As families crunch numbers to
figure out how they're going to make ends meet during this recession, state governors are crunching numbers for their
budgets next year and realizing that they are going to come up short.
Forty-three states expect to see
budget shortfalls in the coming year. And, while the federal government can run
a deficit, most state governments are required to keep a balanced budget. As a
result, 18
states and DC have already cut or are proposing cuts to their Medicaid and
CHIP programs. Cuts in state Medicaid and CHIP eligibility and services pose a
real threat to the very families and individuals who most need the help.
At the National Governors
Association meeting in Philadelphia last week, governors from both sides of the
aisle pleaded with President-Elect Obama to include at least $40 billion for
Medicaid in the economic recovery package that is expected to be signed shortly
after Inauguration Day (January 20). The $40 billion would come in the form of
a critically important federal match increase to the funds that states allocate
to their Medicaid programs. As pointed out in a recent Washington
Post article,
On
average, the federal government pays 57 percent of Medicaid costs, and states
cover the rest. That means for every $1 a state trims from its Medicaid budget,
more than $2 is lost in health care services. Conversely, pumping money into
Medicaid "has a double impact."
But increasing federal
funding for Medicaid actually has an even greater than "double impact." That's
because in addition to helping states pay for extra Medicaid costs, federal
funding for Medicaid will also give state economies a jump start by generating
new jobs, wages, and business activity. In other words, putting more federal
money into the Medicaid program will help state economies move out of recession
and back into the black.
Increasing the federal share
of Medicaid has a proven record of fueling the economy. During the last
economic decline in 2003, Congress made a similar move, and the Kaiser
Commission found
that the additional money "helped states to both balance their budgets and
maintain eligibility." For analysis of how much the latest congressional
proposal would help state economies, see Families USA's new report, A
Painful Recession.
When the economy slows, more
individuals and families enroll in Medicaid. With over a million people
at risk of losing Medicaid or CHIP due to proposed cuts, states cannot
afford to wait any longer for federal help. Including additional federal money
for state Medicaid programs in the economic recovery plan will enable states to
continue their programs without having to cut
eligibility or services.
And during such tough
economic times, that's news that both families and state legislatures can feel
good about.
Health care reform, meet online organizing. Online
organizing, meet health care reform.
After running an unprecedented internet-focused presidential
campaign, President-Elect Obama has brought his online tools from Chicago to Washington,
DC in the form of the new,
interactive transition website, Change.gov. While the site tackles a variety of policy
issues, health care has received significant attention. First, an online video
by Dr. Dora Hughes and Lauren Aronson was accompanied by an interactive community
discussion asking people to share ideas and stories about what worries them
most about our health care system. The result: about 10,000 comments flooded
the website. Sen. Daschle, incoming secretary of HHS, chose a few to respond to
via Web video.
Taking the transition team's online organizing one step
farther, while reaffirming the Administration's commitment to health reform,
Daschle appeared
in Denver last Friday at a Health Care Summit to talk about how he will
initiate the reform process. The plan he
announced is to use Change.gov to help organize grassroots discussions on
health reform, modeled much like the meet-ups from the campaign season. Ideas
that come out of these discussions will then be used in the policy making
process. Via Politico:
"It actually is going to be key for
folks from the federal level to engage consumers and other stakeholders to
create the public will and public accountability to move health care reform and
stay focused and get to the finish line on it," said Dede de Percin, executive
director of Colorado Consumer Health Initiative, a nonpartisan consumer health
care advocacy group.
The Transition Team's use of the web to encourage grassroots
activism and participation is an attempt to avoid mistakes from President
Clinton's failed reform efforts, which primarily occurred behind closed doors.
Understanding this, Daschle
said that he "wants an open process." "What we want to do now is to move to
a discussion across the country....We want your exact ideas."
Although the Bush Administration proclaimed it would "leave no child behind" when it comes to education, 8.6 million American children are now being left behind because they lack health coverage. Last year's bipartisan legislation to reauthorize the State Children's Health Insurance Program (SCHIP), which would have expanded health coverage throughout the nation to approximately 4 million additional uninsured children, failed when President Bush vetoed it twice.
The result is that millions of American children - a majority of whom are from working families - remain uninsured, according to a new Families USA report, Left Behind: America's Uninsured Children, which finds:
One in nine children in America is uninsured.
Uninsured children come from working families. The vast majority of uninsured children-88.2 percent-come from families where at least one parent works.
The five states with the largest number of uninsured children are Texas, California, Florida, New York, and Georgia. Together, the uninsured children in these five states account for nearly half of all uninsured children in the country (48.3 percent).
