AHCA would cap health care programs, harming those in need

Published 9:30 am Saturday, June 3, 2017


Contributing columnist

As the predicted implications of the House-approved American Health Care Act and President Trump’s proposed budget for our social safety net are being decried, officials from the Trump administration are seeing to it that the negative claims are belied. Budget director Mick Mulvaney has stated, concerning the Trump budget in general: “We are not kicking anybody off of any program who really needs it.”

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Of $800 billion in cuts to entitlement programs including Medicaid and Social Security Disability, signaled by capping the federal share of Medicaid spending over the next decade, the director explains, “There are no Medicaid cuts in terms of what ordinary human beings would refer to as a cut. We are not spending less money one year than we spent last year.” In other words, current recipients will not be eliminated.

Another top administration official, Seema Verma — administrator for Medicare and Medicaid Services — posits that job creation will eliminate the need for able-bodied adults to receive Medicaid, assuming that able-bodied adults who are unemployed would be the primary beneficiaries of Medicaid expansion. And that a sufficient number of new jobs for which these people are qualified will be created. And that low-paying new jobs will include health insurance.

It seems that some of us “ordinary human beings” who are not convinced by the administration’s narrative have some explaining to do.

For starters, it is noteworthy that the great majority of those who would be covered by Medicaid expansion suffer from ill health or are already working or attending school or looking for work. Only 13 percent fall outside that description, and 75% of those who do are caring for family members or have been laid off.

Forty-eight percent of adults covered by expansion are permanently disabled or have serious physical or mental limitations. In the overall adult population, a much larger proportion — 28 percent — is unemployed or not in the labor force than is the case in the adult Medicaid-eligible population.

Still, we must reckon with a segment of our body politic that is not convinced that most recipients of Medicaid or food stamps deserve it. One recent attention-getter in this regard is four-term U.S. Congressman from Alabama and Freedom Caucus member Mo Brooks. As he sees it, people who lead “good lives” (he later changed his phrasing to “healthy lives”) should not have to pay as much to provide affordable health care for others.

If they have done the right things to keep their bodies healthy, they won’t fall prey to most of the diseases that kill us, Brooks reasoned. He later backpedaled and acknowledged that a lot of people do have unhealthy conditions through no fault of their own, but he questions what some may be claiming as “preexisting conditions.” Might they merely be people who got sick and lacked insurance? Why, he asks, shouldn’t insurance companies be allowed to require people with higher health-care costs to pay higher premiums instead of punishing people who have taken care of themselves?

Brooks believes that entitlement costs are pushing the U.S. toward insolvency and bankruptcy and that the federal obligation for health care can be limited to a per-capita basis and block grants to the states.

Many of our health problems are self-inflicted, but can we not name people who were rigorous in observing healthy lifestyles but were nevertheless victims of devastating diseases or accidents that involved ruinous costs to treat. And who is omniscient enough to calculate accurately what percentage of our health problems are attributable to heredity, workplace environment, childhood nutrition or malnutrition, neighborhood environmental conditions or poverty?

Race, ethnicity and gender have also been shown to have effects on the expenditures devoted to various illnesses and access to the best health care. Is it really fair to simply regard being poor as the sole fault of the impoverished person, when there are often factors in play over which the person in question has had very limited or even no control?

These questions underline the relevance of a May 15 “Community Challenge” column in the Courier-Journal titled “The clinic opens door to improved heart health,” by Dr. Michael Imburgia, medical director of the Outpatient Cardiovascular Ultrasound Lab at Baptist Health Louisville. In 30 years of practice, this cardiologist has discovered that “where you live is a key indicator of how long you will live.” If you reside west of I-65, you have a life expectancy of about 10 years less than those living east of I-65.

Instances of stroke, coronary heart disease, high blood pressure and COPD — which some would simply blame on unhealthy lifestyles — are significantly higher east of I-65. In fact, writes Imburgia, “death by heart disease and stroke is about two or three times higher in parts of Louisville’s West and South End.”

People acquainted with Louisville will know that income levels and racial composition figure prominently in this disparity.

In response to this disparity, Imburgia and other volunteers started Have a Heart Clinic, Kentucky’s only solely cardiovascular care clinic, in 2008. It offers state-of-the-art care regardless of ability to pay. Choice of its location was determined by the lack of transportation that hampers many West End residents in getting to care. Many of the patients at Have a Heart Clinic have gone too long without health care because they do not qualify for Medicaid and do not earn enough to afford care.

The volunteers at the clinic have learned from experience that improved access to health care leads to better long-term health. It is not only a healthy lifestyle that makes the difference.

If the reservations expressed here have validity, they do challenge the efforts to reassure by budget director Mulvaney and by Medicare and Medicaid Services administrator Verma. To at least some “ordinary human beings,” it seems clear that many people who really need Medicaid are not going to get it if the American Health Care Act passes and the Trump budget is approved. A “cut” by any other name hurts just as much.