Medicaid represents our nation’s moral commitment to help the poor

What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation’s nursing home costs and 43% of all births in California? Well they are.

The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, the reality is that cuts will effect far more people than you expect and may even impact you or someone you know.

Here are a few statistics to ponder:

  • Medicaid covers 60 million people.
  • 2 in 5 children in the United States get their health insurance through Medicaid (30 million children).
  • More than 1/3 of all births are covered by Medicaid which includes prenatal and maternity care.
  • 7 in 10 people living in nursing homes are covered by Medicaid.
  • Medicaid provides 1/4 of all funding for mental health care.

Doesn’t the Medicaid program cost a lot of money?

Yes it does. But it’s a good deal if you consider that the average annual Medicaid spending per child is $2,422 and $7,683 for each adult and that the costs per enrollee is growing more slowly than premiums from employer based coverage (4.6% vs 7.7%).

Medicaid costs are going up because millions more are are needing it in these difficult times. Medicaid would be your safety net if you were to lose a job or experience a sudden drop in income.

For community health centers like mine, Medicaid is a lifeline. 37% of health center patients are covered by Medicaid. And this money is well spent. Community health centers have been shown to provide high quality cost effective care its 23 million patients.

Medicaid has its faults but few would argue that it is a lynch pin for our health care system and represents our nation’s moral commitment to help low income communities.

Attempts to make “reforms” like converting Medicaid into a block grant as championed by Representative Paul Ryan in legislation which passed in the House in April or applying a global spending cap are just gimmicks. The real impact will be a decrease in funds already cash strapped states have to pay for these programs, a loss of services or even closure of community health centers, and more uninsured people. In fact, these methods will not even cut costs, it will just shift the cost to states, providers and patients. It’s a shell game.

To make cuts to a program that is vital to the health of one in every five Americans is hazardous to our nation’s health. Don’t take it from me. One of our patients shares, “My friend is very frustrated with this government that prides itself on its democracy and equality for all, and yet blindly takes away the most basic services from its most vulnerable people who cannot otherwise afford or have access to medical care. There are millions of others in the same situation and it gets worse for those with multiple chronic conditions.”

Ricky Y. Choi is a pediatrician who blogs at SFGate and reprinted with the author’s permission.


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  • Jackie Fox

    Beautifully said. Thank you.

  • Devon Herrick

    At any given time something like 45 million people are enrolled in Medicaid and about 60 million people are either enrolled or cycle through Medicaid each year. The Affordable Care Act will add about 16 million to 20 million additional enrollees. By expanding the program in the face of budget cuts, access to care for the most vulnerable will fall as resources are stretched too thin.

  • Dr_som

    Medicaid for Ohio kids is like the American express gold card. Pays for everything labs, scans, subspecialty visits, pull-ups, humidifiers, ibuprofen with no contribution from those who receive these generous benefits some of whom could afford to contribute. Meanwhile the working class have crappy high deductible plans that make it hard for them to care for kids with something as common and chronic as asthma. I agree Medicaid is important but it needs reform. Oregon Medicaid covers more people with less extravagant benefits.

  • Rob Lindeman

    I was anticipating an explanation of the nation’s moral commitment to the poor. As Dr. Choi left this out of his post, may I assume that the commitment is universally agreed to?

    The Bible teaches a commitment to the poor that devolves upon the the individual. I know of no teaching or statement by the Founders that stipulates the State’s moral commitment to the poor.

    To be clear, we should help the poor. All moral teachings agree on this. It does not follow, however, that this responsibility attaches to the individual AND the State.

    • Margalit Gur-Arie

      The State is not an independent artifact entitled to its own independent morals. The State is a collection of individuals, and whatever attaches to individuals should attach to the collective as well.

      • Brian Kelly

        The State exists for the very purpose of protecting the individual and his or her right to practice their beliefs and morals as they see fit, insofar they don’t infringe on the rights of others. What you are suggesting, is a brand of socialism and impossible with all the differing morals and viewpoints in this country.

