OP-ED

Don’t Forget Medicaid

As we wait for the white smoke to emerge from the “grand bargain” negotiations at the White House, most Americans are already aware of the Republicans’ plan to dismantle and privatize Medicare and Social Security. But what many people may not realize is just how dangerous it would be to slash funding for a program that 60 million Americans rely on for their basic health care needs: Medicaid.

While it seems that just about every major industry or interest group has teams of lobbyists in Washington looking out for them, some of our most vulnerable citizens simply don’t have a voice in a town where unfortunately, money still talks the loudest.

Why? Medicaid covers only the impoverished and disabled, so it lacks a traditional advocacy base. This may be news to Republicans — but most poor people I know are spending all their time trying to find a job and put food on the table. Lobbying Congress just isn’t on these folks’ to-do list right now. Unfortunately, this means that my colleagues aren’t going to spend a lot of time over the next 30 days sticking up for the 60 million Americans who rely on Medicaid to pay their medical bills. That’s unfortunate, because if the Republicans are successful in turning the program into a block grant program that greatly diminishes funding to states, three awful things are going to happen — people are going to die, more jobs are going to be lost, and health care costs and taxes will actually increase.

The fact is that Medicaid is the insurer of last resort for those that reside on the fringes of our economy. But is also pays over 60 percent of all nursing home care in America. So yes, cutting Medicaid will deny health care to a lot of poor women and homeless kids. But it will also force states to choose between three pretty awful options — kick seniors out of nursing homes and onto the street, raise state tax rates to make up for the lost federal money, or change the rules to force younger family members to pick up the cost of their institutionalized relatives. One estimate suggests that the combined economic effect of these state-based adjustments will be an overall loss of two million jobs. And the worst of it all is that these Medicaid cuts won’t actually end up saving the federal treasury any real money. While some of these patients will die from a lack of care, more will simply get shifted to more expensive crisis care at our clinics and emergency rooms, costing the system more in both the short and long run. In my home state of Connecticut alone, turning Medicaid into a block grant would jeopardize nursing home care to 17,000 seniors and disabled residents, impair coverage to over 280,000 children and result in nearly $7 billion less in Medicaid spending.

What is equally alarming is that if the Republicans are successful in dismantling Medicaid during these closed-door negotiations, they may kill health care reform along with it. You see, though most of the 32 million people who will get health care insurance under the Affordable Care Act get it through a tax credit that allows them to buy private insurance, about half of the newly insured are going to be new enrollees in Medicaid. Health reform expands eligibility for Medicaid by raising income thresholds and bringing more poor men into the program. But if Medicaid funding gets gutted, then one of the most likely responses by states is to further undermine the already-terrible rates that Medicaid pays doctors. That means that fewer doctors will accept Medicaid patients just as we need thousands more doctors to sign up the program in order to cover the influx of new enrollees. Thousands of new Medicaid patients could find that they have insurance in name only, which is only slightly less cruel than having no insurance at all. And guess what — Republicans know this, which is why they are pushing so hard for huge Medicaid cuts.

There is a full-scale revolt brewing on Main Street now that people understand that instead of bringing forward any meaningful plan to create jobs in America, Republicans have been hell-bent on tearing apart Medicare and Social Security. But the result of this popular awakening cannot be that the cuts simply flow to Medicaid. Medicaid cuts shift costs to someone or someplace else. But more importantly, a choice to balance our budget on the backs of poor women and children and the disabled would speak something putrid about our nation. One of the great things that makes us Americans is the communal sense of decency and responsibility. This recession has forced more and more families to turn to Medicaid and millions more to say, “there but for the grace of God go I.” If these cuts are allowed, we would be shredding the safety net that the most vulnerable members of our American family rely upon. Over the next few weeks, in order for justice and common sense to prevail, their voice needs become everyone’s voice.

Congressman Chris Murphy represents Connecticut’s 5th District and is running for the U.S. Senate

This piece originally ran at The Huffington Post.

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27 replies »

  1. I agree that often times cuts to Medicaid programs push people to more expensive alternatives. Likewise, I think we fail to pursue innovative programs that can provide needed services more cost effectively.

    A number of years ago during a budget crisis, Illinois found that there were a significant number of people in nursing homes who really didn’t need to be in a nursing home. They were there because it was the only alternative for someone on Medicaid to get the assistance they needed. The state took an innovative approach and developed a program called Supportive Living. This Medicaid-waiver program benefits the State as well as older adults and disabled adults. Those who need some help to maintain their independence but do not require skilled nursing care are able to live in a much more appropriate residential environment rather than in a nursing home. They receive the help with medications and personal assistance they need. Meals, housekeeping and laundry services are included. They also benefit from a wealth of opportunities to socialize with friends and neighbors and participate in a variety of activities.

    The State benefits because the cost to the State of someone on Medicaid in a Supportive Living community is at least 40% less than the cost of the person being in a nursing home. In addition, what is more dificult to calculate is the benefit of someone on Medicaid living in Supportive Living community rather than struggling alone at home and not taking their medication as they should, not eating as they should, and not getting the socialization that can be so vital to good health.