Why did so many children remain uninsured? Rising premiums and stagnant wages prevented many families from being able to afford employer-based coverage. But that's assuming they could even keep their jobs. The unemployment rate jumped in 2007, forcing millions out of work and stripping them of employer-based coverage. As unemployment rose, more families qualified for public programs like Medicaid and SCHIP - actually causing the uninsured rate to fall because more people were absorbed into public programs. Together, Medicaid and SCHIP prevented half a million children from becoming uninsured. These programs offer an excellent safety net for low-income children, but they are in jeopardy. As the economy worsens, state budgets will tighten and these programs may end up on the chopping block. California is already considering putting a cap on enrollment.
For many families, the State Children's Health Insurance Program is a lifeline, allowing children to see a doctor and remain healthy. We are encouraged by signs that the incoming Obama Administration will work to cover more kids and provide them with the care they need by reauthorizing and expanding the State Children's Health Insurance Program, which expires at the end of March 2009. According to Stateline.org:
So far, signs from the incoming administration and Congress are promising on SCHIP. Both House Speaker Nancy Pelosi and Obama's new chief of staff, Illinois U.S. Rep. Rahm Emanuel, have said SCHIP renewal will be one of the first issues the next Congress considers.
As Medicaid enrollment continues to climb, the federal government should also ease the resulting financial burden on states by temporarily increasing the federal share of Medicaid funding (called FMAP, the Federal Medicaid Assistance Percentage) as part of the economic recovery package. This will allow states to maintain their programs in these times of economic distress, instead of being forced to cut coverage for people who need it the most.
In a sign that President-Elect Obama means business, former
Senate Minority Leader Tom Daschle (D-SD) was selected to fill the top spot at
the Department of Health and Human Services. This is good news. Very good news.
"The appointment of Senator Daschle as Secretary of the Health and Human
Services Department is the best news possible for those who want to achieve
meaningful health care reform," said Families USA's Ron Pollack.
In addition to leading HHS, Daschle will also serve as the health
"czar" - or White House point person who will report directly to the
President.
This is a
perfect role for Daschle. Although he was always been interested in health
care, in the last few years he's become a true wonk on the subject, publishing
a book called Critical: What We Can Do About the Health-Care Crisis. It
urges precisely the sorts of reforms President-Elect Obama and his
congressional allies are promoting right now.
Daschle's track-record as Senate Minority leader turned
health wonk gives him incisive knowledge of both the political environment and
the policy required to push legislation through Congress.
Speaking at Families USA's Health Action conference last
year, Daschle
said:
One of the biggest tactical
mistakes we've made, the opponents of health reform have defined the debate. As
a result, we've lived under a number of myths. Perhaps the biggest myth of all
is that the US
has the best health system in the world. So before the debate can begin, we
need to all understand the same basic facts. We need to understand how we got
here and where we need to go.
Incremental change in our
system is no longer a viable option. Instead we need comprehensive reform. In
growing numbers the American people are demanding that we do something. Our
goal should be to build what current and retired members of Congress have
today, and make that available for all Americans.
Daschle's commitment to health care, combined with his astute
understanding of the political climate, gives us reason to believe that health
care reform is not simply a campaign promise, but a likely reality in an Obama
administration.
Today, Senator Max Baucus, chair of the Senate Finance
Committee, revealed his long awaited white paper on
health care reform. According to the Senator,
...the
Call to Action has three equally important legs: (1) a policy that ensures
meaningful coverage and care to all Americans; (2) an insistence that any such
expansion be coupled with an emphasis on higher quality, greater value, and -
over time - less costly care; and (3) an absolute commitment to weed out waste,
eliminate overpayments, and design a sustainable financing system that works
for taxpayers as well as for the nation's recipients and providers of health
care.
Creating ahealth insurance "exchange," where individuals and small businesses
could compare and purchase plans - which would include a range of private
plans and a public plan option.
An expansion of Medicaid and SCHIP.
The plan would allow people between 55 and 64 to
"buy-in" to Medicare as a temporary transition provision until quality,
affordable insurance options are available through the exchange.
Support for the employer based model where
employers would be required to offer coverage to their employees, and
small businesses would receive a tax credit if they comply.
Senator Baucus, along with
Senator Kennedy, is expected to play a very important role, as Ezra Klein explains
here, in the road
to reform. Baucus chairs the Senate Finance Committee, which has broad
jurisdiction, overseeing health care reform, Social Security, unemployment
benefits, and taxes and trade. As chairman, it is up to Baucus to schedule
markups, hearings, and votes - and ultimately serves as the gatekeeper for
legislative action on, say, health care reform.
