I’ve written about dual eligibles and Medicaid before. I’m putting it up again (in an easier to read article) because I can predict, based on the riddled-with-outright-lies health care debate we had last time that this debate will also be fact-free.
This is where we spend Medicaid dollars:
Because of generally poorer health and greater needs for high-cost services, the country’s 8.8 million dual eligibles are the most expensive population within the Medicare and Medicaid programs and the most difficult to coordinate care for, according to a report issued Monday morning by the Center for American Progress and Community Catalyst.
According to the report, dual eligibles make up 18 percent of Medicaid enrollees but consume 46 percent of program spending. Meanwhile, they comprise 16 percent of Medicare enrollees but consume 25 percent of spending.
Old people and the disabled cost the most (there’s a shocker) and then there’s pregnant women and children.
Medicaid, while wildly unpopular among public intellectuals, Republican House members and media personalities, is (surprise!) actually popular with the public:
If you listen to the inside debate you would think Medicaid is America’s most unpopular program. Conservatives don’t like Medicaid on ideological grounds; it’s a government entitlement program. Providers complain about the program’s reimbursement rates. And liberals have long complained about the program’s limitations, especially the gaps in whom Medicaid covers and the large variations in coverage among states. With its joint federal-state financing and welfare-linked heritage, Medicaid is treated as fundamentally different than the two other big entitlement programs — Social Security and Medicare — and thought to have dramatically less public support.
It was against this background that one of our recent polls produced a real surprise. It turns out that the insider’s view of Medicaid is not the public’s view at all. While not viewed as favorably as Social Security or Medicare, Medicaid is actually surprisingly popular with the American people, and they resist the idea of making big cuts to the program.
When we asked in our poll which programs the public was willing to see cut by Congress to reduce the deficit, no surprise, only 8% were willing to see “major reductions” in Social Security or Medicare. But only 13% were willing to see major reductions in Medicaid, the same percentage as for public education. Sixty-four percent supported “no reductions” at all in Social Security as a way to reduce the deficit, 56% in Medicare, and 47% in Medicaid, hardly the mark of an unpopular program. Forty-six percent of independents and a little more than a third (35%) of Republicans said they would “not support any reductions at all” in Medicaid to reduce the deficit.
Paul Ryan is calling his proposal to gut Medicaid “welfare reform” because conservatives and media put a lot of time and energy into portraying Medicaid as a program that only “other people” rely on.
Medicaid is much broader than that, because it includes the elderly, the disabled, and children. I’m not surprised that most people support it. Many of them are relying on it.
trollhattan
90% of the US population could/should rightly eye these programs and think, “There but for the grace of God….” We cannot presume our crazy quilt of savings (401k, pensions, SS, house, whole life insurance, etc.) will be intact by the time we retire, much less adequate to cover all our expenses, including but not limited to health care.
It’s humane to want these programs for the less fortunate. It’s realistic to wonder whether we, ourselves, will need them given the events of the last decade.
FlipYrWhig
@trollhattan:
To me that’s the most remarkable thing about the diehard Republican base. They see that safety net and think, “That’s coming out of my pocket” rather than “There but for the grace of God go I.”
WereBear
@FlipYrWhig: And the irony is that it’s… what? A few hundred dollars for that (a lot more for military, of course,) and they balk at it?
Let kids die for the cost of a new iPod? What?
Lolis
For years, Medicaid was the only insurance I had due to a childhood injury that makes insurance companies avoid me like the plague. Medicaid is awesome. I miss it now that I have a state job and Blue Cross. I will fight for Medicaid for the millions of other Americans whose lives LITERALLY depend on it.
Barb (formerly Gex)
Every one of those groups you mention? Moochers off of John Galt’s genius.
My family used to travel to Hong Kong quite a bit in the 70’s and 80’s (still British “rule”). They had the Randian paradise some here would dream of. The only thing you had to do was get used to old people, disabled people, and children begging on the streets.
theturtlemoves
My first child was delivered using Medicaid, as my wife accepted her college diploma nine months pregnant and huge, so we weren’t exactly gainfully employed at the time. Student health insurance wasn’t going to cover maternity overly well. Since I was working as a high school teacher after college and making a first year teacher’s salary, we also took advantage of WIC. Now that I’m making IT consultant money, I’m more than happy to pay back in my fair share in taxes so others can benefit as we did. Wish these asshole “conservatives” felt the same way.
kay
@Barb (formerly Gex):
I’m betting you’re’ wrong (and I know you’re joking).
