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The
Bush Agenda: No Aid for Medicaid
by Joe Auciello
/ March 2005 issue of
Socialist Action
Critics of President Bush’s scheme to privatize
Social Security have pointed out that the president has exaggerated the
danger of that program’s future difficulties and has misled the public to
pursue his political agenda—reducing a guaranteed benefit for many retirees
to finance income tax cuts for the wealthy minority.
The problems with Medicaid, however, are real.
What’s more, the crisis of Medicaid is worsening by the day. The Bush administration proposes no
viable systemic solution to these problems. Instead, the stopgap measures
emanating from the Republican White House—and already applied by Republican
and Democratic governors—increase the suffering of the most vulnerable
minorities in society while providing no security for the majority.
The crisis of Medicaid is a symptom of the larger
crisis of the American health-care system itself. Until that system is changed so that universal national
health insurance and health care become rights for all, the problems with
Medicaid will intensify. With less medical care available or affordable, a
greater number of people will suffer more and will die sooner. That, in
short, is the president’s proposal for Medicaid reform.
Medicaid, enacted in 1965 as part of President
Johnson’s “unconditional war on poverty,” is a federal-state insurance
program that guarantees medical assistance to low-income families. States
are required by law to provide health insurance through Medicaid to
children 18 or younger who live below the poverty line—$15,670 annually for
a family of three. On average, the
federal government pays approximately 60 percent of the expenses.
Currently, 53 million Americans receive Medicaid
at a cost of $300 billion a year. The federal government distributes money
to the states, which then provide medical aid to the needy, in accordance
with federal regulations. Medicaid costs have risen 9 to 12 percent a year
for the last five years while state budgets have been cut, or in best case
scenarios, have kept pace with inflation. Medicaid costs are predicted to
continue increasing about 7 to 8 percent through the next decade.
Faced with these spiraling fixed expenses,
governors across the country are looking to Washington for financial help.
Instead, President Bush proposes a $60 billion cutback in Medicaid funding
during the next 10 years. It would be the largest of the social-spending cutbacks
the president claims is necessary in order to reduce the national budget
deficit by half.
At the same time, Bush’s $2.57 trillion federal
budget includes a 5 percent increase in military spending, from $400
billion up to $419 billion, plus an additional $81.9 billion to pay for the
military occupations in Afghanistan and Iraq.
Bush’s attacks on Medicaid are not new; these
latest measures simply accelerate the cutbacks begun in his first term.
Then, the attacks came largely in the form of increased restrictions of
eligibility and a lack of federal oversight of services provided by the
states.
In 2003, the General Accounting Office found that
the Bush administration had allowed a record number of Medicaid waivers,
which enabled states to ignore federal guidelines, and also had allowed the
states greater discretion to prohibit services. Not surprisingly, the GAO
found that when the states were not held accountable for the quality of
care, fewer services were provided, eligible patients went unenrolled, and
greater problems were reported.
These bureaucratic maneuvers designed to reduce
aid to the elderly and the sick, continue today. On Feb. 1, according to
The New York Times, Bush’s secretary of health and human services, Michael
O. Leavitt, said that “states should be free to provide less comprehensive
benefits to ‘optional populations,’ whom they are not required to cover.”
This is not merely rhetoric aimed at denying
Medicaid assistance to illegal immigrants or to middle-class families who
want to preserve a retirement nest egg.
It is also aimed at nursing-home residents, a majority of whom
obtain Medicaid funds as optional beneficiaries. For the Bush
administration, Medicaid reform is a license to restrict entitlements and
reduce the number enrolled in the program.
The process is well under way. According to
Business Week (Feb. 21, 2005), “Already, states are scrambling to cut costs
… 47 states are cutting or freezing payments to doctors and hospitals this
year: 43 are lowering drug costs, 15 are making it tougher for low-income
people to enroll in the program, 9 are cutting benefits, and 9 are
increasing patient co-payments … 17 states have targeted long-term care for
cuts, either by trimming payments to nursing homes or slashing
enrollments.”
In New York, Republican Governor Pataki has announced
a $1.1 billion cut in state funds for Medicaid, a program that serves 4
million New York residents. In Tennessee, formerly known for its ample
state funding, Democratic Gov. Phil Bredesen has initiated cutbacks that
will take away Medicaid coverage from an estimated 323, 000 adults. As
state budgets are lightened, people’s suffering grows heavier with little
or no opportunity for relief.
But why do Medicaid costs continue to increase?
Part of the answer is generational: As the 40 million baby boomers grow
older, their medical needs grow with them. But this circumstance was
entirely foreseeable and adequate provisions could have been made in the
Medicaid budget.
The real problem is the state of the economy and
the weakness of the American labor movement. Medicaid enrollment increases
because low-wage workers cannot afford the health-insurance programs
offered by the bosses and the corporations.
The average health-insurance policy for a family
costs $9000 a year. In 2002, more than 60 million people aged 25 to 64
earned less than $25,000. (These figures, of course, do not include the
young and the elderly).
No family can afford to pay about one-third of
its income on health insurance. The inevitable result is that these working
families have no other option but Medicaid. Unable to visit a doctor for
relatively inexpensive preventative care, the working poor are forced into
emergency rooms, where the cost of treatment is much higher.
Additionally, a major study conducted by the
Harvard Law School and Medical School shows that traditional “middle class”
families are only one major accident or illness away from hardship,
poverty, or bankruptcy. A review of 1700 bankruptcy cases revealed that
almost half of the filings resulted from medical bills.
Three-quarters of those filing for bankruptcy
already had medical insurance, but the policies did not cover the expenses.
Those inadequate policies are the direct result
of the bosses’ wish to save profits. Companies that pay a portion of their
workers’ health-insurance cost will choose the least expensive and
therefore least comprehensive policy, which leaves workers less protected.
As the Harvard study observes, “We doubt that
such under-insurance reflects families’ preference for risk. Few Americans
have more than one or two insurance options. Many insured families are
bankrupted by medical expenses well below the catastrophic thresholds of
the deductible plans that are increasingly popular with employers.”
The study shows that about 2 million people now
are forced into medical bankruptcy. These families must try to enter the
Medicaid programs for any health protection at all.
In the past, a stronger labor movement fought for
health insurance for its members. Even non-unionized industries had to try
to match the benefits unions had won for their members. Today, Wal-Mart,
one of the largest employers in the nation, has no union and offers no
medical benefits to most of its workers. As the union movement declines,
health-care benefits erode or disappear.
Yet, while the United States spends more money on
health care than any other industrialized nation on earth, U.S. citizens
have the fewest health benefits of any capitalist country. Some 45 million
people are without health insurance; an untold number of people lack
adequate health insurance.
In Europe and Canada, where pharmaceuticals are
not advertised, the elderly do not pay for the drugs they require, while in
the United States, where advertisement is the norm, they do.
The United States is the only industrialized
nation without a national health program. What’s more, a Congress dependent
on corporate campaign contributions and corporate lobbying will not enact
legislation necessary for the public interest.
Until health care and health insurance become a
right, like public education, instead of a privilege of wealth, the
American ideal of “life, liberty, and the pursuit of happiness” will be out
of reach for the working class and will hold little meaning for the
elderly, the ill, and the poor.
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