huckabee Sanders stated that she is increasing removal of Arkansas citizens from “government dependency”.
HEROIC JOB CREATORS VS. DESPICABLE MOOCHERS
The ”slash and burn” social and health policies of many states eager to drop Medicaid coverage comes from the old, worn out myth about “heroic job creators vs. despicable moochers”. This toxic and misleading ideology is based on discredited supply side, trickle-down, voodoo economics that have consistently failed to deliver good jobs, or recognize that government aid and investment is often a crucial lifeline. The 2017 cruel GOP tax plan, for example, made it very difficult to make the kinds of investments that would realistically put large numbers of Americans back to work in quality, good paying, secure jobs. Much needed today is a large program of infrastructure repair and renewal, enormous national investments in public health programs and single-payer national health insurances.
AYN RAND AND COMPANY
Belief that low-income Americans do not deserve a helping hand derives from the wealthy 1% private corporate business ideology, straight out of Ayn Rand, asserting that the US is a meritocracy where only the most deserving rise to the top. If you’re sick or poor, you’re on your own, and those who are more fortunate have no obligation to help. In fact, it’s immoral to demand that they help. Alarmingly, many believe the ludicrous myth that welfare recipients receiving public benefits are “takers” rather than “makers” which is untrue for the vast majority of working-age recipients.
In 2012, GOP Presidential candidate Mitt Romney and V.P. candidate Paul D. Ryan asserted that 47 % of all Americans are “takers”; that poverty relief will turn the safety net into a “hammock”; and that food stamps turn the inner city into a “culture of dependence with legions of moochers, welfare “Cadillac” queens, anchor babies, illegal immigrants”, ad nauseam. According to these derisive geniuses, removing benefits is necessary to compel the unemployed to work even if their children suffer in the process.
Corporate big business ideology says that human society is a market, and social relations are commercial transactions with a “natural hierarchy” of winners and losers. Attempts to limit competition, change social outcomes eg, estate tax issue, mandated health insurance, etc. is treated as hostile to liberty and big business interests. Unions and collective bargaining must be crushed; tax, public protection regulations and public services must be minimized or eliminated. Inequality is okay since it’s a result of a reward for merit and generates wealth for the tiny .001%, which the false myth says trickles down to enrich everyone in the 99%. Tax and other social policies to create a more equal society are dismissed as counterproductive to the interests of the ultra wealthy.001%.
- Medicaid is financed jointly by the federal government and the states. Early in 2023, 93 million people were enrolled in Medicaid or the Children’s Health Insurance Program, up from 71 million before the pandemic.
- One of Medicaid’s most important dimensions is its irreplaceable role in addressing the immediate and long-term effects of public health crises, such as Covid-19, since it is the biggest single source of health care financing for dealing with critical public health threats. As we are painfully seeing, these threats may begin with an initial, recognized period of a formally declared emergency. They then can morph into events with very long-term effects felt for years or decades after. This was the case with the World Trade Center attacks, which led to an immediate surge in health care spending, followed by years of elevated spending to address the long-term health fallout triggered by the emergency itself. Think about Zika or the opioid crisis, or COVID-19, to understand the near-term/long-term nature of public health threats.
- SNAP, formerly known as food stamps, serves 42 million Americans. At least one adult in more than half of SNAP-recipient households are working. And the average SNAP subsidy is $125 per month, or $1.40 per meal.
- 80% of adults receiving Medicaid live in families where someone works, and more than half are working themselves and doesn’t trap people in poverty or pay people not to work. Temporary Assistance to Needy Families has required work as a condition of eligibility since Bill Clinton signed welfare reform in 1996. The earned income tax credit, a tax credit for low and moderate income workers supports only people who work.
- Workers apply for public benefits because they need assistance to make ends meet. Although American workers are among the most productive in the world, during the last 40 years the bottom half of income earners have seen no income growth. Since 1973, worker productivity has grown almost six times faster than wages.
- Wage stagnation interfaces with costs of housing.Most Americans are spending more than one-third of their income on housing, which is increasingly unaffordable. There are 11 million renter households paying more than half their income on housing. And there is no county in America where a minimum wage worker can afford a two-bedroom home. Still, only 1 in 4 eligible households receive any form of government housing assistance.
- The majority of recipients of public benefits who do not work are primarily children, the disabled and the elderly, people who cannot or should not work. The safety net exists to rescue people during vulnerable periods. Most people who receive public benefits leave the programs within three years.
- Many public benefits pay for themselves over time as every dollar in SNAP spending is estimated to generate more than $1.70 in economic activity. Medicaid benefits are associated with enhancing work opportunities. The earned income tax credit contributes to work rates, improves the health of recipient families and has long-term educational and earnings benefits for children.
MEDICAID EXPANSION NEEDED
The COVID-19 pandemic demonstrated the urgent need for expansion of the Medicaid health insurance program. In too many states, political decisions by state legislators to deny health insurance to thousands of their citizens has resulted in an almost non-existent social and health safety net. Decisions in 2016/2017 by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act resulted in an estimated 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York. The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage remained uninsured.
