Medicrisis

Even as the Affordable Care Act (aka “Obamacare” or the ACA) has settled down into a reasonable operational mode, even after the Republicans in Congress tried over 60 times to repeal the statute and even after the Supreme Court limited the federal government’s right to mandate states to expand Medicaid (covering very low income participants) in 2012, Donald Trump is still trying to force the program to fail. In the first year of his administration, with the vote from Republican John McCain almost a year ago that stopped the last GOP repeal effort (pictured above), Donald Trump and his plutocratic elite political appointees have been consistently hell-bent on eviscerating the ACA through inaction, granting exemptions and contradictory executive orders.

Everyone knows the legislation is flawed. Every seminal piece of social legislation ever passed by Congress has required repeated adjustments through additions by amendment. But the GOP seized on those flaws and have insisted that the ACA should be the only such seminal social legislation in American history that must be repealed and not fixed. The Trump administration has engaged in a litany of exceptions granted to business and states, under the guise of making healthcare more affordable – ostensibly to create less expensive “skinny bundles” and allow states and trade associations to offer very limited coverage – to avoid the ACA’s clear ban on eliminating or charging more for coverage of preexisting conditions and ailments with complex medical solutions. Such plans literally decimate the clear mandate of the ACA. People with those issues? Life is hard! Suffer and die!

The obvious fixes, such as allowing healthcare exchanges to use their obvious bargaining power to negotiate with pharmaceutical manufacturers to reduce costs (a practice forbidden by the ACA, a clause that was inserted in 2010 to get pharma support for the act), languish without any proposed or pending corrective legislation. The GOP-dominated Congress is a willing co-conspirator in the erosion of the ACA.

That Medicaid exception determined by the Supreme Court has effectively allowed different states to opt in or out of an expanded Medicaid plan or to modify their requirements to reflect the local biases for or against the law. Blue states like California, Washington and New York have vastly better coverage under Medicaid than deeply red states where coverage is limited or virtually inaccessible.

Some states have taken the position that poor people should have to share some of the costs of their medical care, regardless of their financial inability to do so. So it is useful to look at how people who need medical care react to programs where they have make real premium contributions or co-payments. Quasi-red state Ohio (actually a swing state) is less burdensome than neighboring red state Indiana. So it becomes interesting to view the differences in how lower income people in need of medical care react and get covered under each state program.

“Even as the Trump administration pushes to make Medicaid enrollees pay a greater share of their healthcare costs, new research suggests this strategy may prevent many poor patients from getting needed care… An independent study of Indiana, which has helped pioneer the strategy of charging Medicaid patients, identified lower rates of health coverage in the state than in neighboring states that do not impose the same costs… And a second study of the state found that low-income Indiana residents have more problems paying medical bills and are more likely to delay care because of cost than in neighboring Ohio, which does not impose the same cost-sharing requirements.

“Indiana’s Medicaid strategy — known as the Health Indiana Plan, and later HIP 2.0 — imposes a complex series of cost-sharing requirements on patients in the program… Patients must contribute to a health savings account used for their medical expenses. Monthly contributions, based on income, range from $1 to $30… If patients make the contributions, medical care is essentially free. People can even lower their contributions by getting recommended preventive care, such as cancer screenings… If patients don’t contribute, however, they lose dental and vision coverage and must make small copays when they see a doctor or fill a prescription.

“For years, Indiana officials, including [Seema Verma, whom President Trump tapped to oversee Medicare and Medicaid and who helped develop the Indiana program], contended that the strategy had broad participation from Medicaid enrollees… But a growing body of evidence has shown that many Indiana enrollees do not make the required contributions.

“One of the new studies, which was based on a survey of low-income adults in Indiana, Ohio and Kansas, found that only about a third of Indiana adults eligible for HIP 2.0 were contributing to the accounts… About 31% of those who were not making the payments said they could not afford them; an additional 21% said they did not think the payments were worth it; and 19% said they were confused by the cost-sharing requirement… At the same time, the researchers found that substantial numbers of low-income residents in Indiana reported trouble accessing care… More than 30% reported that they delayed care because of cost, and 34% said they had trouble with medical bills…

“In neighboring Ohio, by contrast, 25% of low-income residents said they delayed care, and 29% said they had trouble with medical bills… Ohio, unlike Indiana, undertook a more traditional expansion of its Medicaid program that does not put the same cost-sharing requirements on poor patients… Medicaid is available to residents making up to 138% of the federal poverty level, or about $16,700 a year.

“The access problems in Indiana are also reflected in coverage numbers, according to the second study by researchers at Indiana University… These researchers found that Indiana’s uninsured rate fell substantially after the state used HIP 2.0 to expand Medicaid through the Affordable Care Act… But the state’s coverage gains were not as substantial as the gains in neighboring expansion states.” Los Angeles Times, June 21^st.

We can afford to make a trillion dollar tax cuts for the richest in the land, which has shifted money primarily into dividends and share buybacks (vs high-paying jobs), but we have trouble keeping ordinary citizens, particularly lower income citizens, alive and healthy with a fraction of the cost of that tax cut. What’s even more amazing is the GOP pledge further to cut social programs, from Social Security to Medicare and Medicaid, to pay for those tax cuts. We are the only developed country on earth with such a callous disregard for our own people and the only such nation where medical bankruptcies are routine.

I’m Peter Dekom, and I am continually stunned at how many ordinary GOP constituents and other Trump supporters are willing to vote against their own economic and heath best interests to benefit the few at the top of the economic ladder.