Medicaid: It’s not just about hospitals and doctor visits. It may be helping you, your neighbor or co-worker.
When most of us hear about Medicaid, we also think Medicare, a health insurance program that helps pay for hospital visits, doctors and other parts of health care. About 28 percent of the time, we would be right.
We also think that it is health insurance for people on welfare, even though the term “welfare” has been outdated for a long time. If by welfare we mean people who receive benefits from the government — well, almost everyone is on some form of welfare, including some of the largest businesses in this country (e.g. the oil industry and agriculture) and large employers who pay so little that the only way their employees can often survive is by being eligible for food stamps or other benefits (e.g., Walmart). But that’s another story.
If we mean health insurance for people below or near the poverty line, then in fact, the Affordable Care Act — “Obamacare” — did expand Medicaid eligibility to people making up to 138 percent of the poverty line. For one person, that translates to an annual income of $15,800; for a two-person family, $21,300; three-person family, $26,800; and a family of four, $32,300. Most people and families making that level of income can in no way afford to pay for health insurance out of their own pocket and many have jobs without health-care benefits.
And without Medicaid, the only place you could go would be the emergency room — and that costs we the taxpayers much, much more. Those people are in that 28 percentile.
But Texas chose not to expand Medicaid eligibility through the Affordable Care Act, so about 700,000 people with incomes under those amounts are thus not actually eligible for health insurance at all. That is a little less than the number of people who live in the 17th Congressional District. But that is also another story.
So where does the other 72 percent of Medicaid funding get used? You might have been reading about the Texas Legislature battling over early-intervention therapies for young children with severe disabilities. In 2015, the Legislature cut huge amounts from that program. Some legislators are now trying to restore it.
What do we know? Early intervention is the most important time to provide therapies that will help children with disabilities develop for the long run. Many of these kids are on Medicaid, which means their families are not ruined financially by therapies and complex medical issues. These parents still work (and pay taxes). You may know some of these families. We often call them “heroic.” I guarantee you: They are grateful for the support, as you and I would be if we were in their shoes.
But early intervention is only a small piece. Think about most of the people in nursing homes in Central Texas. They are somebody’s mothers and fathers who cannot afford retirement centers. Medicaid pays for ongoing care: nurses, aides, meals, recreation, housekeeping, and more. Think about the programs supporting adults with intellectual and developmental disabilities — both those who live in group homes and those who live at home with their families. In the latter case, supporting someone living at home is much more cost-effective than residential programs. Both options are far cheaper than an institution. Plus, they get to be part of the communities in which they grew up rather than being uprooted and sent away.
In the past decade, Texas has done some good work to redirect general revenue that paid for some of these supports into Medicaid. And they were able to use Texas taxes to draw down more federal dollars. However, the American Health Care Act — the Repeal and Replace Obamacare Act, some call it — would cut federal Medicaid dollars significantly, which means longer waiting lists for aging parents.
Then think about people with psychiatric issues who, if they cannot afford treatment, can often end up unemployed and homeless or in the largest treatment facility in most of the country — the county jail or a state prison. You may now be able to think of people you know. And through the help of Medicaid, the Heart of Texas MH/MR program has been able to start several creative programs to provide treatment that keeps people with mental illness with minor offenses out of jail, avoids admission to Austin State Hospital, and keeps them from being homeless. If Medicaid funding is cut dramatically, those cases might very well overwhelm community-based nonprofits and county services — or, to put it differently, end up falling totally on local and state taxpayers.
After its defeat last month at the hands of ultra-conservative House Republicans as well as Democrats, new attempts have arisen to revise the AHCA — this time by not just cutting Medicaid but also by eliminating the requirement for “essential health benefits,” which means required coverage for mental health issues and substance abuse that the ACA required. Think about people you may know who are addicted to drugs or alcohol or whose insurance is now paying for treatment and recovery programs at whatever income level. The new AHCA being crafted would also allow for insurance plans that would not cover pre-existing conditions — something President Trump once thought necessary. How many people in the 17th Congressional District have pre-existing conditions before they get to Medicare age? Around 400,000, about half of the 17th District population. You would know a lot of those people. You, like me, might even be one of them.
The truth is that Medicaid helps thousands of people in our own congressional district live lives that keep them out of more expensive medical and health services that someone would end up paying for. That someone, ultimately, would be you and me. It helps families at multiple income levels to provide care at home while they also work and pay taxes. It provides the opportunity for children and adults with physical, intellectual and/or psychiatric disabilities to learn, grow and/or recover where they learn and grow best, in community settings that enable relationships, participation, and contribution. When given a fair shot, many have the possibility of a job and becoming a taxpayer themselves.
To make this come alive, you plug in the stories of the people you know whose lives are more secure because of one of these kinds of programs, all made possible by this state/federal partnership we call Medicaid. Tell your stories to our elected leaders. If Texas was willing, we could do something about the ongoing stigma of being one of the states with the lowest quality of long range services for people with disabilities and the highest percentage of people who have no insurance at all.
In one of the richest states in the country, and within sight of some of the world’s best health care systems, this is not just a moral shame. It is obscene.