        • Margalit Gur-Arie

          The State protects the individual from attacks on his/her physical existence from both domestic and foreign perpetrators. Disease could be easily included in such definition without resorting to Socialism and without infringing on individual rights to exercise their personal moral beliefs.
          Surely, there is no moral belief (in any theological or philosophical system) that others should be left to suffer if they don’t have enough money.

  • Dr Sam Girgis

    Medicaid is vital to the health of the nation. I completely agree. This is very evident where I work in the Brooklyn, NY. The New York City public hospital system and the patients that it treats are very dependent on Medicaid. If cuts to the Medicaid budget are passed, there will be grave consequences to many people in NYC and throughout the country.

    Dr Sam Girgis

    • Mlady

      But we must prevent the fraud, waste, and abuse within the system to allow funds to be available to recipients. If the program is losing out on the back end, then it prevents funds and services from being available on the front end to recipients. Internal and external controls need to be tweaked. Its a Catch-22.

  • IVF-MD

    Why money for babies and sick elderly? Isn’t it much much much more important to maintain enough money to continue bombing women and children in the Middle East and to continue bailing out bankers who made bad gambles and to subsidize corporations who spend the most on lobbying and to hire hordes of workers to grope kids at airports? Where are you priorities?

    (If you have no radar for sarcasm, please ignore this comment) :)

    • Payne Hertz

      Well said.

  • kristophine

    This is why I have to be skeptical of any discussion of health care that includes the term “rationing”: we obviously ration care already, and we ration it according to socioeconomic status. People who tend not to vote, people who are living in poverty, who are living with chronic diseases, who don’t have access to education–these people are getting the short end of the stick from politicians with short-sighted gains on their minds.

    Medicaid is amazing. It’s already a lean program, and physicians are already losing money on it. We don’t need to cut it; we need to cut the billions of dollars insurance executives are taking home while the rest of the country suffers.

  • Alex

    While I think Dr. Choi’s heart is in the right place I must say Medicaid is in need of dire reform. There are a ton of new ways of delivering health care at higher quality and lower costs but the free market is not able to deliver them due to the incredible amounts of money the govt injects into the system to status quo providers. The status quo does not get challenged when someone else is footing the bill. The truth is we can’t afford the status quo any longer and we must find a way to do it more affordably or we will all go bankrupt.

  • Angela Caffaratti, MD

    Interesting…. Obama’s health reform is all about expanding Medicaid eligibility… Sounds like this is meant to sabotage his plan. Medicaid is necessary and way too many working poor and middle class have lousy coverage. Insurance is a scam and everyone deserves better. Vote third party!

  • Family Medicine Doctor

    I’m totally ok w cutting Medicaid some.

    IF, we 1) cut defense spending
    AND 2) increase taxes on those making more than 250,000/year in income.

  • Muddy Waters

    I have no problem helping those less fortunate. However, such terms as “less fortunate” and “disabled” have come mean different definitions in recent history. Most people, by nature, take advantage of any situation. If you give something for free, there will be a limitless demand. There has to be limits to our (taxpayers) charity. Eventually, everybody has to take SOME responsibility for their lives (for example, mothers who have limited income should know better than to have multiple offspring that they cannot support on their own). That’s just common sense.

  • solo fp

    Medicaid is great for the patient wanting to use the ER for the primary care clinic. My area has 4-6 week waits for established and 8-12 week waits for new Medicaid patients. Medicaid patients have a $2 copay in the office and no ER copay. CTs/MRIS/Blood work are all free and require no prior auths. Medicaid pays about 50% or less of commercial plans and less than 50% of Medicare. Most docs in my county do not take new Medicaid patients and many have quit Medicaid. There is a small copay of 50 cents for generic meds, $1 for tier 2 and $2 for Tier 3 meds each month. One of my favorite frauds to the Medicaid program is when the patient gets private insurance but continues to use the Mediciad card for free labs and low cost meds, as Private Insurance usually has deductibles and higher copays. Most states are slow to reevaluate the Medicaid patient status for employment and income more than once a year.

