Saturday, September 26, 2020

NEWSPAPER PUBLISHED WEEKLY ON WEDNESDAY • WEBSITE UPDATED WEEKLY FOR THURSDAY

Home Opinions THINKING ABOUT HEALTH: Medicaid still a target of healthcare reform

THINKING ABOUT HEALTH: Medicaid still a target of healthcare reform

By Trudy Lieberman for the Rural Health News Service

What’s going to happen to healthcare now that Senate Republicans have failed to pass their bill, which would have replaced much of the Affordable Care Act? In particular, what’s going to happen to Medicaid, the government’s largest insurance program, which covers 74 million Americans? This is a good time to clarify what was at stake and may still be up for grabs in the months to come.

Despite its importance to so many people, Medicaid has always been the health system’s stepchild. Many doctors and dentists have avoided taking Medicaid patients saying the program didn’t pay enough. Until recently, editors haven’t been keen to feature stories about Medicaid believing that their audience was not interested in reading about people most likely to be on the program – the poor, the disabled, kids, and seniors who needed it to pay for their nursing home care.

Suddenly, media stories about cutting Medicaid and the loss of coverage to millions became news. “In the course of the debate, it’s become clear that Medicaid has tremendous public support. There has been much more focus in this debate than I’ve seen in any health policy debate,” said Shannon Buckingham, vice president for communications at the Center for Budget and Policy Priorities, a Washington D.C., think tank.

So what is this program that affects so many and will undoubtedly surface again either later this year or next as a political football?

It was created in 1965 under the Johnson administration at the same time Medicare was passed. Unlike Medicare, though, which is a social insurance entitlement to which people contribute throughout their working lives, Medicaid is a welfare program. Those applying for coverage must meet strict asset and income tests, which mean they can’t own very much and they can’t earn a lot of money. Everyone who qualifies is guaranteed coverage.

The benefit package that all states must offer is generous, covering many services, including nursing home care and transportation to medical appointments. It pays for care given at rural health clinics and federally qualified health clinics. States can provide optional benefits such as prescription drugs, respiratory care, dental services, physical and speech therapy. Many states do.

States and the federal government share in the cost, and that’s where the fight in Congress comes in. As medical costs have risen – with few controls on how high they can go – states have found that Medicaid is consuming larger shares of their annual budgets, often crowding out other needs like fixing roads. The federal government continues to pay more too.

One solution for this dilemma is to change the way Medicaid is financed – from a state-federal matching arrangement into what’s called a block grant. Under a block grant, the federal government will give a set amount of money to the states. It’s a way reduce its healthcare expenditures while shifting more of the burden to the states to cover their residents who depend on Medicaid.

Conservatives have argued for years that giving the states a lump sum would mean they could manage their programs as they saw fit. That’s why during debates on Medicaid you hear phrases like “more flexibility” and “greater freedom.” But others argue that flexibility and freedom come at a cost. It could allow states to offer fewer benefits and impose restrictions that would make it harder for people to get care.

The Graham-Cassidy bill that was the Senate’s last attempt at remodeling the Affordable Care Act called for block grants and eliminated the ACA’s Medicaid expansion program that had provided healthcare to those with incomes between the poverty level and 138 percent of the poverty level. This year that’s about $16,600 for a single person and about $34,000 for a family of four. The expansion had brought some 12 million people onto the program.

The Medicaid debate is far from over and is shifting to the states. Several have applied for waivers from the federal government to allow them more flexibility. For example, a state might ask for permission to enroll Medicaid recipients in private insurance plans as Arkansas has done. While a private market solution might sound good, it could mean that people on Medicaid would have to pay higher deductibles and other cost sharing.

Indiana has a waiver that requires recipients to make small monthly payments and maintain a savings account mostly funded by the state to pay for some of their care. People who don’t make their payments may be locked out of coverage for a time. Some states like Arizona and Kentucky are eyeing work requirements. Most Medicaid recipients, however, are already working.

These potential changes raise important questions this last debate didn’t answer. Who should get coverage? Should we control rising medical costs by reducing healthcare for those who can least afford it?

Maybe the next debate will give us the answers.

How would you answer these questions? Write to Trudy at trudy.lieberman@gmail.com.

Submissions
Submissions
The Williams Pioneer Review has a small staff of one, covering all of Colusa County; but we’re proud to have the assistance of a large army of community contributors to extend our range and reach. This is one of those stories. If you have a story you would like to share, please email them to: news@colusacountynews.com or give us a call.

More News

Colusa County Office of Education – Request for Proposals

COLUSA COUNTY OFFICE OF EDUCATION REQUEST FOR PROPOSALS The Colusa County Office of Education (CCOE) is accepting emailed bids for the bulk purchase of LTE Equipment...

Samuel Milton Mason (1944-2020)

It is with great sadness that we, the family of Samuel Milton Mason announce his passing on September 20, 2020 in Roseville, CA after...

CUSD working to get some students back to school

The Covid-19 pandemic has changed modern education in a way never before experience. For most schools in the state of California, getting students back to...

Quilters serve local needs, fire victims

Had it not been for a coronavirus pandemic, the Pacific Flyway Quilters would have held their annual Community Service Giveaway Night with a little...

Life, as I see it: Wind down

As the weather turns cooler and days begin to be shorter, I find myself winding down. The business of summer, the craving to spend...

Local Government

City grants permit for cannabis expansion

Colusa’s first cannabis nursery is now looking to expand operations to include full marijana cultivation. The Colusa City Council voted 4-1, on Sept. 15, to...

Local governments spending CARES to boost IT infrastructure

In order to reduce physical interaction between individuals in the era of Covid-19, local governments are using CARES Act funding to invest in better...

County appoints new Airport Advisory Committee

The Colusa County Board of Supervisors on Sept. 1 appointed seven members to the newly restructured Airport Advisory Committee. The previous committee of about 15...

Public & Legal Notices

City of Colusa – Notice of Public Hearing

CITY OF COLUSA CITY COUNCIL NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN THAT THE CITY COUNCIL will hold a Public Hearing in the City Council...

City of Colusa – Notice of Public Hearing

CITY OF COLUSA CITY COUNCIL NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN THAT THE CITY COUNCIL will hold a Public Hearing in the City Council...

County of Colusa – Notice of Vacancy – Colusa Cemetery District

COUNTY OF COLUSA NOTICE OF VACANCY Notice is hereby given that the Colusa County Board of Supervisors  is soliciting applications to fill a vacancy for an...

City of Colusa – Ordinance No. 542

CITY OF COLUSA ORDINANCE NO. 542 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF COLUSA REZONING APPROXIMATELY 5.39 ACRES TO GENERAL COMMERCIAL PLANNED DEVELOPMENT...

Colusa County Resource Conservation District – Request for Statement of Qualifications for Contractors

COLUSA COUNTY RESOURCE CONSERVATION DISTRICT REQUEST FOR STATEMENT OF QUALIFICATION FOR CONTRACTORS FOREST HEALTH PROJECT PHASE 1 IN COLUSA COUNTY The Colusa County Resource Conservation District...