Saturday, January 5, 2008

Medicaid and the states

So let's talk about eligibility standards and the states.

The Bush admin's policy guy at HHS has been 'slpaining us all why states can't determine who is broke enough to need health care through Medicaid. His main argument, and federal policy, reflects the belief that if we start measuring who can't afford health insurance we may end up buying care for people who have jobs, cars and mortgages. And since SCHIP and Medicaid are designed to serve the poorest families and kids, that would be unfair. The pressure is on the states to cover all the poorest children before expanding eligibility upward.

Let's leave aside for a moment the fact that taxpayers are buying those workers (and their kids) health care already, we're just doing it in the most expensive way possible, at every ER in the country. Medicaid coverage for everyone who doesn't have Medicare or an employer-based group policy would be cheaper.

Back to who needs Medicaid, what the hell does having two (retail) jobs, two (leased) cars and a (negative equity) mortgage have to do with the reality that health insurance coverage costs a lot of money relative to the other costs in this sentence? Specifically, health insurance is a monthly cost that doesn't give you a way to get to work or a place to put your stuff...and the middle-class culture of having coverage in case something happens is actually a product of mathematical thinking.

What Pam Hyde said in her meeting with business leaders, over and over, was: We need a cultural shift in which everyone know they need coverage. That's where she agrees with Thompson, apparently; anyone who can afford the trappings of middle-class comfort should be able to afford insurance. What they seem not to recognize is, 'In case something happens' is a cultural artifact of having something to lose.

If the workers who present as not-poor, as having enough stuff to afford insurance, owned their stuff or the house they store it in or the car the drive it around in--they might make sacrifices to have insurance coverage, and if not you'd call them ignorant and be right. But something already has happened to these workers. They woke up one morning and it wasn't 1973 anymore.