Politicians toss a CHIP at poor but ignore big woes like soaring medical costs
Let's give the faintest cheer — maybe of the Bronx variety — to the Republican-controlled Congress for, finally, reauthorizing the Children's Health Insurance Program, aka CHIP.
This means that months of high and needless anxiety will end for nine million or so youngsters who will get health insurance, coverage that their poor or working poor families otherwise could not afford, even under the Medicaid program that serves the underprivileged. The six-year cost to Uncle Sam will be relatively small — $124 billion, and 375,000 poor and expectant moms also will benefit from CHIP, which has halved the uninsured rate among kids in the last decade.
The much-liked program got caught in a bitter partisan cross-fire, becoming a last-minute bargaining chip by congressional Republicans in the battle over the short-lived shut-down of the federal government. (Which, incidentally, ended up as a boondoggle that enriched health care industry players — who didn't need the boost — by more than $31 billion.) GOP lawmakers, who in 2017 passed a $1.5 trillion tax cut package that chiefly will benefit corporations and the richest Americans, spent weeks, claiming the country could not afford CHIP.
Even when they passed the health coverage measure, they left a gaping hole in the system for the poor and working poor to use CHIP. That's because Congress also hasn't acted for more than six months past a deadline to keep funding community health centers that assist 27 million poor Americans in 9,800 rural and urban communities.
Those centers have become an important way the underprivileged access affordable quality care, the nonpartisan Kaiser Health Foundation has found. They have improved and grown their work under the ACA's expansion of Medicaid, and, of course, the GOP Congress continues to batter that program, moving some of the fight to the state level.
Partisans, of course, will spend at least the next few weeks in hand-to-hand legislative combat against another marginalized group — and one with major sway in health care: immigrants. The Wall Street Journal, not exactly a progressive political bastion, reported on its front page recently that GOP efforts to curb immigration could "affect grandma's [health] care."
The newspaper, noting the rapidly graying U.S. population, reported that:
[A recent study shows that] one in four 'direct-care' workers is an immigrant. That universe includes home health aides, personal-care aides and nursing assistants. That means some 860,000 immigrants fill these jobs in the industry. Add in workers who provide such services independently and the number rises to 1 million. Moreover, the share of these workers who are immigrants has been rising, to 24 percent in 2015 from 20% in 2005. In some of the nation's biggest states — New York, California, New Jersey and Florida — 40 percent or more of these workers are immigrants. Among these immigrant workers nationwide … 56 percent are citizens by naturalization, and 44 percent aren't citizens. There already is a shortage of such workers, and that problem may become more acute as demand grows …Perhaps not surprisingly, many of these care workers come from countries that are in the crosshairs of the immigration debate. The largest shares come from Mexico, the Philippines, Jamaica, Haiti and the Dominican Republic.
So, as Republicans take aim at so-called Dreamers, young people who are undocumented because they were brought to this country as children, and other immigrants, they also could upend a vital and difficult to replace corps of health care workers, the Journal reported.
Although opinion polls show that harsh measures affecting immigrants, or the health of the poor are unpopular among Americans, will voters remember how President Trump and congressional Republicans have acted since the new administration and GOP majority took the nation's reins in January 2017?
In my practice, I see not only the major harms that patients suffer while seeking medical services but also their heart-breaking struggles to access and afford quality medical care. Americans spend more than $3 trillion annually on health care, forking over some of the highest such sums among the industrialized nations while getting the poorest outcomes. We cannot see health care as a privilege but as a right, with the costs, risks, and benefits best shared among us all so none are burdened excessively.
Instead, as the Atlantic magazine recently reported, health care adds to income inequality:
Medical spending [has] sent millions of people effectively into poverty or into deeper rungs of poverty. Seven million Americans making more than 150 percent of the federal poverty line—$31,000 for a family of three—dropped below that line if medical expenses were subtracted from their income. That meant that these families spent something like a third or more of all their income on health care. Of the 7 million, 4 million found their post-health-care income reduced below 50 percent of the poverty line, meaning they spent about two-thirds of their total income on health care. The … ACA decreased the amount of inequality caused by health-care expenses, but only slightly.
Partisans may play to their voter base by decrying "entitlements," and insisting their every cut and action is a "reform." But let's talk about the huge missed opportunity and need that's also going on: Who, for example, is tackling the soaring cost of medical care for us all?
Most Americans don't rely on ACA marketplaces to get their health insurance. They get it through their workplaces. But among Americans with such job-related coverage, medical costs rose yet again last year (as was the case between 2012 and 2016), yet another study has shown. Consumers weren't using more services. There was just one thing that caused the medical bills to go up: Higher prices for medical services and products.
Translation: Big Pharma pulled yet more dough out of Americans' pockets, as did doctors and hospitals with shiny new buildings. At the same time, other reports have pointed out, big hospitals keep getting bigger, merging, and consolidating, working themselves into major chains. But when they do so, they aren't helping rural or poor areas around them — or, in the case of chains, they're not improving medical services and sharing possible benefits they achieve from efficiencies and economies of scale.
This all leads at least me to say, C'mon, Congress, quit the nonsense and get busy with tough stuff that matters to not to politicians but to the hard-working folks at home.
Posted in: Accessibility of Healthcare, Communication, Conflicts of Interest, Health Care Reform, Hospitals, Insurance, Medical Malpractice, Preventive Care and Primary Care
Updated: January 27, 2018 5:04 pm