Yesterday, the Senate Finance Committee convened a roundtable to focus on the coverage issues in health reform (a small topic). They covered a lot of terrain although in fits and starts. While the debate over the public plan option continues to take center stage, the Medicaid debate also began to take shape. Senators Grassley and Hatch both noted that if Medicaid were expanded to do what most people think it already does – cover all poor people – it would double in size in their states (Iowa and Utah, respectively). True enough. In Iowa, parents are “over-income” for Medicaid if their earnings are above 86 percent of the federal poverty line, while in Utah, the cut off is 68 percent of the federal poverty line. Other poor adults are only covered in those two states through very limited waiver programs.
Newsflash: Two-thirds of the uninsured have income below 200 percent of the poverty line. People are uninsured because they don’t have good jobs that offer coverage and they can’t afford to buy coverage on their own. Is this a surprise to those considering health care reform? Not likely for those who have considered these issues as long and hard as many of these Senators. At the roundtable, Senators Hatch and Grassley both made it clear that the real issue for them – back to the debate over the public plan – was whether we ought to cover people in “a government program.”
The response by the members of the expert panel who opined was universally, “yes.” Diane Rowland, the Executive Director of the Kaiser Commission on Medicaid and the Uninsured, Ron Pollack, the Executive Director of Families USA, and Sara Rosenbaum, Chair of the Health Policy Department at George Washington University, all offered their views that Medicaid’s track record, benefit structure, cost sharing protections, and links to community-based services meant that it was the appropriate vehicle to cover people with low incomes, who tend to be in poorer health than the general population.
We’ve seen over the years the debate about “public versus private” derail thoughtful discussion over how to assure that people have cost-effective coverage that meets their needs. On one hand, the debate misses a key point: Medicaid and CHIP – like every other component of the existing health care system – have both public and private elements. On the other hand, the debate seems notably stale and unproductive. As we have seen most recently following our financial system crises, the vast majority of Americans understand and agree that government regulation, oversight, and funding have an important role to play in service of the public good. And the clear majority of Americans want our elected officials to reform our health care system.
Brace yourselves – it’s going to be a bumpy ride full of twists and turns but well worth the trip. Here’s a preview of what’s coming down the pike.