Medicaid costs have been skyrocketing because so many people were out of work. It’s not (exclusively) a poor people’s program any more. The safety net, you know, worked.
I just think this media insistence on labeling Medicaid the program for “the poor” is completely out of touch with reality.
JPL
Ryan’s plan does nothing to contain health care costs. As more people are forced into emergency rooms, health care costs will climb higher causing insurance costs to rise.
Ryan’s plan is courageous because?????
Ryan is showing what kind of leadership here???????????
PurpleGirl
Kay wrote:
Yup. When I could no longer pay for the group insurance through COBRA, I went without care for some months. But the time came that I needed new prescriptions for my medications. I finally looked into NYC’s health care/hospitals/clinics. They did full diagnostic workups with me and I’m getting my medications and care from them. Without them, I’d be hard put to afford anything and I’d be a risk for some catastrophic results. (Actually, if I ever get another job, I’ll find a way to keep going to the hospital clinic because I think I got better care there than from the private group practice I’d been going to.)
kay
@PurpleGirl:
I talk to people every day that never anticipated using a program for “the poor”, but we had 17% unemployment here, and they did.
It’s been so hard for me to listen to the national screeching over Medicaid enrollment going up, because I’m thinking “that’s how safety nets are supposed to work”.
Anyhow, I’m glad you were able to get what you needed.
PurpleGirl
@JPL:
Ryan’s plan is courageous because?????
He’s supposedly telling the truth that no else wants to talk about.
PurpleGirl
@kay: Growing up when I did and where I did, I too never thought I’d willingly go to a City hospital. But when push came to shove and I just couldn’t keep the insurance and pay for care… well, I looked into the City’s system. I really should have done it sooner. But I do have a new respect for the doctors and staff at City hospitals.
Mnemosyne
The problem is the cognitive dissonance that Fox News creates. Last Christmas, my parents were simultaneously decrying “government-run healthcare” and praising the care a friend of my brother’s was getting for his lymphoma, which was paid for by Medicaid because he couldn’t work.
They absolutely refused to admit that Medicaid is that ebbil “government-run healthcare” because shut up, that’s why. It was beyond frustrating.
rickstersherpa
Well, given Ryan’s Galtian vision, most of us are going to end up poor and bankrupt.
The most expensive folks in our health system folks are those that end up in nursing care facility. Whether old age, Huntington’s, Lou Gehrig, stroke, or accident, these are the folks that run between $80,000 to $150,000 to care for, and after all the assets are used up, they end up in Medicaid, with more short term Medical expenses covered by Medicare. I wonder what private market insurer is going to step up to cover them. Even now, with relatively young and healthy individuals, insurers are backing out of the Long Term Care market because they are having a hard time calculating what the acturial risk, and hence what preminium they need to be charging.
It does not take a lot of imagination, because most of us have seen it with our families and friends, that any of us could end up dependent on Medicaid, or have someone we love dependent on it.
kay
@Mnemosyne:
This is bordering on cruel, but it’s also hard-headed and true, and not a bad conversation to have for good reasons other than political.
Talk to your parents about what happens if they require extraordinary or on-going care when they get older and burn through all their assets.
Because (as you know) that’s Medicaid.
JPL
@PurpleGirl: In that case he needs to look up the word truth.
During the Bush years, he voted to increase the deficit every chance he got.
PurpleGirl
@rickstersherpa:
And unless you have significant assets to protect, you can’t buy Long Term Care insurance. I had one conversation with an agent and after we discussed my “lack” of assets, it was clear that I wasn’t the customer his company was looking for.
jayjaybear
@FlipYrWhig: That’s not remarkable. That’s actually right in line with expectations, if you examine the people who think it. These are the same people to whom “empathy” was a dirty word back when Sotomayor was still in the process of being approved for SCOTUS. These particular people can’t put themselves in someone else’s shoes, period. But when they or their families need the programs (or abortions, or same-sex marriage, or immigrant amnesty), they suddenly forget all of their previous hostility to them. At least until they or their families don’t need them anymore.
Lack of empathy is the hallmark of the modern American right-wing rank and file.
D. Mason
The proper spin for Dems to put on this is that Republicans are trying to equate people using services they paid for throughout their whole lives to collecting a welfare check because you won’t work.
