The Medicaid Kill-Off

President George W. Bush and Congress slashed $10 billion from the Medicaid budget for this coming year. Medicaid is the primary public health care program for impoverished persons that serves over 53 million people.

The cut is clearly an attack on poor people, and it may wind up killing disabled and chronically ill persons before all is done. It is also a strike from those segments in our society who wish to dismantle the entire Medicaid system. Worse, it will force a rollback of disabled people’s civil rights.

Even before this $10 billion slicing goes into effect, governors and state legislatures in states such as Minnesota, Mississippi, Missouri, and Tennessee are cutting back on Medicaid to reduce costs. Maneuvers include restricting eligibility, paring down the rolls by kicking people off the program entirely; eliminating or reducing “optional” benefits such as prescription drugs, wheelchairs, diabetic testing supplies, rehabilitation services, and even oxygen; initiating co-payments for services including drugs; and reducing payments to doctors and hospitals.

Privatization — or subcontracting oversight of programs — is also being promoted in several states, such as Florida, though there is no reason to believe this will reduce costs. Rather, it is an ideological shift to the right — more “free market” healthcare. Placing private corporations in the middle between citizens and government mostly adds more overhead. Then, of course, those corporations’ goal is to make profits, taking dollars which should go straight to patient care.

Tenn Care?In the middle of all this are disabled people fighting for their right to live in the community. As I write, significantly disabled protesters in Tennessee have occupied the Republican governor’s office at the Capitol for over three weeks to stop cuts to their state Medicaid program (known as Tenncare). Gov. Phil Bredesen has responded by saying: No Food or Water.

Gashing Medicaid promises to roll back the clock on disabled persons who nearly always were locked up or warehoused, with no option to live in the community, before direct (in-home) support services became a part of some states’ Medicaid program. Present rollbacks of Medicaid are undermining disabled people’s civil rights — the right to be free of institutionalized “care” (see the Olmstead v. L.C. and E.W. Supreme Court decision outlining the right for services to be delivered in the “least restrictive” setting).

Tactics like denying medications and treatments force disabled persons into nursing homes to get services they must have to survive. Nursing homes have proved to be costlier than in-home services. Why this fact is not a part of every state’s Medicaid budget discussion is a grave oversight — but then we know the nursing home lobby spends tens of thousands to protect its turf.

ADAPTIn many cases being placed in a nursing home is no less than a death sentence. Some members of ADAPT will tell you they’d rather die than go into a nursing home. They know — firsthand — what goes on in them.

The governors say their budgets can no longer sustain the growing Medicaid program. Rising Medicaid costs are often attributed to the economic downturn. In part this is true because, as people lose their jobs, they generally lose their healthcare. As more people lose their healthcare (unable to afford Cobra premiums), they flock to Medicaid.

There are other factors. Employers such as Wal-Mart, the largest and most profitable retailer in the U.S., does not provide healthcare for most of its employees. Instead, the corporation sends workers to the local Medicaid office to apply for public healthcare.

Private insurers have increased their premiums to unaffordable levels for middle and low-income people, forcing them to turn to Medicaid when they can. Yet another reason is that prescription drugs have increased in price by double digits over the past years, driving up Medicaid costs all across the nation.

Not surprisingly, the Republican governors have struck the first blows against the most vulnerable sections of society. Gov. Haley Barbour of Mississippi (former chairman of the Republican National Committee), Gov. Matt Blunt of Missouri, Gov. Phil Bredesen of Tennessee, and Gov. Tim Pawlenty of Minnesota support slashing this vital program rather than raise taxes or insist that Bush provide more Medicaid dollars (federal government typically pays just 57% of the program’s overall costs) — which Bush could do if there were the political will. Perhaps a reminder is due here that Bush, while at Harvard Business School, said that he opposed Medicaid, Medicare, and Social Security. It is no fluke that we see this attack on Medicaid now.

It is optional whether or not to cover some disabled persons under Medicaid rules — a pure piece of bad welfare state planning if ever there was one. The people who are covered unconditionally are only children, pregnant women, and blind people.

Gov. Haley Barbour’s effort in Mississippi to reclassify 65,000 Medicaid recipients as ineligible “poverty-level aged and disabled” was stopped in court last year.

But new restrictions on medications have been enacted in Mississippi that will limit the number of prescriptions a person on Medicaid receives to five beginning next year. Only two name-brand prescriptions are allowed. While saving the state money, the rule change is likely to seriously impact the lives of 80,000 elderly, mobility-impaired, deaf, blind, “mentally ill,” diabetic, and cancer-ridden recipients.

