Congressional GOP budget knives are sharpened to slash the Affordable Care Act (Obamacare) and, therefore, Medicaid one way or another. Recent news sees senators “warming” to a repeal without offering a replacement. In other words, junk it all and drop tens of millions of poor people from the health insurance roles. (When the proposed replacements from the House and Senate would have removed 23 million and 22 million respectively, complete elimination would likely mean many more.)
The animosity toward Medicaid is palpable among many demanding elimination of the ACA. How dare the country demand that the wealthy pay any more in taxes, no matter how much income growth has been concentrated upward! And Medicaid comes under fire because it helps poor people who, heavens forbid!, don’t have money to buy their own insurance and lack jobs with companies that offer any, let alone good, healthcare coverage.
Are there no workhouses? Technically, no, oh Ebenezers, there aren’t, nor charities that have enough resources to provide the volume of care necessary. (Please, let’s avoid the frequent suggestion that emergency rooms at hospitals provide all the free care people need. Too many of the institutions already struggle financially and they don’t provide significant types of care that someone might need for chronic conditions or serious issues that aren’t life-threatening.)
We have Medicaid because, in the past at least, we as a country felt a moral obligation to provide healthcare for the poor. Some people are able to see the injured and ill and not care. There are even people who call themselves religious “Christians” who claim the Bible never said anyone is owed healthcare (conveniently forgetting the point about loving others as you love yourself).
Most citizens are not like this, which is how Medicaid passed in the first place. The moral issues are strongly framed and difficult to circumvent without admitting indifference to poverty and to the many children in such circumstances. Instead, the people who are comfortable with a Malthusian orientation make a different argument. “Medicaid is terribly wasteful”, they say, “and patients can’t find doctors who will see them. Time to reform it!” Typically, reforms of this type start and end with cuts, not identification of problems and necessary systemic restructuring.
The problem with the argument is that, if you look at the overall figures, as well as a new study looking at Medicaid satisfaction, none of this is true on the whole. I downloaded total monthly Medicaid and CHIP (the children’s health insurance program) enrollment from the Kaiser Family Foundation site and then went to the Centers for Medicare & Medicaid Services site for national health expenditures by type of service and source of funds. The latter’s most recent information was from 2015, so I took the first spreadsheet and calculated an average enrollment for the same year.
The results were $559,752,000,000 — about $559.8 billion for the year — divided by 71,849006 people. Medicaid’s annual cost per covered person runs about $7,790. If that seems like a lot of money, then you’re not familiar with how much healthcare costs on a per capita basis in the U.S. According to the World Bank, in 2014 we spent $9,403 per person, which put us third from the top. (Switzerland and Norway had higher costs.)