Hey Grandma, remember Reagans welfare queens? That’s You.
JCT
@FlipYrWhig:
This is the most basic distillation of the basic problem across the entire political spectrum. You can apply this to almost anything. For example, the death penalty.
Republican Base when presented with a wrongful death penalty conviction: “All of those dirtbags are guilty, no question. And well, maybe if not exactly guilty for this specific crime, they probably did something else, so fuck them”
Thoughtful Human Being: “Holy crap, that’s an abomination. And wow, look what those prosecutors or POs did with the exculpatory evidence or Yikes, that crime lab was mixing up samples (hello Houston). That shit could happen to anyone, even me.”
These FYIGM types have no idea whatsoever how easy it is to find yourself in a very bad situation. And their lack of empathy is horrifying.
@PurpleGirl: I only work part time at a large outer borough NYC hospital and I am amazed on a daily basis by the dedication of many of my colleagues given the enormous amount of bureaucracy and nonsense.
And re: Medicaid — Someone needs to stand up and start shouting from the rooftops that Medicaid pays for Grandma in the Nursing Home and unless folks have LOTS of extra money sitting around they are going to be taking care of grandma in their home when it goes away. G_d, what idiocy.
Karen
@kay:
Actually the media is exactly right.
It’s the definition of “the poor” that is completely out of touch with reality.
Jax6655
@Karen:
Yup.
Erik Vanderhoff
Next time you see a Republican touting Ryan’s plan, ask him or her why they hate kids with cerebral palsy.
Elie
Medicaid covers only about half the poor people in this country. The persons covered have to meet certain criteria (pregnant women, children, the elderly, blind, ESRDdisabled) as well as certain income criteria (means testing). Lots of folks do not receive it and some receive it sporadically when they meet the criteria for income and specific covered group membership. Very few adult (past teenage) males are covered unless they qualify for the severe conditions listed above along with the means test requirements.
Important to remember also, in all of this wanting to cut Medicaid and Medicare. These programs reimburse providers of services, not the beneficiaries directly. Cuts to the program result in cuts to paying providers. While I am sure some can do without Medicaid and Medicare reimbursement, I would be surprised if a whole bunch of docs and hospitals would be glad to go back to providing charity care. As low as Medicaid rates might be for a given doc, they are paid. If Medicaid is not there, well, no one pays them anything. Sure, they won’t see Medicaid patients, but depending on where they live, that could be a huge economic blow. And for institutional providers, absolutely.
So some of this is just plain bull and striking a pose.
Medicare supported and allowed for the development of the many medical specialties we have now and made a lot of these folks rich. They know it and everyone needs to know it. When push comes to shove, there would be no substitute for that loss of income… unless they are all suddenly willing to volunteer their services for all the poor elderly and disabled that would now represent totally uncompensated care or charity cases.
Elie
Other thing about Medicaid. Medicaid, not Medicare pays for the bulk of nursing home and care for the elderly in this country. Unless you are truly rich, you cannot afford the 24K and up annual fee for nursing home care. You just can’t.
Most people in US nursing homes were not poor until they experienced an extreme decline in health status or functioning and then had to spend through their assets to receive Medicaid. Dunno about you, but at 24K and up per year, it wouldnt take too long to blow through most folks’ assets. Long term care insurance is just not that prevalent and it only covers certain services for certain strict periods and criteria…
As our population ages, which it is due to dropping birth rate and other factors, we are going to be in a hell of a long term care services crisis in the next ten years for sure. Cutting Medicare and Medicaid aint gonna work and people will not put up with seeing elderly beggars in the street. Maybe they might get used to it over a long time, but aint no one gonna survive politically who advocates for that…
Our country is filled with entitled, stupid people who have the emotional age of 3 year olds. We will see how many of them can grow up and grow up fast or if we are going to have to live the consequences of their dysfunction. I am betting that there is still a slim margin of sane folks left.
Splitting Image
…it will cost him the next election, as per Yes Minister
For those not familiar with the show, the rule is that a politician’s plan is controversial if it will cost him votes, and it’s courageous if it will cost him the next election. Humphrey Appleby makes a point of gushing over every plan Jim Hacker comes up with in the show as one of the most courageous things a politician ever did.
David Brooks et al. are doing the same thing as Appleby, but they don’t appear to realize the point of the joke.
