As Congress debates how to chop the federal budget down to size, those who are realistic about accomplishing that feat – mostly Republicans – have rightly focused on entitlement programs. Despite all the political bluster, it’s clear that you cannot establish long-term budget stability without taking on Medicare, Medicaid and Social Security.
But not all entitlement programs are alike.
Now that the GOP plan to overhaul Medicare is approaching “dead issue” status, the Republicans seem to be focusing on Medicaid, which is a state-federal partnership. This is the program known as the “safety net” that provides health care to the poor, particularly to impoverished children. What is swept aside by GOP budget cutters is that millions of Medicaid recipients are not urban minorities, they are seniors in nursing homes and the disabled who rely upon in-home care to survive.
Beyond that distinction, here is the dirty little secret that is shunned by most on Capitol Hill, from conservative Republicans to liberal Democrats: Medicaid is a shoddy program that only protects the “dirt poor” among us.
Eligibility standards are so strict that, in many states, the parents of a family of three fail to qualify for coverage unless their annual income is below $5,000. These shameful standards are quietly enforced in states such as Alabama, Louisiana, Texas, Virginia, Missouri, Indiana and Idaho, according to Families USA, a non-partisan health care advocacy group.
While most children get coverage, the states don’t seem to think that the parents who take care of those kids deserve any health care. In Arkansas, for example the limit for parents is $3,139 a year of income for a family of three – 83 percent below the federal poverty line. In other words, only welfare recipients need apply.
Yet, budget-cutters on Capitol Hill are taking aim at Medicaid to further reduce the number of recipients. This miserly program has become just another part of a bloated, out-of-control federal budget.
The GOP budget plan authored by Rep. Paul Ryan of Wisconsin would turn Medicaid into a lump-sum block grant program for the states, giving the governors more flexibility to set eligibility requirements and medical care restrictions.
The Ryan plan would replace the portion of President Obama’s health care reform law that will make Medicaid available to all those who live within 150 percent of the poverty level. That was a big, expensive portion of the 2010 health care bill for which most liberals never once showed any concern or passion.
Medicaid is a program designed to be a 50-50 proposition between the federal and state governments. Those in Washington pat themselves on the back for providing health care for the poor. But the states have a whole different definition of “poor” than the feds.
On March 1, Mississippi Gov. Haley Barbour and Utah Gov. Gary Herbert testified before a House committee and warned that their states cannot afford any federally imposed increases in the Medicaid program.
Yet, Mississippi’s program is paid for on a 3:1 ratio — not 50-50 — by the feds and the standard of care is still abysmal. That family of three mentioned above receives no parental coverage if their annual income is $8,136 or above. That’s the equivalent of $156 a week.
And state rules prevent childless adults in Mississippi from enrolling in Medicaid, even if they are penniless.
In Utah, for whatever reason, the exact same standards apply. The state offers a waiver that allows adult coverage for services received from a primary care physician, if the applicant for this special program is within 150 percent of the poverty level. However, Families USA points out that no medical care provided by a specialist is covered and, in any event, the program is currently closed to new applicants.
In Washington, while the House GOP failed in its attempt to slash federal dollars for Medicare, the upcoming battle for Medicaid will be much quieter – if, that is, the average American hears anything at all.
For the most part, the poor don’t make noise. They don’t have an AARP, they don’t hire lobbyists, they don’t vote in any great numbers – and those that do are overwhelmingly Democrats. The reality is, Medicaid is not a high priority for many congressional Republicans.
And, frankly, it’s probably even less of a priority for conservative Republicans across the nation’s electorate.
Still, if the average GOP voter has little sympathy for those cast aside by this skimpy program, maybe they should consider the fairness issue that’s at play here.
At the same time that Medicaid is limited to the poorest of the poor, a separate program known as SCHIP was expanded with bipartisan support in 2008 by Congress and then again by the Democrats in 2009. That program provides federally funded health care coverage for kids under age 19 who are solidly in the middle class. For a family of four, some states provide coverage for kids whose parents earn up to $67,000. The high end of SCHIP’s eligibility limits is nearly $85,000 in New York.
Does that make any sense? What do you tell parents in Mississippi who makes one-tenth of that $85,000 yet cannot receive any assistance to pay for medical care?
Without much hyperbole, it can be asserted that a lack of health care coverage can become a life-or-death matter.
So, why is the life of a teenager in suburban Birmingham, Mich., more valuable, in the eyes of the federal government, than the life of an impoverished teenage mom in Birmingham, Ala.?