    • Margalit Gur-Arie

      This is a very valid indictment on the administration of Medicaid, not on the validity of the concept though.

  • Pat Allshouse

    I totally disagree.
    There are far too many people on Medicaid that should not be. We are seeing second and third genaration Medicaid recipients! Undocumented people with Medicaid becuse they came to America to have their child and WE ARE PAYING FOR THIS.
    The program needs cuts,

    • Cassandra

      You obviously do not know the actual facts on the participants who do use Medicaid and the fact that it is an application process in which many people get denied. Undocumented people are human beings. All human beings deserve the right to have access and control over their health – plain and simple.

  • Baby Daddy

    “More than 1/3 of all births are covered by Medicaid which includes prenatal and maternity care.”

    Well, I’m sorry, but no one should be procreating while on Medicaid. I say we cut all funding for prenatal and maternity care immediately. Increase funding for birth control and sterilization.

    Quite frankly, I’m not even sure what would compel you, Dr. Choi, to suggest that I help pay for, among other things, other people’s irresponsible *bleeping* or, even worse, premeditated pregnancy while they’re on Medicaid. It defies reason.

    • TFerlet

      So you are saying that, as is happening throughout this country, if I lose my job or become disabled through no fault of my own, I should give up my children and be sterilized (in those few months I still have COBRA) just in case I might get pregnant again – ’cause you want to be 100% sure there…

  • Osler Disciple

    A local OB at a University med school in my state told me that 60% of deliveries in my state are paid for by Medicaid. This is both depressing and ridiculous. Many Medicaid recipients game the system to stay on Medicaid and receive benefits. It often times allows them discretionary income to go on trips, buy the latest electronics or designer clothing, etc. There is nothing more depressing when I admit an unreferred Medicaid patient on ER call and see that everyone on room has an iPhone or Android phone or equivalent as well as multiple laptops cruising the internet. It is about priorities and also whether one considers health care a right or a privilege. Health care is too often viewed as a low priority (unwilling to be paid for) and governemnt finded health care as a right that should be provided to one without question or expected responsible use (i.e. lack of overuse and not for long-term use).

    I believe it was Hawaii that broadened Medicaid benefits in 2007 to cover high risk, uninsured children. Though enrollment went through the roof and the State had to scrap the changes b/c they were not affordable, only half of the high risk children got enrolled in the more lenient State Medicaid program. The other half were children whose parents previously paid for private insurance but gamed the system to get a free handout.

    Do we have a moral obligation to care for the poor? Absolutely and unquestionably! Do we need to reform all entitlement programs to be used for short term needs/finite periods of time and NOT as a way of life? Absolutely and unquestionably! Do we need to reform the insurance industry to force it to better provide for its purchasers? Absolutely and unquestionably!

    There is no longer a stigma associated with taking a publicly funded handout and no focus by the government of propelling people into a better socioeconomic situation once they enter the entitlement system…and thus too many people make entitlement programs a way of life. Lastly, I have a 70 y.o. man who is self employed as a health care /insurance consultant. At our first visit, he stated that his greatest motivation to succeed in life came from his time as a young man standing in the food stamp line for his family. He swore he would never do that once he was grown. That mentality is rare now. And there in lies our problem. And if the producers stop producing b/c of the ridiculous expectations placed on them by the government (see Atlas Shrugged), it all falls apart.

  • Paul Dorio

    Ok. So we’ve read several comments and the post which state categorically that Medicaid is essential. If we are not to make any cuts to this massive entitlement program, could you please suggest from where you would make the cuts instead? And let’s leave out and assume that we’re all in agreement that some reasonable cuts to Defense and some increased taxes are going to happen.

    • Carmen Gutierrez

      There is a lot of wasteful spending that goes on in health care. Labs on a patient are run multiple times when they already exist in some other clinic’s database, supplies are opened, not used and then discarded. Clinics and hospitals have to pay storage for medical files of patients who no longer go to these clinics. Perhaps some of us are capable of maintaining our own medical records? These are all areas where spending can be trimmed.

