Medicaid, Medicare & You
Dear Leading Ladies,
Last week, Medicare and Medicaid, our country’s largest public health insurance programs, celebrated their 60th birthdays. Few of us probably remember that these programs were part of President Lyndon Johnson’s attempts to desegregate American healthcare and fight poverty. They were part of the president’s War on Poverty.
“How are we celebrating this birthday?” asked Lawrence Gostin, a professor of global health law at Georgetown Law in a recent article by Jessica Glenza in The Guardian. “Now, in order to give tax relief and spend more on defense, we’re kicking off our most needy citizens from life-saving care.”
Yes, President Trump’s Big Ugly Bill, is projected to add significantly to the national debt while bankrupting Medicare’s trust fund, which pays for hospital care, and throwing millions of people off the rolls of health care.
Happy Birthday to us.
There has been a lot of talk about what exactly the cuts to Medicare and Medicaid will be, who will be affected, and how. We tried to suss out some of the truths from fiction, acknowledging that Trump’s positions change frequently, earning him the new nickname of TACO – Trump Always Chickens Out.
What seems accepted truth is that the Big Ugly Bill cuts over $1 trillion from health programs, “the largest rollback of federal support for health care in American history,” according to MedicareAdvocacy.org. “Today, Medicare insures more than 68 million seniors, while Medicaid insures an additional 71 million low-income elderly and disabled adults,” Glenza wrote. Trump’s cuts are expected to result in “12 million people losing Medicaid coverage and another 5 million people losing health insurance because of a reduction in government subsidies to private insurance, through so-called ‘Obamacare’ plans.”
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Impact of the Big Bill on Medicaid
One of the big changes in Medicaid eligibility is a new work requirement for those between the ages of 18 and 64. According to Laura Baron-Lopez of PBS, these Medicaid recipients will need to “prove they're either working, in school, or doing community service for 80 hours a month. The Congressional Budget Office estimated that 11.8 million Americans could lose Medicaid coverage over the next decade because they may struggle to navigate the new paperwork, miss deadlines, or simply not apply at all.”
She explained on a July 7 broadcast that there isn't a lot of evidence showing waste, fraud, and abuse in the Medicaid program on the part of recipients, so “all the time and money being spent on this checking into fraud is ill-spent.” The same holds true for the SNAP program, she said, where kicking families off the program has not enhanced “labor force participation.”
Pamela Herd, a policy professor at the University of Michigan, substantiated Baron-Lopez’s position, pointing to the state of Georgia, which instituted a work requirement for Medicaid recipients. They spent $90 million implementing the plan and only $26 million went to beneficiaries.
“[M]any people with cancer are physically unable to hold or apply for jobs. The new bill gives an exemption for people with ‘serious and complex medical conditions,’” Elizabeth Darnall, senior director of federal advocacy at the American Cancer Society Cancer Action Network, told ThinkGlobalHealth.org, “but it's unclear whether that exemption covers all or just some cancers, or how patients will have to prove that they qualify.”
In addition to the impact of the new work requirements, more frequent eligibility checks, new immigration restrictions, and reduced state funding will throw more people off the Medicaid rolls. For details of these restrictions, go to https://medicareadvocacy.org/impact-of-the-big-bill-on-medicare/
Hospitals in rural areas, which rely on Medicaid reimbursements to stay open, will face closure, according to many sources, including the National Rural Health Association (NRHA). The reductions in Medicaid funding “will accelerate rural hospital closures, and for those rural hospitals that remain open, lead to the elimination or curtailment of critical services, such as obstetrics, chemotherapy, and behavioral health,” according to NRHA.
With so many people losing Medicaid coverage, people will die (many from preventable diseases) because they won’t have access to screening tests, regular medical visits, follow-up care, and treatments of everyday ailments. Many will become very sick and need to be cared for by family and friends who will need to stop working. This will happen not because Medicaid prevented the care; it will happen because so many people will no longer be eligible to receive Medicaid at all.
Impact of the Big Bill on Medicare
“While broad health care cuts in the Big Bill will affect many Medicare beneficiaries indirectly, including those who are dually eligible for both Medicare and Medicaid, several provisions of the OBBB directly target Medicare beneficiaries,” according to MedicareAdvocacy.org.
For instance, there are new limits on lawfully present immigrants, eliminating all but US citizens, Green Card holders, Cuban and Haitian residents, and individuals from certain Pacific Island nations with special agreements with the US. This leaves out refugees and people granted asylum, people with temporary protected status, survivors of human trafficking, survivors of domestic violence, and individuals granted humanitarian parole. While undocumented immigrants have never been eligible for Medicare, lawfully present individuals who worked and paid into the system have historically been able to qualify for Medicare benefits.
The new bill also blocks improvements to Medicare Savings Programs which help lower-income Medicare beneficiaries pay for premiums and out-of-pocket costs; blocks implementation of national minimum staffing requirements for nursing homes that were designed to improve quality of care; and limits Medicare’s ability to negotiate prices for certain high-cost medications. Furthermore, the bill will bankrupt Medicare’s trust fund (which pays for hospital care). More details available here.
While we are worried about our Medicare benefits, we need to spend some time on whether or not to sign on to a Medicare Advantage plan. After the CEO of United HealthCare was murdered in plain sight in downtown New York City, his company received a lot of bad press for its inhumane policies, giving all advantage plans a bad rap. Turns out they are not all bad. The non-profit ones seem to do better for patients than the for-profit ones (shocker!); and, depending on your health situation and age, advantage plans just may or may not be the way to go for you. As always, when considering, check your sources.
It is important to note that the Big Ugly Bill does not specifically call for the end of screenings such as for prostate cancer (a screening every 12 months for men over 50 is now covered by Medicaid and Medicare). However, those who lose coverage, because of the new eligibility rules about working and the new complicated administrative paperwork, may not receive the screenings, leading to a serious uptick in the incidence of late stage prostate and other forms of cancer. What may be needed are grass roots efforts to help senior citizens and second language speakers navigate the new eligibility requirements so no one loses coverage unnecessarily.
Closing rural hospitals and clinics will mostly, but not entirely, adversely affect poor people. Lots of senior citizens of all means live in rural areas and need more health care as they age. If the services in their communities become sparse and their ability to travel long distances to get therapies of various kinds becomes more difficult, they will languish and die.
Lots to think about
The Big Ugly Bill represents a rejection of the progress achieved by the Civil Rights Movement, the War on Poverty, and Obamacare. We are confronted by the blatant and supremacist face of discrimination and hate dressed up in fiscal responsibility. Whether it affects us or a neighbor or relative, these new regulations and denials of coverage will hurt our country.
If you or someone you know may be in danger of losing coverage, reach out to your US representative for help in filling out the administrative paperwork to stay covered. Make sure you and all those around you make appointments for yearly tests such as mammograms, prostate PSAs, flu and COVID shots, in case anything gets canceled in the coming year.
And get ready to vote in the mid-term elections. Only a change in power in the House and Senate can protect all the people in our country.
To our health,
Therese (she/her/hers)
Judy (she/her/hers)
Didi (she/her/hers)
Leading Ladies Executive Team
Leadingladiesvote.org
ladies@leadingladiesvote.org