PhoenixRising
Dual coverage is all that is standing between my family’s current stable finances and having 3 aging parents who need their care paid for. From some bucket of money we don’t have hidden in a mattress.
Speaking of, where’s my refund for what I’ve thrown into the elderly-support portions of the New Deal?
‘
Also too: Thank Bill Clinton for CHIP, as it allowed Medicaid to save my family business.
rikryah
everyone knows someone who has been touched by Medicaid. it’s time to speak up.
Elie
@rikryah:
..and that is the critical piece that has to happen.
The other place that Medicaid pops up is if someone in your family experiences a catastrophic medical event such as a big car wreck and has no funds or limited funds. This applies to many young people with sub-optimal or seasonal employment and without families who have them covered on their insurance. Medically needy category in some states helps pay for the inpatient costs for these catastrophic events. I have a dear friend who was between jobs when she received the diagnosis of Non Hodgkins Lymphoma, and thankfully she was in a state with a relatively decent Medically Needy benefit and she was able to get much of her inpatient treatment covered.
By the way, even for the so called “middle class”, medical expenses are either number one or two on the reasons for declaring bankruptcy…
Ruckus
@PhoenixRising:
It’s good to find out that your daughter is doing well and got the help she needed.
I wonder how many politicians have kids/grandkids who have issues that require extra treatments/surgeries/lifetime care? I wonder how many of them have the kind of struggles that PhoenixRising had to get that help for their kids?
kay
@rikryah:
A lot of people don’t know they’re on Medicaid. People here whose children are on S-CHIP tell me “we’re on the Buckeye” because that’s the name of the program. If they’re over 150% of poverty level and unmarried they’re actually paying (some) for it, and they still don’t know.
I write down “Medicaid”. I don’t know what they’re thinking between Point A (program) and Point B (purchase).
Church Lady
As a society, we really need to look at the family’s responsibility towards caring for their elderly relatives. At what point should we as a society step in to take care of someone when their children or grandchildren won’t? It’s sad to me that many times residents of nursing homes could be cared for by their children, but their children would rather foist the cost of their care off on the general public. Before the advent of Medicare payment for long term residential care, most people took care of their aging parents.
The entire system needs to be revamped. I know people that are quite wealthy themselves, but have Mom or Dad in a nursing home and having the costs borne by Medicaid. On the other hand, I also know people of lesser means that have Mom or Dad living with them, but if they require any kind of in home assistance to do so, have to bear those costs out of their own pockets. That is completely f’d up.
Given the aging of the population, there is no way that the system can continue the way it is. I don’t have the answers but solving it is going to make a whole lot of people unhappy no matter what is done.
jafd
@Church Lady: Well, I’m an only child, college grad, 60+ now. Was out of the labor force for most of 2000-2005, seeing my parents through their last years – Father had what the docs called ‘stroke-induced Alzheimer’s’ (Fortunately modern medicine and maybe a small miracle got him back with us for a couple of years, till he died of heart failure), mother bad arthritis.
Six years later, am still trying to find a permanent, full-time job that’ll keep me over the poverty line – let alone saving anything for retirement.
Until we revamp the American ‘working enviroment’ so that those who fulfill “the family’s responsibily towards caring”, are not only bearing the efforts of helping their kin but disadvantages on the job market as well, let’s forget about trying to scrap Medicaid, stopgap though it is.
chines
@Elie:
You have made some very good points on this thread. Thank you.
My cousin died last August after a 2 year fight w/ colorectal cancer. He was a single father of 3 kids without insurance, so Medicaid paid for his care, thankfully. This was in Idaho, however, so it often seemed as though he wasn’t getting the treatment he needed. I believe his Medicaid status led to his providers’ prejudice. It seemed radically unfair, especially in comparison to my father in the same cancer treatment center. Dad had terrific insurance and it really seemed as though the doctors went out of their way to try new and expensive treatments and surgeries that merely prolonged his suffering. I sometimes can’t help thinking that if only the doctors had been as radical with my cousin that maybe he’d still be alive today.
My cousin enrolled in a phase I clinical trial because his doctors couldn’t, or wouldn’t, do any more. He died within a couple of days of his first treatment due to the treatment toxicity. It’s likely he would’ve died anyway, but I think he was desperate to fill the vacuum of treatment his medicaid status placed him in. He was a victim of “rationing”.
I’m not arguing to scrap Medicaid–just wish we could’ve had a really significant healthcare reform, like single payer.