End to health­care for poor

GOP’s Med­i­caid cuts will hit dis­abled chil­dren — and their fam­i­lies — the hard­est.

Los Angeles Times - - OPINION - By Henry A. Wax­man

Three mil­lion and $1.6 tril­lion. The first num­ber rep­re­sents an es­ti­mate of the chil­dren who would lose health­care cov­er­age un­der the bill Repub­li­can sen­a­tors worked on in se­cret and fi­nally un­veiled Thurs­day. The sec­ond num­ber re­flects the to­tal amount of Med­i­caid cuts — in the form of the elim­i­na­tion of the Med­i­caid ex­pan­sion for work­ing fam­i­lies that was part of the Af­ford­able Care Act, capped fed­eral spend­ing for Med­i­caid and ad­di­tional cuts pro­posed in the pres­i­dent’s bud­get — that would go to pay for tax breaks for bil­lion­aires.

As with the House ver­sion of the Amer­i­can Health Care Act — also writ­ten in se­cret and passed in reck­less haste — the Se­nate re­vi­sion would end Med­i­caid as we know it. In essence, Trump­care would aban­don the fed­eral gov­ern­ment’s 52-year re­spon­si­bil­ity to guar­an­tee health­care for those un­able to af­ford it on their own.

If Repub­li­cans suc­ceed in pass­ing this leg­is­la­tion, mil­lions of par­ents who work hard but strug­gle to make ends meet will find it pro­hib­i­tively ex­pen­sive to get their chil­dren the care they need. Mil­lions of ear­aches will go un­treated, lead­ing to hear­ing loss. Those who can’t see the black­board in school won’t re­ceive eye­glasses. Treat­able ill­nesses will turn into hos­pi­tal­iza­tions. Some will die; one study found that in-hos­pi­tal mor­tal­ity rates are 60% higher for unin­sured than in­sured chil­dren.

And suf­fer­ing most of all will be the 60% of chil­dren with dis­abil­i­ties — and their fam­i­lies — who cur­rently re­ceive Med­i­caid cov­er­age. In­sur­ance com­pa­nies will not be ea­ger to step in to cover them.

I’m think­ing of chil­dren such as Spencer, who lives in In­di­anapo­lis, an 11-year-old who ex­pe­ri­enced a stroke in utero. Mul­ti­ple surg­eries were re­quired to cor­rect prob­lems with his arms and legs and left him with autism, be­hav­ioral prob­lems, seizures and a blood­clot­ting dis­or­der.

Thanks to Med­i­caid, Spencer has ac­cess to what’s called ap­plied devel­op­ment anal­y­sis ther­apy, the most ef­fec­tive autism treat­ment avail­able. Some of it is cov­ered by the In­di­anapo­lis school sys­tem, but most is paid for by Med­i­caid.

Be­cause Spencer’s health of­ten re­quires his mother, Erica, to take time off work, she has strug­gled to keep a full-time job. To­day, she is cov­ered through Med­i­caid too, which al­lows her to take care of her­self while she cares for Spencer.

Erica says the leg­is­la­tion mov­ing through Congress has left her “stressed to the max.” Sadly, she has good rea­son to feel that way. If it be­comes law, she and Spencer could be kicked off Med­i­caid — In­di­ana may take an op­tion avail­able un­der the Amer­i­can Health Care Act to stop cov­er­ing the ther­apy so es­sen­tial to his health, or it sim­ply may not be able to pick up the ad­di­tional costs if the law is passed and Med­i­caid cuts be­come re­al­ity.

We have a moral re­spon­si­bil­ity to pro­tect the well-be­ing of chil­dren. That’s why when I was chair of the House health sub­com­mit­tee, I au­thored sev­eral bills in the 1980s and ’90s ex­pand­ing Med­i­caid cov­er­age for chil­dren and strength­en­ing ben­e­fits.

These vi­tal gains will be re­versed if Congress shifts the fi­nan­cial re­spon­si­bil­ity for Med­i­caid from the fed­eral gov­ern­ment to the states through a per-capita cap. Such a pro­posal would not merely re­peal the Af­ford­able Care Act, it would also fun­da­men­tally change the much longer-stand­ing, suc­cess­ful pro­gram for work­ing fam­i­lies, chil­dren, peo­ple with dis­abil­i­ties and the low-in­come el­derly. And the ef­fects will be felt be­yond the in­di­vid­ual loss of health cov­er­age.

The cuts to Med­i­caid fund­ing are so steep that many safety-net hos­pi­tals and clin­ics would be forced to close. This would be an un­mit­i­gated disaster for ru­ral com­mu­ni­ties, where health­care op­tions are few and far be­tween, leav­ing res­i­dents with less ac­cess to care where and when they need it.

For states to deal with the large bud­get short­fall that would re­sult from caps on fed­eral Med­i­caid dol­lars — which will in­crease each year un­der the cur­rent pro­posal — they would have to raise taxes, or make cuts in other ar­eas such as ed­u­ca­tion or in­fra­struc­ture or, most likely, keep cut­ting Med­i­caid ben­e­fits, eli­gi­bil­ity or pay­ments to providers.

In the Se­nate’s dis­cus­sion draft, the work­ing group at­tempts to pro­tect chil­dren with spe­cial health­care needs from Med­i­caid caps by main­tain­ing the cur­rent match rate that ap­plies to them.

But to shield chil­dren with spe­cial health­care needs while also balanc­ing its bud­get, a state would have to make much deeper cuts in care for other chil­dren, par­ents and work­ing adults on Med­i­caid.

Leg­is­la­tion needs to pass suf­fi­cient public scru­tiny or it’s un­wor­thy of be­com­ing law. If mon­u­men­tal, trans­for­ma­tive leg­is­la­tion can be writ­ten in the dark and en­acted in a rush— and chil­dren’s lives are com­pro­mised or ru­ined so that bil­lion­aires can get tax cuts they don’t need — it would rank among the worst scan­dals in U.S. history. Amer­i­cans of con­science must mo­bi­lize now to stop this from hap­pen­ing.

Henry A. Wax­man rep­re­sented Cal­i­for­nia’s 33rd Con­gres­sional District from 1975 to 2015. He’s cur­rently chair­man of the public af­fairs firm Wax­man Strate­gies.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.