Mar 242017
 

A few thoughts on the demise of the American Health Care Act:

  • Paul Ryan is not a smart man. As others have noted, he is a dumb guy’s idea of a smart man. He actually thought he could pass a bill in a month without doing any of the hard work necessary to pass major legislation. He didn’t reach out to stakeholders. He didn’t hold public hearings. He barely allowed any debate on the bill. And I’m not even getting into the substance of the bill, which was breathtaking in its cruelty.
  • Trump is low-energy! Seriously, he couldn’t be bothered to focus on the task of realizing a major campaign promise for more than a few weeks. He claims to be more interested in tax reform, but that’s likely to be even more arduous than his failed attempt to repeal the ACA. He’ll need to be able sell tax reform on its merits, but he’s shown no capability for this.
  • The voices of constituents matter. If you called your representative or senator, if you showed up at a town hall meeting, if you wrote a letter to your newspaper, then you played a part in the demise of this terrible bill.
  • The fight is not over. Republicans will try to sabotage the ACA through regulatory actions, funding cuts, and other shenanigans. People of good conscience must be prepared to fight any efforts to diminish the effectiveness of the ACA. We must also offer practical solutions to fix the shortcomings of the ACA. And maybe we can even find bipartisan consensus on those fixes.
Mar 132017
 

I drafted the op-ed piece below in an effort to explain why the proposed cuts to Medicaid in the American Health Care Act would be so detrimental to me and millions of others. Alas, the Times was not interested, but perhaps this is a more fitting place for it.

Soon after I turned thirteen, I was hospitalized with pneumonia and my parents confronted an agonizing choice: should they surrender their parental rights to ensure that I received the health care needed to ensure my survival? I was born with spinal muscular atrophy, a rare neuromuscular disability that severely weakens muscles and compromises breathing. I had several bouts of pneumonia as a child and had always managed to recover, but this time was different. My lungs had weakened to the point where I would need a ventilator to help me breathe. Doctors advised my parents to place me in a facility that could care for children with intensive medical needs.

Fortunately for me, my parents refused this option and eventually I returned home with a boxy yet portable ventilator on the back of my wheelchair (this was 1987, when most technology was still in its boxy phase). Caring for me wasn’t always easy for my parents. I’m essentially a quadriplegic and I need help with everything from bathing and dressing to scratching my nose when I have an itch. But thanks to Medicaid, they didn’t have to care for me around the clock. Medicaid provided nurses to take me to school, which allowed my parents to keep working. It paid for modifications to my wheelchair so that I could leave the house more easily. Without the supports provided under Medicaid, I would not have been able to finish college and move to Minnesota for law school.

Today, I’m 43; I live independently and work as an attorney for the State of Minnesota. My life is ordinary in the best sense of the word. When I’m not at work, I go to the movies (Logan was great!), check out the occasional concert (you really must see CHVRCHES live), and generally indulge my pop culture obsessions (that new Star Trek series had better be worth the wait). None of this would be possible without the excellent, round-the-clock care that I receive under Medicaid.

Medicaid has made my life immeasurably better, along with the lives of countless others. However, that isn’t stopping congressional Republicans from embarking on an ideological mission to starve Medicaid of funds. Last week, House Republicans unveiled a bill to repeal and replace the Affordable Care Act. The entire bill is a travesty, but its proposed changes to Medicaid are particularly troubling. First, the bill would gradually repeal the expansion of Medicaid for low-income adults without children. This provision would rob eleven million people of the health coverage that they gained just a few years ago. Many of the people who benefited from the expansion have chronic conditions such as diabetes or mental illness that previously went untreated. Medicaid. Second, the bill makes radical changes to the funding of Medicaid. It would establish caps on the amount of federal funding for each Medicaid enrollee. While this may seem like a technical change, it would dramatically reduce Medicaid funding over time. Under such a scheme, states like Minnesota would soon face budget shortfalls totaling billions of dollars and they would be forced to find savings by cutting services, reducing payments to providers, or both.

For people with disabilities like me, such cuts could be catastrophic. States could eliminate services that we depend on in our daily lives, such as personal care attendants or specialized equipment like communication devices. Those of us who are employed could lose the option to buy into Medicaid, forcing us to quit our jobs in order to preserve our health coverage. In some cases, we may face the dreaded possibility of institutionalization and isolation from our communities.

Republicans claim that these changes are necessary to “save” Medicaid and protect it “for the most vulnerable.” These claims are absurd and deserve no credence. Like any program devised by humans, Medicaid has its flaws, but the Republican bill would do nothing to address those flaws. The true rationale for these cuts to Medicaid is to pay for the repeal of the taxes on businesses and the wealthy that fund the ACA. The vulnerable people whom Republicans claim to champion are those who will suffer the most if this bill becomes law.

Medicaid has been instrumental in helping people with disabilities achieve lives of independence and dignity. Advocates have worked tirelessly to improve the program and its focus on providing services in the community. The Republican bill puts those hard-fought accomplishments in jeopardy and threatens real harm to those of us who depend on the program for our very survival. The only thing that Medicaid needs saving from is this vicious and mean-spirited legislation. 