PRIVATIZED ADMINISTRATION/MANAGED REIMBURSEMENT/CARE IN MEDICAID
To worsen the situation, many states have over the last decade privatized administration of their Medicaid program into a managed care program administered by the private profit health insurance industry. The companies are paid by state government, and their profit depends on spending as little as possible on Medicaid patients. It’s hard to imagine any greater disconnect between public good and private profit: the interest of private health insurance companies lies not in the obvious social good of delivering quality health care to patients but in having as few as possible treated as cheaply as possible. No better example exists of a private capitalist enterprise that feeds on the misery of man.
You might think that we learned the lesson of discredited managed care in the 1990s. The term “managed care” is confusing to many, but really amounts to managed reimbursement rather than managed care. A set prospective annual payment is made by federal/state governments, as in the case of state Medicaid managed care, to cover whatever services patients will receive over the coming year. There is therefore a built-in incentive for managed care organizations to skimp on care and pocket more profits.
ACA PROMOTES MEDICAID MANAGED CARE
Unfortunately, privatized Medicaid managed care was facilitated further by the Affordable Care Act (ACA). More than one-half of Medicaid beneficiaries are now in privatized plans, which have been enacted in many states based on the unproven theory that private plans can enable access to better coordinated care and still save money.
That theory is not just unproven, it is patently wrong as the state of Florida discovered. In 2016, Medicaid ate up 45.9 percent of growth in general revenue , ballooned by approval of a 7.7 percent increase in payment to private managed care plans. Privatized programs have high administrative costs, built-in profits, and do not save money or improve care. Their route to financial success is by finding more ways to limit care and deny services.
Without evidence or disclosure by the private Medicaid plans business/profit interests, private HMOs claim they save the state millions annually. Shockingly, we let many state administrations get away with this illusion by forgetting that adding a “profiteering middleman” to manage health care delivery always adds cost, and does not lower them. The Florida and other state GOPs, for example, lobbied hard for Medicaid managed care. Using scare tactics, they claimed that more than 3 million recipients (Fla.) would receive better care and also save the state money, sternly warning the roughly $23 billion a year Medicaid bill was consuming the state budget.
WHY DO WE STILL WORSHIP AT THE ALTAR OF PRIVATIZATION IN U.S. HEALTHCARE?
John P. Geyman, M.D., former chair of the University of Washington Department of Family Medicine and one of the most published family physicians in the U.S., asks, “Why do we still worship at the altar of privatization in U.S. health care, especially for the poor and most vulnerable among us?”
Several answers stand out:
- there is a lot of money to be made by insurers operating health programs subsidized by state governments;
- exploitive privatized programs are perpetuated by well-funded “free market” think tanks, their followers in Big Business, and compliant politicians responding to industry lobbyists;
- regulations are inadequate to prevent gaming by insurers at patients’ expense;
- as a society, we still don’t seem to care when people have bad health outcomes and die because of failed health care policies.”
Wendall Potter, a New York Times bestselling author, health care and campaign finance reform advocate, and authority adds more re., privatization/profiteering:
A). big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the insurance companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.
B). the for-profits now control more than 70% of the Medicare Advantage market.
In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.
That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion.
C). big insurers’ revenues have grown dramatically over the past decade, the result of consolidation in the PBM business and taxpayer-supported Medicare and Medicaid programs.
D). what has changed dramatically over the decade is that the big insurers are now getting far more of their revenues from the pharmaceutical supply chain, Medicare, Medicaid and from taxpayers as they have moved aggressively into government programs. This is especially true of Humana, Centene, and Molina, which now get, respectively, 85%, 88%, and 94% of their health-plan revenues from government programs.
E). the two biggest drivers are their fast-growing pharmacy benefit managers (PBMs), the relatively new and little-known middleman between patients and pharmaceutical drug manufacturers, and the privately owned and operated Medicare replacement plans marketed as Medicare Advantage.
F). huge strides in privatizing both Medicare and Medicaid have been made. More than 90% of health-plan revenues at three of the health industry companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular. Enrollment in government-funded programs increased by 261% in 10 years.
US citizens should demand that private corporate HMOs be removed and banned from the administration of our public health insurance programs in all states. Privatization of Medicaid increases costs, without any corresponding increase in quality or access to care. Private insurers maximize profits by mainly limiting benefits or by not covering people with health problems. The greed of casual inhumanity is built in the business model and the common good of citizens is ignored. Excluding the poor, aged, disabled and mentally ill is sound business policy, since it maximizes profit. As long as insurance for health care remains so lucrative for private insurers, patients’ needs and the public interest are disregarded by health insurance profiteers.
After we expand Medicaid to meet today’s immediate challenges, tomorrow we need to insist that the federal government finance a nationwide, not-for-profit, Medicare for All system of universal, single-payer coverage, based on medical need and not ability to pay. This would resolve persistent problems of failed market policies, and would resolve what Martin Luther King, Jr. once described: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
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