      The other thing that we need to do is to make spending transparent. Hypothetically, does that syringe really cost $150, or is that just how much the insurance companies are willing to charge for it? Maybe that syringe only cost $0.05 to make and they just charge whatever they can get? No one will ever know since all of the costs are hidden through the “pool” that we call health insurance.

      It is impossible to keep a budget when we don’t know exactly how the money is spent and whether it is being put into a cost-effective use. I think we can do a better job of being less wasteful, if we put our minds to it–in all areas of spending.

  • MLady

    I agree that Medicaid costs are rising with the increase in our nations population. However, having worked with the Medicaid program, there is also a lot of fraud, waste, and abuse by white collar professionals who have bled the program to its near death. The federal government (CMS, HHS, and OIG) are diligently working to combat these criminals, recoup monies paid in error, to free up money that can be used for the health care of financially challenged citizens. I would like to also note that controls need to be in place, monitored, and implemented to prevent people from obtaining Medicaid benefits when they are not authorized. The system is really a “free for all” well, at least those who cannot or choose not to provide proof of household income….

  • Brian

    Certainly mostly accurate, but one side of the coin. The other side of the coin is- Americans have become overly dependent on many things, especially the government. My health and healthcare is my responsibility. Of course, though, I will take what is offered, in most cases. But as we look at the next 40-50 yrs, we cannot offer as much, no way around it. So, fiscal planning now should include preparing us all to save more, take better care of ourselves and live more efficient, productive and less risky lifestyles, so we can be able to respond / response-able to our own needs ourselves as much as possible, relying on insurance, community and government as little as possible. Then, we will be able to take care of all the people who have legit needs. How do I determine “legit”? Well, some things are obvious, some not. The kids I treat with CP, MD and other congenital defects top the list. The obese smoker is at the bottom. Hard to pick and choose risky behavior vs. bad luck, but beggers cannot be choosers when it comes to ethics. Cuts to balance the budget to stop the borrowing have to happen. Making programs more efficient / less wasteful / more effective can help. But gradually weaning ourselves off of enabling policies that include disfunctional expectations (“…gov. should solve death”) would force more people off the dole, force wealth creation, but more importantly, create less dependence which adds dignity. Really.

  • miolly Ciliberti RN

    How we treat the pooret among us says a lot about us as a people. Raise the taxes on the rich back to where it was under Nixon and meet our responsabioity to those in need. This is something that government should do instead of spreading death in the middle east, Iraq and Afghanistan.

    • Brian Kelly

      Why doesn’t anyone understand that taxing the rich won’t solve anything, they already pay the majority of the income taxes in this country? Even if the top 1% pay 75% of their income, this wouldn’t put a dent in the deficit and certainly would do nothing but prolong the imminent implosion of Medicare and Medicaid. Solvency is only attainable by reigning in spending and by eliminating waste, redundancies, and unnecessary testing in government programs like Medicaid.

      • Paul Dorio

        THANK YOU for saying exactly what I’ve been saying online and in person to anyone who will listen (and to some who won’t)! You could amend the statement to “even if the top 1% pay 100% of their income, the deficit would still be massive and undented.”

        But the naysayers will continue. There are always people who want to see taxes raised on the group that makes more than X, where X is $1 more than they make. Not quite fair, but convenient.

        Seriously, though, excellent comment. Spending must diminish, and by more than just “cutting the Defense budget.”

  • Jo

    The reason the “care of the poor” is not in the Constitution of the US is that it was well known throughout the colonies that it was religion’s reponsibility not government to care for the poor, the widows and orphans.

    Early last century the Catholics and Baptists ran most hospitals and teaching programs with the help of donations and medical costs were kept low as overhead and supplies surrounding medical care were affordable.

    When the government became an insurance agency (Medicare/Medicaid) then all costs soared as everyone began to think that all medical costs could be paid for from one pot, the government. Medical supply companies and pharmaceutical companies took advantage of the fact the government would pay. Then because the government did step in and pay, philanthropy for medical care died and people began to demand that all medical problems be treated always for free with no out of pocket cost. Now we have the post above that touts this as a good thing.

