Stigmatizing Medicaid Recipients with false facts

Speaking at the release of President Trump’s first budget, Mick Mulvaney, the White House budget director, said: “We’re going to measure compassion and success by the number of people we help get off of those programs and get back in charge of their own lives.  We’re not going to measure our success by how much money we spend, but by how many people we actually help.”  (A)

Mulvaney’s underlying premise: “We need people to go to work.  If you’re on food stamps, and you’re able-bodied, we need you to go to work.  If you’re on disability insurance and you’re not supposed to be — if you’re not truly disabled, we need you to go back to work.  We need everybody pulling in the same direction.” (B)

One of the big targets for reductions is Medicaid.

“We hear a lot about Medicaid in both the local and national media. It is oftentimes classified as a free program for those disinterested in working and paying their fair share, making it one of the most misunderstood and misperceived programs on the books.
It is imperative that everyone across the nation understand the purpose of Medicaid — that it is not for people who do not want to work or are simply looking for a handout. Medicaid is a safety net for everyone because we are all one medical crisis or catastrophic event away from financial ruin. It is a stepping stone for people when the unexpected occurs. It is for the middle class, for the financially stable, and even for those who once considered themselves upper class. If you have worked during your life, Medicaid is a program you helped fund and one that is available to you and your children when you need it the most. But few know exactly what that means.
To be clear, Medicaid covers more than just low-income families, it covers children, pregnant women, the elderly and the significantly disabled. AND, IT WILL COVER YOU IF EVER NECESSARY. (C)

In 2015, Medicaid provided health coverage for 97 million low-income Americans over the course of the year. In any given month, Medicaid served 33 million children, 27 million adults (MOSTLY IN LOW-INCOME WORKING FAMILIES), 6 million seniors, and 10 million persons with disabilities, according to Congressional Budget Office (CBO) estimates.
Children account for more than two-fifths of Medicaid enrollees but less than one-fifth of Medicaid spending. Only slightly more than one-fifth of Medicaid enrollees are seniors or persons with disabilities, but because they need more (and more costly) health care services, they account for nearly half of Medicaid spending. (D)

“When debating health care, we tend to talk far more about health insurance than about the institutions giving the actual care. Whatever the government decides to spend, poor people will get sick. And when they get sick enough, they will receive treatment. This is because federal law requires all hospitals to provide emergency care to all patients, regardless of their ability to pay.
For uninsured patients, lifesaving surgeries and treatments, along with a limited recovery period, are often covered through Emergency Medicaid funds. But patients who don’t fit neatly into our medical system for reasons of health or finances or their social situation — the “medical misfits” that any one of us can become under the wrong circumstances — need far more long-term support. This is often where safety-net hospitals step in.  (E)

If Medicaid is cut that does not mean that those formerly covered do not get care. They go to the nearest Emergency Room usually at an academic medical center or teaching hospital, “safety-net” hospitals, the same place we all go when the highest level of care is required. But the hospital either does not get paid or gets underpaid putting its finances in jeopardy, and therefore its surge capacity, the ability to take on community emergencies like the flu or Zika, and compromises its disaster preparedness.
“Almost 470,000 additional New Jersey residents wouldn’t have health insurance coverage under the House Republican-passed bill to repeal and replace the Affordable Care Act, according to a report released Thursday.
More than half of the 469,500 residents — 246,000 — would not be covered due to the American Health Care Act’s $834 billion cut to Medicaid, which would end the extra federal funding for new enrollees in states like New Jersey that expanded the program under the current health care law.” …of which about 56,000 would be in Hudson County served by Jersey City Medical Center where I was President and CEO for 17 years. (F)

Cutting Medicaid has a ripple effect on safety-net hospital sustainability which eventually will impact on access to health care for all of us.


(A)   Trump Budget Cuts Programs for Poor While Sparing Many Older People by Yamiche Alcindormay, NYT,

(B)   Off-camera Briefing of the FY18 Budget by Office of Management and Budget Director Mick Mulvaney,

(C)   Medicaid: A Stepping Stone, Not a Stigma, by Mark A. Wallace, Hufffington Post,

(D)   Policy Basics: Introduction to Medicaid,

(E)    Where Will the Medical Misfits Go? Safety-net hospitals keep us all healthy by treating the patients no one else wants. Don’t let Republicans destroy them by Ricardo Nuilamay, NYT,

(F)    NJ Politics Digest: 470,000 in NJ Could Lose Health Coverage by Steve Cronin The Observer,

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