Family Story Shows Why Medicaid Matters To All Of Us

August 14, 2011

Some of you may recall my young guest blogger Laura, who told us why Medicaid matters to her and her family. Turns out there’s much more to the story — the family’s years without Medicaid benefits.

These tell us, in a different way, why we should be so concerned about the Medicaid cuts states are making now and bigger, broader cuts that may result from this new federal debt deal we’ve got.

The family’s story begins when Laura’s older brother Matthew was born. Like Laura, he came into the world with a form of mitochondrial disease, an incurable disorder that prevents body cells from manufacturing energy properly.

At the time, both parents — Rylin and David — were school teachers with a combined annual income of $60,000, health insurance and a home they were easily enough paying the mortgage on.

The health insurance plan called for them to pay 20% of costs. What with surgery, tests, prescriptions and the like, their out-of-pockets in the first year alone totaled $200,000. Even the costs of parking at the hospital were beyond their means.

With no resources for home health care, Rylin had to quit her job to care for Matthew — and three years later for Laura as well. The couple refinanced their home three times. They put some medical expenses — these totaling well over $3,000 a month — on credit cards, though they’d steered clear of consumer debt while childless.

Social workers told them repeatedly that they wouldn’t qualify for public assistance because their income was too high. Turns out they were eligible for a state program for children with special health care needs, which is in part federally-funded under Title V of the Social Security Act.

Once they learned this, they enrolled and got several years of help with medical costs. But then David got a raise, pushing the family above the income eligibility ceiling.

The other option for them was a special waiver program that lets Indiana use Medicaid funds to provide home and community-based services for children with disabilities. But signing up meant getting put on a waiting list. And waiting — ten years for Matthew and seven for Laura.

Meanwhile, the family cut its grocery bills back to $40 per week, bought second-hand clothes and went without anything that wasn’t absolutely essential.

The parents still had to make some agonizing medical choices. Their insurance didn’t cover the biopsies needed to diagnose their children. So they had only one child diagnosed. Four specialists wanted to see Laura monthly, but the parents had to limit visits to generally once every three months.

Thanks to Medicaid, the family is no longer accruing significant medical debt. And, Rylin says, she and David “are able to work on meeting [the children’s] needs in a more appropriate way.”

But their situation is tenuous.

Indiana has already cut Medicaid vision and dental benefits for adults. People in the know say more cuts are likely to follow. And that’s under Medicaid as we know it now, with the federal government paying more than half of Indiana’s costs.

Health care costs are rising. And we’ll soon have a new Congressional committee looking to reduce the deficit by $1.5 trillion over the next 10 years.

Medicaid will be protected from the automatic spending cuts that will kick in if a majority of committee members can’t agree to a plan that meets the target — and then gets passed by both houses of Congress and signed by the President.

But it’s by no means clear that a committee majority won’t agree to something that will shrink projected federal Medicaid spending. They’re likely to figure that American voters won’t raise hell, as they will if they get wind of tampering with Medicare or Social Security.

We don’t much like the idea of safety net spending cuts — well, most of us don’t. But we don’t think they could affect us.

The Rodgers’s story shows how mistaken we are. Two financially-responsible, middle-class people with good jobs and employer-provided health insurance wind up with such inordinate medical expenses that they can’t always buy enough food.

A child who recalls how “very, very scary” that was. She thinks that elected officials, whatever their party, need to understand that families like hers “are important parts of the country.”

Me too.


A Bad Debt Deal, But It Could Have Been Worse

August 2, 2011

Welcome to the Monday Morning Quarterback Club. We’ve got lots of members rehashing the weekend debt ceiling game — players as well as spectators like yours truly.

The White House is celebrating a bipartisan deal that it claims is a win for both “the economy and budget discipline.”

House Speaker John Boehner says “it’s not the greatest deal in the world,” but there’s nothing in it that violates our [right-wing Republican] principles.”

The pundits generally agree with Boehner that it’s not the deal one would have wanted. Beyond that, they diverge dramatically. Washington Post blogger Ezra Klein provides a good sample — and a smart assessment.

The deal, he says, represents “the lowest-common denominator.” No entitlement cuts, no tax increases, no stimulus spending and no infrastructure investments.

Actually, there’s not much of anything specific, except for targets and process. Which makes it very much like the balanced budget amendment the deal commits Congress to vote on.

Big dollar figures. Percent cuts for this and that. Very little that enables anyone to fault the President or members of Congress for their choices about program-specific spending.

By and large, I agree with many of the less ferociously angry analysts and advocates on the left. It’s a bad deal, but not as bad as it could have been. And not nearly as bad as no deal at all.

It’s a bad deal because there’s no balance between spending cuts and revenue raisers — though that was rightly a key item for the Democrats.

Not so bad as it could have been because, Boehner notwithstanding, the bipartisan Congressional committee that’s been charged with figuring out how to get to the bigger of the two deficit reduction targets could, in theory, propose new taxes and/or other tax code reforms that would reap more revenues.

It’s a bad deal because it requires spending cuts when the economy actually needs another infusion of stimulus spending.

New figures show the economy has all but stopped growing. Economists say that’s largely because consumers aren’t buying enough.

Federal spending cuts will inevitably throw more people out of work. And jobless workers and their families don’t go on shopping sprees. Nor others who feel justifiably anxious about future paychecks.

To make matters worse, the deal doesn’t provide for an extension of long-term unemployment benefits — something many hoped the White House could get into the package. A top-rated stimulus left for another, doubtful day. A growing gap in the safety net meanwhile.

The deal is not as bad as it could have been because the first round of cuts will be small, relative to the total deficit reduction targets. Also not so bad because a significant portion will have to come from defense — meaning that programs for low and moderate-income people won’t bear the entire brunt.

It’s a bad deal because it puts these programs at high risk.

Congress has to come up with about $900 billion in savings and then an additional $1.5 trillion.

That second target will almost certainly mean deeper cuts in non-defense spending of the kind Congress must approve on an annual basis, e.g., aid to public education, job training, targeted nutrition programs, or big cuts in mandatory spending for entitlements like Social Security, Medicaid, Medicare and food stamps.

The deal is not so bad because the programs for seniors and low-income people of all ages would be protected from the automatic spending cuts that will kick in if Congress doesn’t act. Well, almost. Medicare provider rates would be cut, but benefits couldn’t be.

Last but not least, the deal is not so bad because the alternative would have been no hike in the debt ceiling at all.

No one knows what this would have meant for our economy and all of us hapless spectators. Surely a spike in unemployment and a halt to monthly disbursements for veterans’ benefits, Social Security, food stamps and the like.

Either that or a Constitutional crisis if the President decided, as some advised, to just direct Treasury to pay our government’s bills anyway. Hard to believe our floundering economy wouldn’t have totally tanked.

A good bit of the Monday morning quarterbacking has involved what the President could have done to get the debt ceiling raised without such collateral damage.

He’s roundly faulted for not being tough enough. I myself have felt frustrated to see him shift so far to the right that he would actually, as in the White House statement, laud a rollback in non-defense discretionary spending to a level last seen under President Eisenhower.

But I’m inclined to agree with former White House economist Jared Bernstein’s view that “lousy negotiating skills” had little to do with the outcome.

The President and Democrats in Congress had to deal with the fact that a significant number of House Republicans were willing — some even eager — to see the economy plunge off a cliff.

There are times when you’ve got to pay the ransom to save the hostage. I think this was one of them.

I take some comfort in knowing that whatever dreadful deficit reduction plan this Congress passes can be undone by future Congresses.

In short, we live to fight another day. And fight we truly must.