    Here is a research question, “What effect has Medicare/Medicaid had on cost per person medical care in US?” Then put into the research the fact that religious organizations and philanthropic groups would have kept building and funding hospitals and teaching programs and that medical supplies (scapels to MRI machines) would continue to rise at pre-government “cost of goods to manufacture” projection rates and that medical and pharmaceutical research would still get same amount of money from government as research grants (maybe more as cost of Medicine to government would have been less).

    Another good research project would be to see if someone started working at age 24 years of age (out of college) and made $30K per year average, and at age 65 years could only get out of Medicare what they had put into it, how far would that money would go to pay for the average person’s medical costs, (keeping in mind the previous stated research) and what if that money could have been used to pay for medical insurance and what is not used, put into 3%interest bearing retirement accounts along with Social Security, what would then be the average amount of savings in their account?

    There are more ways than one to provide medical care to the poor (medical missions overseas is very cost effective) than to have government be the end all.

  • bostonfan

    Good grief – 43% of all births in CA are covered by Medicaid? That’s infinitely depressing. I AM in favor of universal coverage, but not like Medicaid. And since we don’t currently have universal coverage and Medicaid is for people who can’t afford insurance – they also shouldn’t be having kids.
    And yes, people absolutely DO game the system, and not just “white collar criminals”, but your average freeloader layabout.

  • Dorothy Green

    Good term – “a free for all” even a “free fall” at this point –

    The State of United States is depressing particularly in healthcare – the mess we have here started a hundred years ago and really escalated with the start of Medicare and Medicaid – because of concessions to doctors and hospitals the stage was set for fraud, waste and abuse and because anti- universal health system. And then came employer health care (in lieu of increased wages) and the advent of market insurance IF you could afford it. Now, healthcare is the costliest evidence of what is wrong with the US. How can the richest democracy in the world have so many people in proverty, in jail, uneducated, and eating the most unhealthy food (90% processed) and the most chronic preventive diseases, using the most and most costly pharmaceuticals in the world and a citizen eating a healthy diet, exercising and developing say, ovarian or pancreatic cancer going bankrupt because of the cost?

    Those of us responding to this blog are, most likely, not in the tails of the bell-shaped curve where there is the most serious amounts of fraud, waste and abuse.

    There are good people in the 2% top (one tail of the curve) but many have demonstrated their greed at the expense of taxpayers.

    At the other tail of the curve, there are a good people who honestly need help but now it seems many choose to “stay on the dole” by devious means, including having babies when they have nothing to give them, moving to places where there is no work, and other dishonesties at the expense of taxpayers.

    Extreme greed and laziness are now what gets rewarded in our government and has come about it seems to satisfy either one or the other tail of our income curve. Only one economist along the way proposed ideas that would have prevented this present day travesty – Hyman Minsky. The Bowles – Simpson report has a number of these ideas but as Simpson said in the news – “if they (the politicians) would just read the damn report” – what they need to do is there.

    It doesn’t go far enough.

    Even if B and S recommendations were all instituted there would still be welfare – for the greedy and the lazy. We can’t correct our out-of- control sickness costs until we stop both. No more subsidies to the BIGs – wall st, agribusiness, Pharma etc -real tax reform, universal health care, taxes on the sugar, fat and salt in processed food that is the cause of overeating, legalize and tax marijuana, rehab for addiction not jail – lots of green stuff even if you don’t believe in climate change we must change our consumption patterns – work programs instead of hand outs. More made in the USA – foster innovation both in the private sector and in concert with our government. We also need a true separation of church and state to make our democracy work.

    Some jobs lost – in sickness care (administration, in hospitals), jails, lawyers, Big farms, pharmaceutical salesman, wall street Quants (stop the brain drain from reseach and education).

    Some jobs gained – small local farms, teachers of all kinds and age, researchers in all kinds of science and math related programs, social programs, addictions counselors and rehab centers, wellness care. Merit system in all.

    Then, of course, there won’t be much of a need for this website.

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