By Jocelyn Guyer
The Wall Street Journal is reporting that the nation’s incoming Republican governors (and four of those who are on their way out) are releasing a letter today asking Congress to dismantle the protections in the Affordable Care Act for low-income Americans aimed at holding Medicaid and CHIP coverage steady until health reform can be implemented in 2014. The protection, known as the “maintenance-of-effort” or “MOE” requirement, was one of the most important early wins in the Affordable Care Act for low-income families and individuals. It requires states to maintain their Medicaid and CHIP eligibility rules and enrollment procedures that were in effect on March 23, 2010 – until 2014 for adults and 2019 for children. (One exception is that states with coverage of adults above 133% of the federal poverty level can eliminate their coverage if they are facing a budget deficit.)
The MOE requirement already has been extraordinarily effective in holding coverage steady for families losing their jobs and job-related insurance (particularly the children in these families); seniors in need of health and long-term care services; and people with disabilities. Without the MOE requirement, for example, Arizona would have entirely eliminated its Children’s Health Insurance Program in June of 2010, and some 47,000 children would have instantly become uninsured.
The Republican governors strike a strident tone in the letter calling the maintenance-of-effort requirements “unconscionable” because they “force governors to cut other critical state programs, such as education, in order to fund a ‘one-size-fits-all’ approach to Medicaid.” Frankly, if I had to use the word “unconscionable,” it wouldn’t be to describe the plight of the nation’s governors, but rather to describe the potentially life-threatening implications of cutting back on coverage for low-income people when they need it now more than ever.
If anyone needs a vivid example, check out the story of Tiffany Tate in Arizona, a young woman who has battled cystic fibrosis for 26-years, largely successfully. She has managed to become a high school basketball player and to become an assistant coach at Setton Catholic High School. In September, Tiffany was taken off the transplant waiting list due to Arizona’s decision to deny organ transplants to Medicaid beneficiaries (an optional service which is not protected by the Affordable Care Act’s maintenance-of-effort requirements). Without a transplant, Tiffany would die. Her family started raising the $277,000 needed to privately fund the transplant. It is unfortunate that her family had to resort to fundraising to save her life but, fortunately for Tiffany, publicity about her case helped them raise $200,000 and she is now back on the waiting list. Other Arizona Medicaid patients in need of transplants haven’t been able to raise the funds in time and have lost their lives. Charity can’t take the place of a strong, stable Medicaid program. Tiffany’s story underscores the need for stronger maintenance-of-effort protections, not weaker ones.
While there is no disputing that the country’s weak economic recovery will continue to pose major challenges to state budgets for at least a while longer, it will be even tougher on families as they continue to face dauntingly high unemployment rates. It may take determined, effective leadership, but states need to find a balanced way to get through the remaining budget downturn that doesn’t involve cutting off coverage for low-income families, seniors, and people with disabilities.