  2. hey Chris, where do States get their money to fund their portion of Medicaid?

    The exact same Taxpayors

    So Chris how is it people will die, healthcare cost will increae, and jobs lost if I give my taxes to my state instead of sending them through the federal government so you can take a processing fee and send it back? Does DC have a magical cash multiplier that turns my $1 of taxes into $2? Of course not, the truth is by getting the federal government out of the middle we can create jobs, lower the cost of healthcare and save lives.

    Why don’t i see a single reference to reducing the 10%+ of medicaid spending lost to fraud? Is it really the seniors you worry about Chris or the fraud and abuse your supporters live off of?

  3. It’s really a great and helpful piece of information. I am satisfied that you just shared this useful information with us. Please keep us up to date like this. Thanks for sharing.

  4. “Is it absolutely necessary to indict the President in every conversation”

    Every time you indict business I respond with the president, I think that then makes the questions do you need to indict business in every conversation?

    “Would “your folks” support taxing GE and all other corporations fairly, i.e. more than they pay now?”

    Your folks? Why do you have to be so racist, no thats not it, sexist, no thats not it, um partiest, ya don’t be such a partiest Margalit.

    Do I support what you said, no, theres a term for this type of question but I can’t rememebr what it is, its a false something. “and all other corporations” I disagree 100% that ALL corporations are taxed unfairly. I think most corporations are overtaxed, especially for what is expected of us. When I was in CA I was overtaxed up the, you know what. So its a bogus question and if I drilled you on it I would bet even you would admit you got carried away again.

    So if we were trying to have an honest and productive debate, remember that? Do I think some corporations need to pay more taxes yes I do.

    I think the first thing we need to do is break GE up and tax it back to the 1950s for all the BS it has got away with.

    I think the equal protection clause of the constitution, as a liberal your probably not familiar with it as most of your idelogy rejects its existance, applies to businesses as well as people and as such individual corporations should not be allowed to get specific tax breaks, i.e. giving my competitor a taxpayor grant tax reduction to stay/move to a town or hire people. The tax code should apply equally to everyone

    I think we should tax consumption not existance

    We should never tax anything in such a way that discourages labor, i.e. the 20-25% surcharge on salaries I pay to employee people.

    Not the answer you were looking for I’m sorry

  5. Is it absolutely necessary to indict the President in every conversation, whether it has anything to do with the substance, or not?

    Would “your folks” support taxing GE and all other corporations fairly, i.e. more than they pay now?

  6. Maybe “those” bad decision makers should also be handed a mop and placed at least 5 miles away from where the money is. Perhaps even hand them some orange overalls while they mop.

  7. The fact that we still have to advocate for MedicAid only goes to show the failure of the Democrats’ (pansy) health care reform.

  8. Your right Margalit what the hell is Obama thinking?

    FORTUNE — Since naming General Electric CEO Jeff Immelt to head a CEO-heavy jobs council back in January, the White House has faced some tough criticism from both the left and the right.

    Jeff Immelt on the job.

    The charge from labor-friendly liberals and free-market conservatives has been the same: the appointment represents pure crony capitalism. The leaders of the largest U.S. multinationals are hardly the best suited to give advice on domestic job creation, the line goes, when they spent the last decade eliminating 2.9 million jobs at home and adding 2.4 million overseas. And in particular, the chief of GE, No. 6 on the Fortune 500, shouldn’t be charged with heading that effort, considering the company’s sprawling lobbying agenda in Washington.

    The company spent more than $39 million on lobbying efforts last year alone, making it the third-biggest spender in the city, according to the Center for Responsive Politics. And its advocacy reaches into just about every conceivable policy debate, from the narrow — the Commercial Advertisement Loudness Mitigation Act, the Iran Sanctions Enabling Act — to the sweeping, including the fights over health care and financial reform and a multibillion-dollar battle with Pratt & Whitney over a military jet engine.

    Immelt himself has made clear that his part-time, volunteer work for the council won’t distract him from his day job. “This is my passion, I’m committed,” he told analysts on an earnings call in January. But he’s been more equivocal about how GE’s interests would inform his participation on the panel, officially known as the President’s Council on Jobs and Competitiveness.

  9. and what does any of your ranting have to do with state rainy day funds? I can’t wait to hear this connection between state budgets and what ever it is your running on about.

    So why did Obama name the GE guy to his job creation council? So he could learn how to move jobs?

  10. Yes, end the wars, the oil and gas company subsidies, the tax breaks to the very wealthy… A no-brainer…

  11. “Then they should save in good times to pay the bills in bad times. Our current system rewards bad decision making.”

    Is this a joke, Nate?

    Like Google and GE being rewarded for not paying taxes? Like Wall Street being rewarded for stealing? Like the auto industry being rewarded for inability to compete?

    Or is it OK to reward bad decisions for corporations so they have ample cash to afford the traumatic move of their headquarters to China?

    http://www.washingtonpost.com/business/ge-healthcare-moving-x-ray-leadership-team-from-us-to-china/2011/07/25/gIQAHL65XI_story.html

  12. “Whats the cut off for HUD housing?”