Feb 182017
 

As expected, House Republicans announced on Thursday their plans to cap Medicaid as part of their broader effort to repeal and replace the Affordable Care Act. Medicaid would be transformed from an entitlement program that covers anyone who is eligible to a fixed amount of funds. This fixed amount of funds would not be sufficient to keep pace with rising health care costs or increased need for Medicaid during economic downturns, forcing states to make some combination of cuts to eligibility, covered services, and payments to health care providers.

One of the most disturbing aspects of the plan is that it pits vulnerable people against each other in a scramble for pieces of a diminishing pie. Republicans portray this as an effort to save Medicaid for “the most vulnerable,” but that’s a lie. Everyone–kids, people with disabilities, the elderly, and poor adults–would suffer as a result of these radical changes to Medicaid. Minnesota alone would face budget deficits in the billions of dollars because of these cuts and the consequences would be felt by a wide swath of my fellow citizens. Republicans aren’t really interested in “saving” medicaid for us poor cripples. They view Medicaid as a huge redistribution of wealth that must be cut as deeply as possible for the sake of free-market principles and survival of the fittest. I’m sure that they would protest this characterization, but it goes to the heart of their ideology.

Of course, this policy fight is personal for me. Medicaid has provided me with the supports I need to live an independent and productive life. If the Republican plan becomes law, I could lose some or all of my nursing care. Minnesota could eliminate the buy-in program that allows me to purchase Medicaid coverage and earn an income, forcing me to quit my job as an attorney. It’s conceivable that I could even end living in an institution. These are scary prospects for me, but millions of other people will be facing even more calamitous prospects if they lose their Medicaid coverage. As I’ve noted before, those of us who depend on Medicaid for our survival can’t allow ourselves to be divided in this fight. If that happens, we will have already lost.

This is only the opening shot in the war on Medicaid. Formal legislation has yet to be introduced and it must go through a lengthy process before it becomes law. But in the meantime, we need to tell our stories to our representatives and senators. They need to understand how Medicaid has made our lives better and how funding cuts could make our lives worse. Those stories need to be told via phone calls to congressional offices and at town hall meetings with your representatives. If enough of us tell our stories, we may be the ones who actually save Medicaid.

Jan 112017
 

Immediately after the election, Republicans and various pundits began writing the obituary for the Affordable Care Act. We were told that repeal would be accomplished within days of Trump’s inauguration with the caveat that repeal would take effect in two or three years while a suitable replacement was developed. Those plans are now colliding with reality as several Republicans realize that a repeal-and-delay strategy could sow chaos in the health care industry. Even President-elect Trump has gone on record saying that repeal and replacement should occur “essentially simultaneously.”

But this approach has its own problems. First, Republicans would need to agree on a replacement and that doesn’t seem imminent. Any GOP-backed plan is likely to cover far fewer people and offer fewer benefits, but Republicans don’t seem ready to admit this publicly yet. Also, a replacement would require 60 votes in the Senate, but Democrats don’t seem eager to play a supporting role in replacing a landmark piece of legislation for something demonstrably inferior.

So what happens next? Republicans may ultimately decide to proceed with repeal even if a replacement isn’t waiting in the wings. After promising repeal to their base for so long, they may feel that they have no choice but to fulfill their promise. Is this what the base really wants, though? Plenty of Trump supporters have purchased coverage through the exchange or they received coverage through the expansion of Medicaid. Their complaints regarding the ACA generally focus on the cost of coverage, not abstract notions of free-market principles. Issues of cost can be addressed through compromise, which could be entirely feasible in a saner political environment.

Governance is hard work and crafting health care policy is even harder, as Republicans are discovering. The ACA could certainly not be long for this world, but it has dodged fatal blows before. Perhaps it can defy death one more time.

Apr 262015
 

When Republicans took control of the Minnesota House last fall thanks to the support of rural voters, they promised to enact policies that would promote the interests of greater Minnesota. But House Republicans are now pushing for a major tax cut that would be paid for with the elimination of MinnesotaCare, the health care program for low-income Minnesotans who don’t qualify for Medical Assistance. Republicans would require these individuals to purchase private insurance via MNsure and pay the associated higher premiums and cost-sharing.

It seems unlikely that our Democratic governor and Senate will agree to this. Minnesota has a budget surplus of $2 billion and it makes little sense to eliminate a program that provides affordable health coverage to so many and that, until recently, has enjoyed bipartisan support at the Legislature. Republicans also seem reluctant to acknowledge that a substantial number of people eligible for MinnesotaCare live in rural districts; perhaps because it would undercut their claim to be champions of rural Minnesota. They should have been clearer in their campaign literature: “Minnesota Republicans–we’ll cut your taxes! And that’s about all you can expect from us.”