Having Baucus on board with such a comprehensive plan is
certainly encouraging. To quote Families USA's own Ron Pollack:
"The white paper
released today achieves a sound balance between public- and private-sector
approaches, and it blends good policy with a sound view of what is achievable.
"There has never
been a more auspicious opportunity to secure meaningful health care reform: The
President-Elect has made it a top priority; key congressional committee chairs
have made it their top priority; and the large and diverse health care interest
groups are working cooperatively to find common ground.
"As a result, we
have a unique opportunity to succeed this time in securing much-needed health care
reform."
We heard encouraging words from Michael Myers, staff director for the Senate
Health, Education, Labor, and Pensions (HELP) committee, chaired by Senator Ted
Kennedy, at Families USA's post-election health care briefing:
"With the Obama victory, the
question is no longer whether we'll pursue comprehensive healthcare reform, but
when and in what form."
Determined to see health care reform come to fruition, Senator
Kennedy has wasted no time in convening regular meetings with key stakeholders in
the hopes of introducing comprehensive legislation in early January. In an
op-ed in Sunday's Washington Post., Kennedy reiterated
the urgency for reform:
"...despite the current economic downturn, we must forge
ahead with this urgent priority. The system is broken. And it's no longer just
patients demanding change. Businesses, doctors and even many insurance
companies are demanding it as well."
The specifics of his reform proposal remain under wraps,
according to Kennedy's office, but Myers
suggested that it will look much like Obama's plan and the Senator will
pursue a "single bill" strategy.
Senator
Obama's proposal builds on our current system of health coverage, preserving
what works and strengthening aspects of the system that need improvement. Under
his plan, workers who are satisfied with their employer-based coverage would
keep it. A new National Health Insurance Exchange would enable individuals and
businesses to purchase health coverage that's as good as the coverage for
members of Congress and other federal employees. His proposal requires that all
children have insurance. It would also cap out-of-pocket expenses and regulate
insurance companies so that they can no longer cherry-pick the young and
healthy and deny coverage to people with pre-existing conditions.
Many observers are poised
to see reform finally happen. Having learned a thing or two from the last
reform efforts in 1993 led by President Clinton, and understanding that reform
is not inevitable, many stakeholders (who don't always see eye-to-eye) are
searching for common ground. In Congress, staff from three jurisdictional
committees -- Finance, Budget, and Health, Education, Labor and Pensions (HELP)
-- have met to form working groups to discuss coverage expansion, systems
reform, and financing. In addition, Senator Baucus, chair of the Finance
Committee, which must approve any legislation before it goes to the Senate
floor, is also committed
to reform:
"I made sure the finance committee
spent this year learning and preparing for action on a comprehensive overhaul
of the healthcare system, and I intend for us to move swiftly and decisively with
legislation in early 2009."
We'll hear more from Baucus this week when he releases his
white paper on health reform.
Having had a few days to process such an historic election
and adjust our lexicon from Senator
Obama to President-Elect Obama, it's
now time to hit the ground running. Our
first order of business: quality and affordable health care for all. And we're
not the only ones who feel that way. According
to exit polls, of the issues that swayed voters in the voting booth, 60%
ranked the economy, followed by Iraq,
and then health care.
A closer look will show that within voters' economic concerns, health care is numero uno. According
to survey data recently released by Lake Research Partners, health care ranked
as the number one economic concern of voters, followed by rising gas and food
prices, and jobs. Specifically, affordability was the top priority for reform.
So what does this mean? When it comes to economic security,
voters also seek health care security and access to affordable coverage. Health
care has become
too costly.
The correlation between the economy and health care is sometimes
overlooked, but one recent study found that
half of home foreclosures were due, in part, to medical crises. Just as health care costs were a growing burden
to families (uninsured and insured)
leading up to the economic downturn, they continue to be a source of distress,
especially with today's news that the unemployment
rate is soaring. As individuals lose their jobs, they are likely to lose
their health coverage, putting them in the precarious position of searching for
coverage on the unregulated private market unless they qualify for Medicaid.
Yet
even Medicaid, which covers 50 million Americans, is
facing troubled times. In times of economic distress, as un- and
underemployment rates rise, more people qualify for Medicaid. According to the
Kaiser Family Foundation, "for every 1% jump in unemployment, about 1 million
more people enroll in Medicaid." But states - which are losing revenues in the
downtown and which face much stricter budget limits than the federal government
- are forced to cut critical programs like Medicaid.
And those who can't find private insurance or who can't
enroll in Medicaid? Too often, tighter household budgets force them to forgo
medical treatment, care, medications, tests, and so on.