    What cut off would you like to see? Many on housing assistance are elderly and disabled and children, maybe you think the street would get their asses off the public dole.

    “Unemployement is up to 99 weeks?”

    Well, that’s an end. Looked at how long it takes to get a job now? I wonder how bad the housing market would be if unemployment assistance was not available.

    “How long is Disability?”

    I don’t know, how long before the disabled find a cure? Who would you throw onto the street? Maybe evangelicals can go forth and heal.

  13. take away their free emergency room visits for non emergency care

    open clinics inside 7-11 funded by an excise tax on tabacco, alchol, and snacks sold in that area

    Set up check points to check for the illegal importation of undertaxed goods into the hood

    tell cops to stop arresting people for drug violations, confiscate their drugs then sell them via the surplus/confiscated goods process using the proceeds to fund police, fire, and those 7-11 clinics

    Stop mailing or auto depositing welfare checks and food stamps. Have them check in at the beginning of a 5 mile trail and hand them out at the end. Pay these benefits daily

    Anyone seeking treatment for non emergency, self inflicted, or lifestyle illness is handed a mop and not treated until they have cleaned for 2 hours.

    thats a few off the top of my head

  14. According to a recent article in the WSJ, a mere 9.7 million poor elderly people eligible for both Medicare and Medicaid (dual eligibles) account for $300 billion of healthcare costs annually or fully one-third of the combined cost of the two programs. The article can be found at: http://online.wsj.com/article/SB10001424052702304453304576392194143220356.html

    There is enormous potential to better coordinate these programs themselves and the healthcare and custodial care provided to this very expensive to care for population. By contrast, children on Medicaid are comparatively cheap to insure. A large piece of the remaining TANF segment of Medicaid covers prenatal care and childbirth for poor women.

  15. “You do realize that this argument was won in the 90s? People dont get to live indefinitely on welfare anymore.”

    Whats the cut off for HUD housing?

    Unemployement is up to 99 weeks?

    How long is Disability?

    “The problem with states as sole payors for Medicaid is recessions. States are not, usually, allowed to run deficits. Having a mix of Federal and state funding, mostly controlled by the states, means that states have a stake in keeping costs down (Medicaid is the cheapest payor) while letting the Feds smooth out revenue shortfalls.”

    Then they should save in good times to pay the bills in bad times. Our current system rewards bad decision making.

    mostly controlled by the stats? PPACA took away almost all state control, everything must be approved by the Feds, been this way for years or you lose your matching funds. SCHIP expansion is a perfect example of Feds dictating for years.

    The states have an incentive for keeping cost high, the higher the cost/need the more federal funds they can chase.


  16. We have two classes of poor in this country, those that are content to be poor and live off their government benefits”

    You do realize that this argument was won in the 90s? People dont get to live indefinitely on welfare anymore. The real growth in govt spending is for the elderly, mostly in the form of Medicare.

    “hey Chris, where do States get their money to fund their portion of Medicaid?”

    The problem with states as sole payors for Medicaid is recessions. States are not, usually, allowed to run deficits. Having a mix of Federal and state funding, mostly controlled by the states, means that states have a stake in keeping costs down (Medicaid is the cheapest payor) while letting the Feds smooth out revenue shortfalls.

    Steve

  17. “This may be news to Republicans — but most poor people I know are spending all their time trying to find a job and put food on the table.”

    Are these real people or the ones you meet 3 seconds before a press conference supplied to you for political purposes?

    As a small business owner I find it hard to believe poor people are spendind much time at all looking for work or putting food on the table or they wouldn’t keep turning down jobs that don’t pay a high enough premium over unemployement.

    We have two classes of poor in this country, those that are content to be poor and live off their government benefits and the much smaller group who are poor and are actually trying to do something about it. That second group is mkuch smaller becuase this is America and with a little hard work its not that unlikly at all to live comfortably.

    “because if the Republicans are successful in turning the program into a block grant program that greatly diminishes funding to states, three awful things are going to happen — people are going to die, more jobs are going to be lost, and health care costs and taxes will actually increase.”

    Apparetnly Chris doesn’t understand financial systems very well. Hey Chris where does the Federal government get their money to make these block grants?

    Taxpayors

    hey Chris, where do States get their money to fund their portion of Medicaid?

    The exact same Taxpayors

    So Chris how is it people will die, healthcare cost will increae, and jobs lost if I give my taxes to my state instead of sending them through the federal government so you can take a processing fee and send it back? Does DC have a magical cash multiplier that turns my $1 of taxes into $2? Of course not, the truth is by getting the federal government out of the middle we can create jobs, lower the cost of healthcare and save lives.

    Why don’t i see a single reference to reducing the 10%+ of medicaid spending lost to fraud? Is it really the seniors you worry about Chris or the fraud and abuse your supporters live off of?

  18. It is so very difficult to read this typical liberal chicken little fear mongering. Unfortunately the government is broke.

    Most Medicaid patients in the ER absolutely do NOT need to be there.

    Do you have a solution?

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