Medicaid is our moral compass

Medicaid provides essential services and supports for almost 80 million people – or about one in four Americans. Here in Pennsylvania, it provides health care coverage for over 2.8 million people, including 1.2 million children – and half of all births! It helps over a half-million people receive mental health treatment and over 200,000 get substance abuse care. It covers over 700,000 Pennsylvanians with disabilities, including 55,000 with intellectual and developmental disabilities. It sustains over 55,000 seniors in nursing homes – over 64 percent nationwide! – and helps our school districts with over $100 million annually in direct health and related services for our kids. 

In short, it provides help for those who need it the most, assuring services otherwise unattainable; it opens doors; cradles falls; and in many ways, is our measuring stick as a great society as to how we treat and value those who are less advantaged. It is our moral compass. 

Most likely almost every Pennsylvania family has relied on Medicaid in some way or another to care for a loved one, but may not realize its structure or understand the changes currently being discussed in Washington, D.C.

Medicaid is a state and federal partnership which essentially splits the costs of services 50/50. In Pennsylvania, 40 percent of Medicaid spending goes to people with disabilities, 20 percent to seniors, and another 20 percent goes to low-income families. Those commitments have nothing to do with the Affordable Care Act (ACA), they pre-date it. However, the remaining 20 percent of expenditures are due to those who are qualified for coverage thanks to the Medicaid expansion option that is part of the ACA.

In order to increase health care access for over 700,000 Pennsylvanians, Gov. Tom Wolf expanded Medicaid upon taking office. Thanks to his effort, individuals who made about $16,000 annually qualified for coverage, as did families of three who made less than $27,000. What we found is what is always found when people finally get access to health care: they come into the system with more problems and chronic conditions than typical, most often long-neglected issues due to their inability to previously pay for care. Expanding Medicaid helped more sick people, more people with mental health issues, more people suffering from addiction – and improved outcomes while creating tens of thousands of jobs and growing our economy.

Now the majority leadership in Washington wants to dismantle the ACA. At best, this seems to be motivated by a belief that despite the Supreme Court ruling, the ACA represents government overreach. At worst, some seem agonizingly caught between fulfilling a campaign promise based more on political hyperbole than sound policy and the actualization that doing so would likely impact so many people negatively.

Regardless of intent, the latest proposed plan seeks to “modernize” Medicaid – not just Medicaid expansion, but ALL of it. Instead of working to improve the ACA in order to lower deductibles, premiums, and prescription costs, some see an opportunity to reign in a safety net they have long-despised, regardless of how many foster kids, children with autism, adults with Down syndrome, seniors in nursing homes, or babies born into generational poverty may disagree.

In “reforming” Medicaid they seek to block grant or cap federal expenditures. Under the current reimbursement approach, Medicaid funding grows as actual expenditures grow. Block granting changes that by setting a limit on how much each patient is worth as far as federal dollar support.

If you or your loved one exceeds that threshold, it will force the states to either find the money, cut services or lower eligibility levels. They also plan to “save” money by redefining how they fund future needs of the program. Initially, funding projections are based on the Medical Consumer Price Index (MCPI), which is a tailored tool that focuses on all actual medical-related expenditures. Accordingly, it tends to be a higher index than the general Consumer Price Index (CPI), which includes everything from the cost of tires to the price of a Coke. Their plan is to phase out the MDPI in favor of the general CPI, which will likely result in a massive fiscal hole for the states to deal with – which, by the way, will also impact local school districts in relation to their special education costs.

To reiterate, I believe there is common ground to be found in amending the ACA. I hope our representatives in D.C. do so. But in attacking the viability of Medicaid, they will likely create a fiscal problem that Pennsylvania (like most states) will not be able to bear – especially since we already have thousands of people with disabilities on waiting lists for Medicaid-related services.

Even in tough times, we must not abandon our moral commitments to those who were made a different way or to those who are less fortunate. In the final analysis, how else would we want to be judged as a great nation?

DAN MILLER

42nd Legislative District

Allegheny County