By Julie Reiskin
October 23, 2017
To remind readers, Part I of this blog post from early October began with my statement that I was recently in a discussion with someone about health care policy. When I shared that CCDC does not support Medicare for All, and that we did not support Amendment 69 during the recent fall elections, there was shocked silence. “Aren’t you the people always protesting and carrying on about health care?” Yes-we are.
What follows are several more reasons not mentioned in Part I of this essay that compel CCDC to advocate for “Medicaid for All” as the way to go in health care reform ahead:
Medicaid has multiple requirements for public involvement.
There is a federally mandated advisory council that requires client involvement. In Colorado, just about every program has a robust public committee that complements other ways for the public to be actively involved. If one was so inclined, one could go to meetings about Medicaid policy with the state every day of the week. Nothing happens in Medicaid without an opportunity for public involvement. This may sound tedious unless your life is altered by how rules are made or enforced. This level of involvement is impossible on a national level.
As we all know, having lobbyists in DC opining on issues does not translate into understanding of how a policy affects the people. We are slowly learning about some of the very negative effects of the recently passed 21st Century Cures Act which imposes national mandates on states to impose on Medicaid clients and providers. The motivation may have been good, but the outcomes are bad. Working things out on a state level in terms of day to day management of programs works much better than trying to write rules or policies on a federal level for every single issue. Medicaid currently has national standards; those are clearly met. The details are often left to the states. If the states follow the rules, the states are not hassled. If they fail to follow the rules, they have to answer for that. Medicare, on the other hand, has no such accountability. There is no workable process to solve a problem with Medicare in terms of how it works on a day to day issue.
There are other differences.
Medicare in some areas does pay better than Medicaid, but if there were more money in Medicaid, rates could be raised. Over the past ten years, states have worked hard to get Medicaid rates at least close to the Medicare rate. Most providers accept Medicare, not all take Medicaid—again, if the population on Medicaid increased and rates were increased a bit, that would change. Some providers that do not take Medicaid have outdated information. Many years ago, it was true that Medicaid would take forever to pay for services rendered. That has not been the case for more than a decade. Medicaid is now one the fastest payers.
Finally, and this is very important, Medicaid cannot just take away benefits.
To take away a benefit from everyone, there would have to be a legislative bill which would give people a way to be part of the process, and hopefully a solution. To take away a benefit from an individual requires a notice, and the right of the beneficiary to have a hearing before a neutral judge. Whoever wants to take the benefit away has to prove that something changed. One of our big concerns with Amendment 69 was that a board could vote away our benefits if funds were tight. The board did not have any requirement to have input from the disability community – despite how deeply many of our lives depend on these services.
The Nevada legislature passed a bill that would allow Medicaid for all people in Nevada; those not poor would pay a premium. Sadly, this was vetoed by the Governor of Nevada. In Colorado, adults with disabilities have this option—we can buy into Medicaid but only if we have a job and are under 65. If we lose our job and do not get another one in ten days, our Medicaid disappears. Even though no one retires at age 65 anymore—this program stops at 65. Other than those two gaping problems, the Medicaid Buy-In Program works well. For many people with disabilities buying insurance is useless because we need what Medicaid offers, not what insurance offers. While we may use doctors, need labs, and need hospitals, we really need LTSS and medical equipment. Non-disabled people would not need LTSS but they could buy into the regular Medicaid package.
While this is not a national program, and a state-by-state approach carries some dangers of people with greatest needs moving to states with the best benefits, it is a much more appropriate solution than Medicare for all. Medicare for all sounds good because Medicare does not have the stigma of Medicaid. However, many advocates of Medicare for All are using this term out of a place of ignorance based on privilege. Medicare for all will NOT solve our nations’ health care problems. With a proper federally mandated floor regarding covered benefits, Medicaid for all is the best of all worlds. Guarantee of health care with state control and allowing states to make reasonable rules and provide the benefits that best work for their populations. People with disabilities have always been the canaries in the mine of health care. The people promoting Medicare for All really need to listen to us—or at least, roll a mile on our wheels.