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“Saving That ‘Worthless’ Medicaid”: The Idea Of ‘Worthless’ Is Correlated To The Idea Of The Life Of Poor Folks Being ‘Worthless’

As noted earlier today, it’s the 50th anniversary of the enactment of Medicare and Medicaid.

I strongly suspect the former will get more attention, because it’s a non-means tested program with an extremely powerful bipartisan constituency (despite constant GOP efforts to screw over future beneficiaries via a phased-in voucherization or some other way to shift costs to old folks). Everybody’s either on it or going to go on it if they live long enough.

Medicaid’s another matter, of course. It’s means-tested with the states having significant control over eligibility and benefits, which means it involves different sets of people (particularly now that half the states have accepted the ACA’s Medicaid expansion while half haven’t) and significantly different benefits and service delivery models in different states. With the exception of a little-understood long-term care component that pays for nursing home care for people who have disposed of most of their assets, Medicaid is a poor folks program–you know, for those people–which because it is state (and to some extent locally) operated means these poor folks are not necessarily dealing with the friendliest policy-makers, administrators or providers, particularly given Medicaid’s relatively low reimbursement rates.

But to the Republicans who have all pretty much agreed upon a policy of “block-granting” Medicaid, which means dumping the Medicaid population on the states with a fixed (and ultimately declining) sum of money and letting them do whatever they want to do with them, the question about Medicaid isn’t whether its structure and financing are giving the poor the kind of health care the rest of us would want, but instead whether it’s worth anything at all. That’s largely the function of prejudice plus a 2013 study in Oregon of people receiving and not receiving Medicaid benefits which provided some startling-sounding data on how little real benefit Medicaid created. It’s hard to read any conservative discussion of Medicaid and not hear the Oregon study “proved” Medicaid’s worthless.

So that’s why with Medicaid’s fate perhaps hanging in the balance after the upcoming election, three excellent policy writers, Harold Pollack, Bill Gardner and Timothy Just, have written an explanation of the Oregon study that rebuts its invidious use.

[P]erhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. [The Oregon researchers] placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.

So the idea of Medicaid being “worthless” is closely correlated with the idea of the life of poor folks being relatively “worthless” (there are defensible reasons for this valuation in the study itself, but not for the way it’s being used by anti-Medicaid ax-grinders) as well. If you don’t share that premise, you shouldn’t share the related conclusion, either.

In any event, progressives should gird up their loins for a fight to save Medicaid in the near future. I’ve thought of myself as a warrior for the continuation of Medicaid ever since I was drawn into the 1981 Reagan Budget fight, wherein the administration suffered a rare defeat in its efforts to “cap” federal Medicaid spending, thus gradually making it a state-financed program. The fight just ahead could be even tougher.

 

By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, July 30, 2015

August 2, 2015 Posted by | Medicaid, Medicaid Expansion, Medicare | , , , , , , , , | 1 Comment

“Making Medicaid Matter”: The Real-World Impact For Today’s Struggling Americans

Much of the 2012 policy debate, such as it is, has focused on Medicare, and with good reason — the Romney-Ryan plan to replace the Medicare system with a voucher plan is important and worth scrutinizing in detail.

But in his convention speech last night, Bill Clinton not only stressed Medicare, he also delivered a forceful reminder about the importance of Medicaid and what would happen to the program under Republican rule:

“Now, folks, this is serious, because it gets worse. And you won’t be laughing when I finish telling you this: they also want to block-grant Medicaid, and cut it by a third over the coming 10 years.

“Of course, that’s going to really hurt a lot of poor kids. But that’s not all. A lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid.

“It’s going to end [Medicaid] as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down’s Syndrome or autism or other severe conditions.

And honestly, let’s think about it, if that happens, I don’t know what those families are going to do. So I know what I’m going to do. I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen.”

The future of Medicare is obviously important and should be a central issue in the presidential race, but as Matt Yglesias noted, “Medicaid is the one where much more is at stake on the ballot.”

Why? Because the Romney-Ryan plan, with a position they’re not at all bashful about, would block-grant Medicaid, leaving states with fewer resources, and leaving the poor and disabled in even more jeopardy.

Remember, unlike Medicare, Medicaid is a partnership between federal and state governments. The program undermines state budgets in a big way during economic downturns — more people begin to rely on the program and states, which can’t run deficits, struggle badly with the finances — and the moment a Romney-Ryan administration gives states the flexibility to do so, Republicans governors will start improving their finances by taking health care from the most vulnerable, who don’t exactly have lobbyists looking out for them.

What’s more, as Clinton reminded us, for all of Romney’s talk about leaving seniors’ benefits intact, the moment the GOP guts Medicaid, plenty of elderly Americans will feel the effects.

There’s no shortage of policy differences between the two major-party campaigns, but this is one of the more dramatic areas of disagreement, especially as it relates to the real-world impact of struggling Americans. Medicaid deserves to be an important part of the national debate, and kudos to Clinton for giving the issue the spotlight.

By: Steve Benen, The Maddow Blog, September 6, 2012

September 6, 2012 Posted by | Election 2012 | , , , , , , , , | Leave a comment

   

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