Nationally and locally, right-wing Republicans are out to destroy Medicaid. They believe that the public health and medical service program is inefficient and unprofitable. In Missouri, Republican Governor Matt Blunt is hoping to set a national precedent by attempting to eliminate Medicaid in Missouri completely by 2008. Blunt and his right-wing corporate supporters are waging an ideological war against the poor and society’s most defenseless.
Fortunately, there is a strategy to fight against the Republican agenda. Missouri public sector unions like the Service Employees International Union (SEIU), the American Federation of State, County and Municipal Employees (AFSCME) and Communications Workers of America (CWA) have taken the initiative to help build and fund a statewide coalition, Missourians for Health (MFH). The coalition aims to protect Missouri’s most vulnerable citizens, unite advocates of Medicaid and other health care services and focus the debate so that all government sponsored health care programs are protected.
Facts about Medicaid
In Missouri, nearly one million people receive Medicaid benefits, including 550,000 children or nearly one out of every three children in the state.
Medicaid became law in 1965 and is a federally aided, state operated and administered program that provides benefits to low-income, mentally ill and disabled individuals in need of health and medical services. As a social safety-net service, Medicaid provides health and medical services to our most vulnerable citizens and insures that those unable to care for themselves are not only cared for, but are treated with dignity and respect.
Medicaid is one of our nations most efficient programs, far more efficient than traditional private, for-profit health insurance programs. Low administrative costs allow most Medicaid funds to be used for patient care. Medicaid is the nation’s largest provider of nursing home care (around 60 percent), and it provides a buffer in times of recession, as employers cut benefits and increase layoffs.
It is commonly believed that Medicaid only provides benefits to low-income elderly individuals; in fact, the program provides benefits to all low-income age groups with severe health or medical needs. Nationally, Medicaid provides health or medical services to 50 million people, making it the largest source of funding for health and medical services for low-income families. In Missouri, nearly one million people, around 20 percent of our population, receive Medicaid benefits, including 550,000 children or nearly one out of every three children in the state.
The attack
The attack on Medicaid isn’t just about denying society’s most vulnerable citizens access to health and medical services, it is also part of a long-term ideological agenda to destroy social safety-net services completely and eliminate all government sponsored health programs.
(illustration by Victor Velez)
Due to Missouri’s current budget deficit, Governor Blunt claims he has cut state and federal funds for Medicaid by more than $626 million. This will not only eliminate Medicaid services for at least 130,000 state residents and limit medically necessary services for hundreds of thousands of others, but will cause Missouri to lose about 10,000 jobs and $737 million in economic activity as well.
While many of the Medicaid cuts will be achieved by direct reductions in coverage and services to individual recipients, Blunt and the Republican state legislature also want to close public health care facilities and let private, for-profit facilities take over.
For example, the Bellefontaine Rehab Center has 342 clients and employs over 900 state workers, members of SEIU and AFSCME. The center costs the state $286 per day, per client and of that $286 the federal government reimburses the state 61 percent. The actual cost to the state per day, per client is $111.54. Currently, Missouri is allocating $288 per day, per client to private facilities; two dollars more per day, per client than in public facilities. Governor Blunt says closing the Bellefontaine facility will save $13 million a year. In reality, closure will cost taxpayers more.
Not only are Missouri residents paying more per day, per client, subsidizing the private facility’s profit margins, but they are also footing the bill by what is called "cost-shifting."
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The Church at the Crossroads
Cutting people off of Medicaid will not eliminate their need for medical care. Without health insurance and with little or no money to pay for care, the cost of these services will be shifted to doctors, hospitals, other safety net providers, families, correctional facilities, employers and emergency rooms, i.e. to taxpayers. Eventually, cost will be passed on to those with health insurance through higher premiums.
Blunt’s plan doesn’t stop at cutting services to Missouri’s citizens. He wants to destroy Medicaid in Missouri forever. The Republican controlled House and Senate have passed Senate Bill 539 for just that purpose. The bill establishes a Medicaid Reform Commission whose sole purpose is to end Medicaid as we know it by 2008.
According to the bill, the commission will consist of 10 members, five from the House and five from the Senate. Six of the 10 members can come from the same party and are nominated by the majority leadership in each chamber, both currently Republican. The commission will make recommendations to the General Assembly by January 1, 2006 on "reforming, redesigning and restructuring a new innovative healthcare delivery" system to "replace the current state Medicaid system."
According to MFH, the reform commission will end Medicaid whether or not an acceptable or legal alternative is developed. Low-income Missourians and seniors will be left with no plan for how they will receive health insurance or their long-term care. In fact, finding ways to improve the existing Medicaid program is not one of the options to be studied by the commission.
Over one million Missourians could lose Medicaid coverage, around 25 percent of Missouri’s total population. If the reform commission is successful it will set a dangerous precedent for other states to follow and the most vulnerable sections of our society will be left without access to health and medical services.
Fighting Back
Missouri’s public sector unions, SEIU, AFSCME and CWA have initiated a strategy to fight back. They have brought together and funded the largest health care coalition in the state, Missourians for Health (MFH). MFH is not only made up of traditional union allies, but also includes organizations such as the Arthritis Foundation, the Foster-Adoptive Care Coalition, the Save First Steps Coalition, Paraquad and many others.
The broad spectrum of health and medical service advocates brought into the coalition link the fight to protect all government sponsored health programs – programs that are significant to all Missourians, not just low-income Missourians – to the fight to save Medicaid.
In order to broaden the coalition, MFH has focused on health and medical services in general, but it has not forgotten about the Bellefontaine Rehab Center, nor the 900 union members who work there. Union members at the Bellefontaine Rehab Center have been working with the Center’s Parents Association and others to collect petition signatures demanding that Blunt keep the facility open. Union members have highlighted the fact that allegations of abuse at private facilities are often covered up or ignored, that accountability and public oversight are almost impossible and that administrative costs at private facilities are many times higher than those at public facilities, which increases costs for consumers. According to the Parents Association, "even if clients could survive the traumatic transition, most families can’t afford care from a private facility."
The 900 union members who work at Bellefontaine earn an average of $17,000 a year and would lose their jobs if the center closes. The MFH’s fight to protect Medicaid and other health and medical service programs is tantamount to preserving union jobs and insuring that the clients at Bellefontaine receive the type of treatment and care they deserve.
MFH coalition member, Missouri Pro-Vote, has suggested that the state legislature close corporate tax loopholes as one way of funding Medicaid and other health and medical service programs. As of 2002, ninety of Missouri’s biggest corporations – those with $50 million in taxable income – didn’t pay a penny in state taxes and more than 16,000 of the state’s most profitable corporations paid less in taxes than the average Missourian. Closing these loopholes could generate nearly $200 million for the state budget, money that could be spent on Medicaid and other health and medical service programs. While closing corporate tax loopholes won’t solve all of the problems, it will place the argument in context and encourage others to ask the question: Why are corporations and wealthy individuals getting tax breaks while Missouri’s most vulnerable citizens are forced to sacrifice?
A Fight We Can’t Afford to Lose
Right-wing Republicans control the Missouri House, Senate and executive office. Eliminating Medicaid is part of their long-term, ideological strategy, put in motion during the Reagan administration, to weaken and cripple social service safety-nets that working-class people rely on.
If we lose the battle to preserve Medicaid, one of our most efficient and effective health and medical service programs, nearly one million Missourians will be hung out to dry. The fight to save Medicaid is a fight to the death for many Missourians. This is a fight we can’t lose.
--Tony Pecinovsky is a reader from St. Louis, Missouri.