Mar 162015
 

Sarah Kliff of Vox offers an excellent explanation of Republican plans to transform Medicaid into a block grant. Instead of guaranteeing to cover a fixed percentage of all enrollees’ medical expenses, the federal government would give each state a specific amount of money to spend on Medicaid coverage. Republicans claim that this would give states more flexibility to tailor coverage to meet the needs of their residents. But by placing a specific dollar limit on Medicaid spending, millions of people would likely lose coverage. In other words, “block grant” is a euphemism for deep cuts.

Republicans are deeply hostile to any Medicaid spending that benefits low-income adults because they see it as a disincentive to work. These are the people who are most likely to suffer under Medicaid block grants. And many of them work low-paying jobs that don’t provide affordable health insurance. It would remove an already frayed safety net from those who dwell on the economic margins of society. The elderly and people with disabilities are also likely to see substantial cuts in services, so everyone will feel some pain if block grants are implemented.

Republicans will do their best to disguise the true human cost of their policy proposals, which is why explanatory posts like Kliff’s are so important. We can’t allow conservatives to put innocuous labels on their terrible ideas.

Feb 032015
 

I tend to think of anti-vaxxers as highly educated liberal white people, so I’m a little surprised to see GOP presidential hopefuls pander to that crowd. But I also get that opposition to vaccines can be symptomatic of a deeper suspicion of government and/or science, characteristics that are deeply embedded into the DNA of the modern conservative. I’m just not sure that efforts to appeal to the relatively small number of people opposed to vaccines are worth the risk of being perceived as a kook by the rest of the electorate.

And yes, opposition to vaccines is decidedly kooky. Given the absolute lack of evidence showing that vaccines are harmful, along with the recent evidence that the decision not to vaccinate does  harm others, it’s difficult to understand how intelligent people can continue to hold such irrational beliefs. Of course, I often ask a similar question regarding people who are religious, which implies that I simply don’t understand beliefs rooted in faith and nothing else.

Jan 272015
 

Over at Vox, Sarah Kliff looks at the growing number of Republican governors who are expanding Medicaid under the Affordable Care Act—with conditions attached. GOP governors are negotiating with the Obama administration for waivers that allow them to give  their state Medicaid programs a more conservative bent. For example, some states use Medicaid dollars to purchase private insurance for low-income individuals. Other states require enrollees to pay an increased amount of cost sharing or they restrict access to certain benefits that aren’t deemed essential.

These waivers are expanding Medicaid to millions of individuals, which is better than not expanding coverage. Some of these conservative policies, like charging premiums to individuals with extremely limited means, seem to have less to do with promoting personal responsibility than with winning the favor of far-right state legislators who possess an almost pathological animosity towards the poor. But thanks to the Supreme Court, states are not obligated to expand Medicaid and they are in a much stronger position to seek concessions from the feds.

Dec 102014
 

MIT professor Andrea Louise Campbell writes an essay for Vox describing how Medicaid forces people with disabilities to live in poverty in order to receive health coverage. She focuses on California’s Medicaid system (Medi-Cal), which she was forced to examine after her sister-in-law became a quadriplegic in an automobile accident. Many of her criticisms of the program, such as the harshness of the income and asset limits, won’t come as a surprise to those familiar with Medicaid policy.

In fact, Campbell’s outrage strikes me as naïve for a professor who teaches social welfare policy and her critique carries a worrisome undertone of middle-class entitlement. Disability advocates have long made the argument that Medicaid eligibility criteria traps people with disabilities in poverty, but Campbell only acknowledges this in passing. At one point in her essay, Campbell describes how a relative bought formula for the couple’s newborn baby and she writes, “I wondered what people who don’t have middle-class relatives do in a situation like this.” It’s really not that difficult to imagine the deprivations that people with disabilities without middle-class family members must endure, but Campbell seems shocked that this kind of thing goes on in America.

I get that most Vox readers don’t give much thought to disability policy and the article is meant to illustrate how such policy affects real families. But if Vox plans on exploring this topic further, it might be a good idea to get insights from the actual people with disabilities who live with the consequences of these policies on a daily basis.

 

Dec 062014
 

Over at Vox (my favorite new site of 2014), Sarah Kliff has a great article pointing out the emerging and conflicting narratives of the Affordable Care Act. From a political perspective, the ACA seems like a train wreck. It continues to poll terribly, its backers have made some boneheaded remarks about American voters, and senior Democrats like Senator Chuck Schumer are now saying that it was a mistake to pass health care reform. This is not what the story of a successful law should look like.

And yet, the actual policies seem to be working. More Americans have health coverage than ever before. Health care costs are slowing at a remarkable rate. And during the current open enrollment period, over 750,000 individuals have already selected an ACA health plan.

The law continues to offer real benefits for millions of people, but this fact gets lost in the political echo chamber. As for second-guessing Democrats like Schumer, I suggest they take a running leap into a very shallow lake. If Democrats had done a better job of actually explaining how the ACA helps people, the conservative misinformation campaign might have been less successful. They could have also fought harder for a public option plan or, even better, Medicare for all. Instead, they spent an interminable amount of time trying to win conservative support that never materialized.

The ACA is certainly a flawed piece of legislation, but it is ultimately making life better for Americans. Rumors of its demise remain greatly exaggerated.