By Al Norman
I was about to turn 17 when President Lyndon Baines Johnson declared a War on Poverty in his State of the Union speech in 1964. Johnson was responding to a national poverty rate at the time of around 19 percent. Congress passed the Economic Opportunity Act to oversee the local application of federal funds targeted against poverty.
“Our aim is not only to relieve the symptom of poverty,” President Johnson said, “but to cure it and, above all, to prevent it,”
Fifty-three years later, the federal War on Poverty has turned into a war on poor people. The battle lines have shifted from alleviating poverty, to eliminating poor people. Instead of attacking poverty, the field has been reversed, and the attack is on poor people themselves.
The epicenter of this shift is around the Medicaid health insurance program, one of the key federal programs created as part of LBJs Great Society. There are 70 million people on Medicaid nationwide, and roughly 1.9 million MassHealth recipients statewide. We are one of the states that took advantage of the Affordable Care Act (ACA or “Obamacare”) to expand access to MassHealth insurance. But as Congress and the White House replace the ACA, our state is also seeking to reduce the MassHealth caseload.
The Senate version of the “repeal and replace” bill known as the American Health Care Act, was released June 21. The Senate version would phase down the Medicaid expansion over four years (2020 to 2024), a little slower than the House version. But both bills still end Medicaid expansion, throwing millions of low-income people under the bus.
The Senate bill clamps down harder on Medicaid in later years. The cap imposed by the House would grow more slowly than Medicaid spending has, but the Senate’s cap would grow even more slowly than the House’s.
“That would leave states with few options,” said the non-partisan Kaiser Health News, “other than raising taxes, cutting eligibility, or cutting benefits in order to maintain their programs.”
Both bills would also cap federal funding for the Medicaid program. Since 1965, the federal government has matched state spending for Medicaid. The new bills would shift much of that burden back to states.
Just before the Senate version of the Obamacare repeal came out, President Donald Trump urged lawmakers to come up with a bill that “has heart in it,” and that would improve health care for all Americans. But the judgement on the Senate bill was just the opposite.
“The heartless Senate health care repeal bill makes health care worse for everyone,” said the group Protect Our Care. “It raises costs, cuts coverage, weakens protections and cuts even more from Medicaid than the mean House bill. They wrote their plan in secret and are rushing forward with a vote next week because they know how much harm their bill does to millions of people.”
The Senate plan has not yet been analyzed by the Congressional Budget Office. But the House version cuts Medicaid by $834 billion over 10 years. Medicaid cuts would increase over time and provide no increases for unanticipated events. As a result, the number of Medicaid beneficiaries would fall by 14 million in 2026, a reduction of 17 percent relative to the current law.
The day before the Senate bill was unveiled, the Baker Administration released a plan of its own to cut back on Medicaid services at the state level. The plan was loaded with proposals to reduce the MassHealth caseload. The day after the Administration’s plan was released, it drew this strong rebuke from the Massachusetts Law Reform Institute: “Reducing MassHealth eligibility from 133 to 100 percent of the federal poverty level, denying coverage to the working poor with access to employer-sponsored insurance, and authorizing cuts in any optional benefits is going too far too fast.”
Medicaid is a partnership between the state and federal governments. If both these partners conspire to “go too far,” it will hurt millions of people whose only offense is being poor. There is no possible trajectory that allows America to become “great” by swelling the number of its citizens who are living without health insurance. Declaring war n the poor is an act of self-defeatism.
Al Norman is the Executive Director of Mass Home Care. He can be reached at info@masshomecare.org or at 978-502-3794.
