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.

Oct 092014

Americans are masters at freaking about things that really aren’t threats. Case in point: Ebola. 20% of Americans are afraid of catching Ebola; a ridiculously high number considering that exactly one case has been diagnosed in the country. As Jeffrey Young of HuffPo points out, the flu virus presents a much more significant danger to public health. Thousands of Americans will die from the flu in the coming months, yet I’m betting that most of the people in hysterics about Ebola won’t bother getting a flu shot.

If you are concerned about becoming sick in the next few months, get a flu shot. Tell your friends and family to get flu shots. A flu shot will provide actual protection against a real threat. Panicking about anything is rarely helpful and only makes us look incredibly silly to the eyes of the world.

Jun 192014

40 percent.

That’s how much Minnesota has reduced its uninsured population since fully implementing the Affordable Care Act back in January.

40 percent!

Of course, ACA opponents won’t be impressed with this news. They’ll continue to grumble to themselves about death panels and government takeovers. But in the land of the sane, this can’t be viewed as anything other than a huge achievement. Thousands of Minnesotans now have access to health care who otherwise would still be uninsured. Much of this reduction is due to the state’s expansion of Medicaid, a policy choice that neighboring states like Wisconsin and the Dakotas have resisted. Perhaps this news will give some elected officials second thoughts about their ongoing refusal to act in the best interests of their constituents. Minnesota shouldn’t be an island of decency in a sea of Tea Party-fueled callousness.

May 022014

I’m late linking to this, but Harold Pollack has a great post in Wonkblog about how Medicaid forces poverty on people with disabilities. This is common knowledge in disability policy circles, but most people don’t grasp how difficult it can be to maintain Medicaid eligibility and have any semblance of financial independence. It’s common for people with disabilities to hide assets with a family member or keep income off the books to ensure that they don’t lose access to vital services. Those of us who buy into Medicaid are allowed a bit more leeway with our finances, but we still must be careful.

Congress really should revisit the strict Medicaid income and asset limits for people with disabilities. But as long as Medicaid is regarded as a program for only the poor, policymakers won’t be eager to change the status quo.

Apr 012014

Six months ago, most observers would have bet that Obamacare would fail miserably at enrolling seven million people by March 31st. Hell, I wasn’t feeling particularly optimistic. But as the President announced today, that’s exactly what happened. This news will do little to deter opponents of health care reform from proclaiming yet again that the whole endeavor is either a misguided failure, a socialist plot, or both.  Fact on the ground matter, though. Obamacare now has a constituency; real people who will suffer if the law is repealed or scaled back. It’s a constituency that may not be the most politically well-connected, but they have a real stake in ensuring Obamacare’s success and longevity. Republicans will probably continue to pretend that this constituency doesn’t exist, even it makes them seem increasingly oblivious to reality.

I expect the law to be tweaked and revised in coming years, as it should be. But Obamacare is now a permanent fixture of America’s policy landscape, a fact worthy of a little celebration.

Feb 282014

The Arkansas legislature is currently debating whether to continue the state’s expansion of Medicaid for low-income children and adults. Since this is Arkansas, a bloc of Tea Party legislators has been blocking the extension because it might make the lives of poor people just a bit less miserable. One of the opposing legislators is Josh Miller, who also happens to be a Medicaid beneficiary because of a spinal cord injury sustained in an auto accident.

In interviews, Miller justifies his opposition to the expansion with claims that it would benefit people who don’t want to work or who want to abuse prescription drugs. He also is terribly concerned that the federal government will default on its obligations and he doesn’t want to make promises to his fellow Arkansans that can’t be kept.

People with disabilities span the political spectrum and Miller and is entitled to his opinion. But his stance that some people “deserve” assistance while others don’t is disheartening, particularly given his own experience with public assistance. He isn’t the first person with a disability who wants to protect Medicaid for people like himself, yet his position as a legislator gives him a unique opportunity to shape the programs that benefit him so extensively. It’s an opportunity I would love to have. If he chooses to use that opportunity to deny health care to 100,000 people, that’s his right. A day may come when Miller’s fellow legislators want to save money by trimming benefits for people with disabilities. If that happens, will Miller be as quick to side with his conservative brethren?

Jan 292014

Republicans finally got around to releasing a concrete alternative to Obamacare and it’s kind of awful. It reduces eligibility for subsidies to purchase insurance and does away with most of the Medicaid expansion. Even better, it eliminates the requirement that insurance companies cover individuals with pre-existing conditions. Finally, it pays for the whole thing by making employer health plans taxable, an idea that has already proven wildly unpopular.

None of this has a chance of becoming law anytime soon. But as Sarah Kliff notes, the most interesting thing about this plan is what it doesn’t do. It doesn’t completely scrap Obamacare. It doesn’t envision a pure free-market solution and it doesn’t take away coverage from everyone who currently has coverage under Obamacare. To a degree, this plan accepts the status quo and recognizes that we can’t return to the health insurance regime of 2009. As more people gain coverage under Obamacare, it will probably become even more difficult to propose more limited alternatives. The plan put forth by the GOP presidential nominee will likely be even more moderate. And that’s a good thing.

Jan 162014

The Atlantic examines how Obamacare could drastically improve the lives of former prisoners. Many will be eligible for Medicaid if they live in a state that has chosen to expand the program, while others may be able to purchase subsidized coverage from the exchanges. Most of the people coming out of prison are men without children at home who, in the past, would not have qualified for any public health care program. They often had access to health care only when they were incarcerated. A significant percentage of this population suffers from mental illness and chemical dependency, access to health care in the community could go a long way towards reducing recidivism rates. As the article notes, it may be challenging to actually connect former inmates to health care services, but that’s a better problem to have than a total lack of coverage options.

Jan 022014

A new study in Science finds that expanding Medicaid increases emergency room visits, undercutting previous claims from lawmakers and policy wonks that expanding Medicaid would decrease ER use. these findings shouldn’t be a complete surprise to those who are familiar with the program and the people it serves. Many of those who are newly eligible for Medicaid likely have medical conditions that have gone unadressed for long periods of time. They also didn’t have an existing relationship with a physician, which probably explains why they turn to the ER as soon as they have coverage.

These findings shouldn’t be interpreted as a reason to not expand Medicaid. Access to Medicaid results in better mental health and increased financial stability, which are no small things. But as health economist Jonathan Gruber notes, making people healthy shouldn’t be framed as a cost-saver. States should expand Medicaid because it’s the right thing to do. And perhaps state Medicaid programs can do a better job of connecting new enrollees with primary care physicians.