Ask Congress About Medicaid

After Congress failed to meet self-imposed deadlines to put together a comprehensive plan before the August recess, it's clear healthcare reform has run into some major issues. Some of them - like the wailings of a wacky former Governor about "death panels" (sounds like bad siding) are easily dismissed. Others are issues that are not likely to go away, and may well affect what happens to healthcare reform when Congress resumes in September.

The press and many progressive advocates have latched onto the "public plan", shorthand for some sort of government run insurance plan which would serve as a backstop for households when no other insurance option was available. The "public plan" has come to symbolize, for the right, the threat of a "government takeover" of healthcare... and for the left it has become a rallying cry of necessity if reform is to be done right.

Neither is entirely the case. First, I agree with other progressive advocates urging you to call your members of Congress about healthcare reform.  But rather than emphasizing the public plan, if you're concerned about healthcare and poverty... ask them how they plan to defend and strengthen Medicaid.

It seems clear that getting to a full insured population has been shelved as a goal for now, in favor of a focus on expanding coverage, incrementally, to key populations as a first step.  One of those key populations has to include people in poverty.  When medical costs have the potential to bankrupt individuals and create financial disasters for families, the most important thing to have is a safety net... and currently, we don't. Medicaid, badly underfunded, handled in a hodgepodge of programs that vary widely from state to state, does not guarantee insurance or healthcare to people with essentially no other option, as it should. Returning Medicaid to federal control, improving its reimbursement rates to doctors so they will take poorer patients... these are key reform elements that are vital to changing our healthcare system. Having coverage and access will help enormously in getting poorer patients out of the emergency room, and in turn reduce the likelihood of patients turning up well after preventative care would have helped. Those changes would help enormously in reducing costs for healthcare across our systems.

Making a "public plan" the be-all and end-all of healthcare reform is both too much and too little; it's putting too much emphasis on an element of the reform process that has the potential to derail the entire deal (Republicans, clearly, believe that they can use opposition to a public plan to unite themselves, and are unlikely to break ranks for any public option). It's too little because a public plan cannot stand in as insurance for every hard case - a truly worst case scenario would be using a public option to scoop up some workers just above the poverty line, while leaving a more tattered Medicaid for everyone below the line. And it's too little because the compromises needed to achieve unity on a public option sacrifice other very desirable, and even necessary elements of real reform. One of which is committing the resources needed to expand Medicaid coverage and to improve the program's reimbursement rates.

Already, it's clear that desperation to "do something" has started a rush to make compromises to the original, ambitious plans to reform health insurance for all.  Making the salvaging of a public plan option the key driver of healthcare negotiations among Democrats seems to be bad news for Medicaid. Ambitious proposals to federalize Medicaid have already been scaled back in one of the House bills.  The Senate Finance Committee, which oversees Medicaid, is clearly stuck, in no small measure on the costs associated with Medicaid changes, even though the debate over a public option has grabbed the spotlight. The likelihood that a backroom deal to salvage some sort of a public option - even just the co-op proposals that are also floating around - would involve scaling back Medicaid reforms is all too likely. In terms of robbing Peter to pay Paul, Medicaid is the only victim where you could undo reform...and few might notice.

That, of course, is because Medicaid lacks loud, vocal activists fighting for change, and represents a constituency all too often ignored or left behind. If someone is going to speak up, and speak out for Medicaid... the time is now. So when progressive groups ask you to contact your members of Congress and urge them to support a public option, consider what's at stake, and ask your elected officials to also commit themselves to serious improvements to Medicaid, and defending healthcare for the poor.

(Photo of a Speaker at Healh Care Can't Wait, organized by Howard Dean and SEIU local 1199, taken by ProgressOhio and used under a flickr Creative Commons license)