This commentary is by Jane Katz Field, M.D., a retired pediatrician who practiced in Brattleboro and lives in Putney. She is vice president of the Vermont chapter of Physicians for a National Health Program.
A 7-year-old boy, in remission from leukemia and living in Florida, was unable to access potentially lifesaving treatments because his insurance coverage was suddenly cut off. This is the face of the government’s cruel cancellation of Medicaid coverage for millions of Americans.
What’s behind this nightmare?
The Covid-19 pandemic demonstrated that it was actually possible to expand health care services and coverage to more individuals; all 50 states agreed to maintain Medicaid coverage for their beneficiaries in exchange for enhanced federal funds.
But now we’re witnessing a bipartisan effort to take those gains back. Starting in February, states have been combing through their Medicaid rolls to decide whose coverage continues and whose is dropped. This 14-month process to “redetermine the eligibility” of 93 million Americans is being called “Medicaid unwinding.”
According to the U.S. Health & Human Services Department, about 15 million people, 5.3 million of whom are children, could be declared ineligible, the biggest change to the U.S. health care system since the Affordable Care Act.
An estimated 45% of the people (6.8 million) who stand to lose Medicaid will be disenrolled solely for avoidable procedural reasons, even though they are otherwise eligible. Oklahoma has disqualified 70% of its Medicaid recipients for such reasons. Disenrollment has been triggered by the state’s failure to send out a renewal notice or mailing it to an out-of-date address, the renewal notice being confusing or not written in a language people can understand, the state losing the paperwork, or the enrollee having difficulty providing documents.
Are these really justifiable reasons for Americans to lose their health insurance? And what about our children?
More than half of all children in the U.S. are covered by Medicaid and CHIP (Children’s Health Insurance Program). Almost three-quarters of the children who will be disenrolled (3.8 million) will be dropped despite remaining eligible.
And this pain will not be spread out equally. Sixty-four percent of Latinx and 40% of Black children will lose Medicaid for procedural reasons, as opposed to 17% of non-Latinx white children.
Are there other options for these kids? In too many states (like those that have failed to expand Medicaid under the Affordable Care Act), there are no affordable options. Private health insurance comes with unreasonably expensive premiums, copays and deductibles, which force many into medical debt or even bankruptcy. The Kaiser Family Foundation found that more than four in 10 people with Medicaid as their only source of health insurance “say they wouldn’t know where to look for other coverage” if they were removed from the program.
The Congressional Budget Office estimated that the states’ Medicaid eligibility “redeterminations” will likely leave 6.2 million people without any insurance at all.
In Vermont, the state estimates that 38,000 people (30,000 adults and 8,000 children), could lose their Medicaid coverage. During the month of May, over 5,800 Vermonters were disenrolled from Medicaid.
When untreated chronic illnesses spiral out of control, the sick will flood our emergency rooms. Many with no insurance, or who are underinsured, will be unable to afford prescriptions or preventive care — or will simply not be able to seek care and, as a result, will develop more medically complex diseases. And those who do seek care risk falling into debt, leading to possible evictions and homelessness.
Let’s look at the notion of “eligibility.” Almost everyone would agree that certain services are fundamental — services such as libraries, parks, roads and fire departments. Most other high-income countries consider health care to be fundamental as well.
Public investment in health care (currently proposed in Congress) extends far beyond the benefits to individual children and families; its social impact touches all our lives, and we all benefit. The Covid pandemic reminded us that our individual well-being is tied to the health and well-being of everyone else. So, the bottom line is that we should all be “eligible” for health care, based simply on our humanity.
With a universal, publicly financed health care system, we wouldn’t have to submit documents explaining our income, household size, disability, family or immigration status — nor would we have to pay sky-high deductibles to get the health care we need.
We can and must avoid a future tragedy like the “Medicaid unwinding” policy. Medicare for All would achieve this, and there are bills in the U.S. House of Representatives (HR 3421) and the U.S. Senate (S1655) designed to create such a system. Let’s work to have these enacted!