As voters experienced first hand, the economic crisis isn't
happening in a vacuum. When the economy shrinks, more people rely on safety net
programs, like Medicaid, for health care. This is one more reason why health
care reform must be a priority in the Obama Administration - to give Americans
a better sense of health and economic
security that they are so loudly demanding.
Posted by: Ron Pollack, Executive Director, Families USA on Nov 05, 2008
The election we witnessed yesterday was not simply historic - it was truly transformative.
Just 43 years ago, Congress passed, and President Lyndon Johnson signed, the Voting Rights Act. For decades, since the end of Reconstruction, voting for many in the states of the old Confederacy was an act of unmatched heroism. To vote was to lose a job - even the laborious job of chopping and picking cotton for a meager $3 a day. To vote was to have your house shot into in the dark of night. To vote was to risk, and for too many to lose, one's life.
The Voting Rights Act was borne out of the heroism of many. Most visibly, it was catapulted onto the national agenda by the hundreds of brave souls, led by John Lewis in March of 1965, who crossed the Edmund Pettus Bridge leaving Selma, Alabama east on Route 80 to march towards Montgomery. As they crossed the bridge, they were brutally assaulted by police and highway patrolmen on horseback. They were beaten but not defeated.
Dr. Martin Luther King re-started the march soon thereafter. Thousands marched with him, sleeping in the fields at night. Singing their defiance of then-Governor George Wallace, they chanted:
Wallace, you never can jail us all,
Wallace, segregation's going to fall!
And they made it triumphantly to Montgomery. At night, after the final speeches were over near the State Capitol, Viola Liuzzo - a then-unknown civil rights activist who participated in the march - was murdered.
In the first election in Mississippi after the Voting Rights Act, a number of brave heroes decided to run for local office: sheriff, county board of education, mayor, county supervisor. They knew they wouldn't win, but they were undaunted.
I remember in the all-black town of Mound Bayou, Mississippi - in the heart of the Mississippi Delta, in the poorest part of our nation - black leaders assembled in houses before the elections, not knowing what violence they would face. Some had guns and other weapons to protect themselves and their families; others, more schooled and adherent to Dr. King's admonitions of non-violence, simply brought their bodies and heroic determination to vote for the first time.
Now, only four-plus decades later, we have witnessed an election that no one could realistically have dreamed about during those dark and difficult days. President-Elect Barack Obama's triumph - more profoundly, the triumph of our nation - is, in no small part, the victory of so many people who risked all they had to work for a better day.
For those of us fortunate to see, and participate in, this transformative election, our work must continue and start anew. This election is an opportunity - an opportunity to bring fairness and decency and dignity for those who have yet to share our nation's bounty. It is only the achievement of such justice that will enable us to realize Dr. King's dream: "Free at last, free at last, thank God almighty, we're free at last."
Last year, Congress tried - without success - to renew the
popular and successful State Children's Health Insurance Program (CHIP) and to
expand it so another 4 million uninsured kids could gain health coverage. The
BushAdministration cried
wolf, complaining about crowd-out (replacing private coverage with public
coverage), socialized medicine, and the "$83,000 family." The President then
vetoed the CHIP bill. Twice. So Congress reluctantly just extended the program
(without significant new federal funding) until March 31, 2009.
Currently, 8.6 million kids remain uninsured.
So what do we know about these kids who don't have health
insurance? Over the next few weeks, Families USA will be releasing a series
of state reports about uninsured kids. These reports,
drawing on new data from the Census Bureau, will feature the number of
uninsured children in each state. They will also include surprising information
about the families uninsured children come from. For instance, the majority of
uninsured children-regardless of the state-have at least one working parent.
And more than half of uninsured children in most states also have a parent who
works full-time.
Medicaid and CHIP are an essential source of quality,
affordable care for these hard-working families. Congress and the next
Administration can take two quick, easy steps to make sure the programs are
there for the growing number of families coping with economic hardship in the
current recession. First, Congress
should pass a stimulus bill that includes a temporary boost to state Medicaid funding;
this will ensure that services don't get cut as states try to trim their
budgets. Second, Congress must reauthorize
CHIP and, equally importantly, must provide enough funding to cover the kids
currently enrolled and to let states reach out and offer coverage to even more of
the millions of uninsured children.
Uninsured children may not be in the headlines now,
but it's still just as important as it was last year - if not more so, given
our economic crisis - to make sure that they can get the health care they need
to be healthy, learn in school, and grow up to be productive citizens. And
they're waiting. It's time to stop leaving these children behind and take the
actions necessary to ensure that all American children get the healthy start
they deserve.
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Category: Health Care Costs,Medicaid,Children's Health