This type of rollback does not deal with the outrageous prices placed on medicines by drug manufacturers nor other kinds of healthcare inflation. Instead, it forces cutbacks that are damaging to recipients’ wellbeing.

In Missouri, Gov. Matt Blunt has scheduled 90,000 Medicaid recipients to be severed from the state rolls next year. The cut was Blunt’s solution to balancing the budget without increasing taxes, despite widespread public disapproval.

“The cuts we face sent a big refund back to the feds because they won’t have to pay out matching funds for Medicaid,” says one advocate from Missouri.

The White House had people on the ground in Missouri when the state was working on ways to end Medicaid there, according to one source.

Gov. Blunt’s stated plan is to end Medicaid in four years.

“It could be a brutal cautionary tale. We should watch for other states to try to enact some of the same kinds of change,” my source warned.

Since 1996 the costs of prescription drugs to the Minnesota Medicaid program have skyrocketed. Gov. Tim Pawlenty is overseeing reductions of services provided by MinnesotaCare. He is in the process of slashing Medicaid costs by reducing services and increasing fees for those enrolled in the program.

Under the governorship of Phil Bredesen in Tennessee, people on Medicaid are in a desperate situation. Gov. Bredesen is executing the cruelest slashing of public health coverage in the history of the nation. According to ADAPT, every day, around two thousand people enrolled in TennCare receive letters of termination or reduction of benefits.

Hundreds of thousands of disabled and chronically ill Tennesseans are living in fear because of Gov. Bredesen’s decision to strip them of the only health care they have. Many Medicaid beneficiaries have disabilities, and virtually none can afford to pay for their health care out of their disability checks.

The protestors are still in formation in their sit-in at the Gov.’s office. They are there to try and stop the Governor from making massive cutbacks to TennCare that would dump over 200,000 people off services.

Among the people who will be deeply harmed by the cuts are 100 individuals who use ventilators. Up until now, they were getting services in the community, but the Governor’s plan shuttles them into nursing homes. This is a clear swipe at their civil rights: a violation of the Olmstead Supreme Court’ ruling on “least restrictive environment.”

ADAPT confronted Gov. Bredesen.

“So you are saying,” asked Randy Alexander of Tennessee ADAPT, “you will institutionalize people because they have a disability?”

“Yes,” replied Bredesen, “I care about them, I’m not cutting their services I’m going to provide their services in a nursing home.”

“We are talking about basic human rights here,” said Alexander before the Governor could leave. “You have admitted today this state is willing to imprison people simply because they have a disability.”

This is only the beginning. Ten billion more to be taken from Medicaid next year.

A record deficit, coupled with right-wing ideology and over-extended empire, underlies the demolition of Medicaid upon which these disabled people’s freedom rests.

The current impetus is towards less restriction of pharmaceutical and insurance corporate profits, a rollback of government programs for the people, large tax cuts to the rich, and less health care security for the working class. The endless war Dick Cheney spoke of will feed the “defense” contractors and the “rebuilding” company Halliburton, Bechtel, and Kellogg, Brown and Root. It will increase military spending needed to maintain the US Empire — all of which will continue to increase the already over-stretched deficit.

Bush’s term will be marked as one that killed tens of thousands of innocent Iraqis and others in territories the US has invaded, as well as over 1800 troops who should not have been sent overseas in the first place. Now, given time, his policy will kill off Medicaid and innocent poor people with it in the US — if the people do not arise and fight this momentum as though their life depends on it — and it does.

Marta Russell writes on the political, social and economic aspects of disablement. Her socio-economic analysis has been published in the Berkeley Journal of Employment and Labor Law, the Review of Radical Political Economy, the Journal of Disability Policy Studies, Disability & Society, Monthly Review, Disability Studies Quarterly, Left Business Observer, Real World Micro (9th edition), Socialist Register 2002, and Backlash Against the ADA: Reinterpreting Disability Rights (Ed. Linda Hamilton Kriege, University of Michigan Press, 2003). She has also published her articles in CounterPunch, The Ragged Edge, New Mobility Magazine, and Mouth, the voice of disability rights. Her book Beyond Ramps: Disability at the End of the Social Contract (Common Courage Press, 1998) is an indispensable resource for all activists who fight for the rights of the disabled.