The human toll of the Senate health plan
Senate Majority Leader Mitch McConnell has delayed a vote on the heath care bill that he and his colleagues negotiated in secrecy and with no public input. For that, at least, we can be thankful.
The Senate bill made the House bill even worse, with estimates that both bills would leave more than 22 million additional Americans without health care insurance because of the high cost of premiums and deductibles.
Whatever reason enough Senate Republicans gave for withholding their support for now — some said it was too harsh, others not harsh enough — the delay gives everyone time to understand the bill’s true implications. And it has delayed harm to the most vulnerable Americans — the elderly, poor, disabled and children — from the devastating effects of losing coverage and benefits they now have.
Consider Philip, who is 60 years old, and whose name has been changed for privacy. After a series of setbacks, he found himself at a low point in his life. He had to file for bankruptcy and was evicted, and he alternated between living in his car and in low cost motels. The stress impacted his health and he began experiencing severe stomach and back pain. In addition, he has only one kidney. Philip had no health insurance before the Affordable Care Act (ACA) went into effect.
Thanks to Medi-Cal expansion, Philip qualified for benefits. After months of severe pain, he was able to receive regular preventive care and support for ongoing pain relief.
Or Sara (name also changed for privacy), an 85-year-old Holocaust survivor from Romania. In 1940, when she was 12 years old, she fled to Uzbekistan. Her parents were executed. She eventually moved to the United States with her husband, but talking about her history has been very difficult.
Now a widow and frail, Sara has many medical problems, including myeloma, which necessitates ongoing chemotherapy treatments. She suffers from poor balance and coordination and has severe pain in her back and legs along with osteoarthritis and osteoporosis.
Medi-Cal (California’s Medicaid program) pays for her medical treatment, her in-home care and the social worker that keeps all of her systems coordinated.
The Senate promised a more humane bill that doesn’t perversely target seniors or children born with disabilities. Yet they didn’t seek input from the experts — doctors, hospitals, clinics, community providers, researchers or patients — and produced a plan that takes the worst pieces of the House bill and adds deeper cuts to Medicaid, which provides health coverage to nearly one-quarter of all Americans.
As drafted, the Senate bill goes beyond undoing Medicaid expansion, which has helped millions of Americans. The Senate also is looking to remove the guarantee of a federal match in Medicaid, which has been in place for 50 years, that helps ensure the program will be in place to provide medical care to those who need it most. The Congressional Budget Office estimates the House bill would cut federal funding to Medicaid by 25 percent, both through the rollback of the Medicaid expansion and implementation of spending caps.
With lower funding, states will be forced to slash services, restrict eligibility and cut benefits for seniors, children, people with disabilities, and low-income adults. All indications are that these cuts will fall disproportionately on nursing home residents and those needing home-based care.
California, which would face a $24 billion cut to Medi-Cal, would have to limit health care services and reduce access for 14 million state residents who rely on Medicaid for safe, reliable health care. These cuts would go beyond hurting half of all California children or two-thirds of all nursing home residents who are on Medi-Cal — it would affect the entire health care system that we all rely on.
Across the country, Jewish social service agencies will be unable to offer assistance to tens of thousands of their clients and community members — Jewish and non-Jewish, alike. For providers such as Jewish Family Service of Los Angeles (JFS), the Los Angeles Jewish Home, and other local organizations that provide health care services, Medi-Cal is the major source of funding for home and community-based services and long-term care. Seniors and those with pre-existing conditions will lose much needed coverage. Older adults, the fastest-growing segment of the Jewish community, often struggle financially and are dependent on the Medi-Cal safety net.
At JFS, we fear the proposed cuts will not impact only our elders, but will unfairly target other vulnerable populations we serve. Low-income women escaping abuse and violence rely on Medi-Cal to receive medical treatment for broken bones and bruised spirits. Holocaust survivors rely on in-home care and case management programs to remain safely in their homes and avoid unnecessary institutionalization. And children with special needs rely on Medi-Cal for lifesaving treatment that enables them to live independently.
The Senate did the right thing this week by not voting on a pernicious bill. Now, lawmakers should take the next step and start over, crafting a bill that helps — not hurts — millions of Americans like Philip and Sara.
PAUL S. CASTRO is president and CEO of Jewish Family Service of Los Angeles, a multifaceted, multi-service nonprofit organization serving individuals and families throughout Los Angeles.