Today's Managing Health Care Costs Number is 85%
There's a lot of talk from (generally Republican) governors about the need to impose work requirements for Medicaid eligibility. Many are looking to the Indiana Medicaid waiver negotiated by Seema Verma, the designated new head of the Centers for Medicare and Medicaid Services. They also look at the requests for Medicaid waivers rejected by the Obama administration because they would have made it more onerous for those eligible to qualify for Medicaid coverage.
I find this deeply disturbing because I believe in the right to health care - I think health care should not be available only to those who are "worthy."
When I was a first-year medical student I wondered how it would feel to take care of a cigarette smoker dying of lung cancer. When I was a third year medical student - I discovered that the tragedy of a human suffering from terminal lung cancer was no less because that person had smoked "cancer sticks." If we think access to health care is a human right - it's a right for everyone - not just those who appear to be "worthy."
Brook Gladstone of NPR's On the Media finished an excellent five part series on poverty in America this past week - she notes that while many complain about the lazy or unworthy poor -the Census Bureau reports that of those who receive cash assistance, 25% are children, 14% are elderly, 13% are disabled, 9% care fulltime for a family member, 8% are students and 16% are already working full time. Yup -that's 85% of those receiving cash assistance. Sure, there are able bodied people who benefit from government programs - but they represent a tiny minority. More statistics from Gladstone: 40% of Americans will have income below the poverty line for a year or more during their working lives -and the value of temporary assistance for needy families has decreased by 20% since it was block granted to the states twenty years ago.
Imposing these types of requirements on Medicaid recipients is not just abhorrent from a humanistic perspective - it's terrible public policy. These onerous requirements to requalify for Medicaid overwhelm the poor who often have tough lives with little cognitive bandwidth to deal with new requirements, leave people with gaps in coverage, and require expensive administrative bureaucracy.
The benefits of Medicaid are most profound for young children -- should they be tossed off Medicaid because their parent or parents make a mistake, forget to fill out a form, or are too busy to go to a well-meaning but worthless seminar? If we are serious about addressing inequality and the diminishing opportunity for the poor to climb into the comfortable middle class or beyond, we should be expanding health insurance eligibility, and avoiding imposing burdensome requirements on recipients.
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