When it comes to government services, generally speaking there are two major categories: “rights” and “benefits.” A “right” is a service that one is entitled to under law; a “benefit” is a service that you can access if you do certain things. In terms of health insurance, wealthier nations view health care as a “right”: You get it based on being a citizen, no questions asked. Here in the United States, health coverage is a “right” to everyone aged 65 years and older. When you hit that age, you are entitled to it.
Health insurance benefits for those under 65 are often provided by an employer; it is a “benefit” that one receives for working. If the employer doesn’t offer coverage, the state provides coverage with the cost subsidized by government.
Of course, a benefit that is unaffordable for many isn’t much of a benefit.
The fight over the size of federal health insurance subsidies is at the heart of the partial federal government shutdown that started last week. Most Republican members of Congress and the President want to reduce subsidies; most Democrats want them to stay the same.
There is no entitlement at risk, only the size of the subsidy for the benefit.
For lower income individuals, there is a form of a health coverage entitlement through the Medicaid program. If an individual is under a certain income, they qualify (or if they have some form of disability). Since Medicaid is a joint federal-state program, those income levels and scale of coverage can be significantly different from state-to-state.
But until recently, if you were low income, you were entitled to coverage.
National policy on access to health care changed significantly this past summer. As part of the Trump Administration’s budget, the Medicaid program saw dramatic changes, most fundamentally one in which many current beneficiaries have lost their entitlement, their right to coverage. For those individuals, in order to qualify for Medicaid coverage, you now have to find work.
Proponents say the policy will reduce federal spending and promote self-reliance. However, according to experts, that plan is unlikely to work. Here is why:
Most non-disabled Medicaid enrollees already work, perform other qualifying activities, or are exempt from work requirements. The current proportion of adult Medicaid recipients who work now is 44% and most of the other 56% are engaged in alternative work activities like caring for children or have a health-related work limitation. Only 10-15% of adult Medicaid beneficiaries are estimated to be impacted by the work requirement.
Where states have enacted similar programs, they have failed. In the state of Arkansas for example, after its enactment, 18,000 adults left Medicaid in just six months. Research found that many people were unaware of the new rules and confused about reporting requirements. There was no evidence that workforce participation increased.
Remember, the only way to realize savings is by getting people off Medicaid. That means current Medicaid beneficiaries would either find work with health coverage, or they would have to drop off the rolls completely. Forcing people to become uninsured is an indefensible policy, but effectively that’s what is likely to happen.
The changes would result in 7.5 million Americans losing Medicaid coverage, according to the non-partisan Congressional Budget Office. One medical journal study projected the changes to Medicaid and the Affordable Care Act would result in as many as 16,000 preventable deaths annually nationwide.
Why is this happening? First the projected “savings” were used to offset a massive tax cut for the wealthy. Second, there are those who simply are philosophically opposed to “rights.”
What can be done? It is far past time for the United States to follow the lead of other wealthy nations. As mentioned, the U.S. already has a program for those 65 years of age and older – Medicare.
Legislation proposed in New York, the New York Health Act, would end the needless rationing of health care that defines the current system. Instead, it would establish, simply, that health care is a right and that all New Yorkers have access to care. Regardless of ability to pay. Regardless of race or ethnicity. Regardless of whether they live in a city or rural area. Regardless of employment status. Regardless of pre-existing conditions.
The New York Health Act should improve health care as well. New Yorkers would have better insurance — with broader coverage, including for long-term care — than they do now. Doctors and nurses would be freed to provide care, rather than spend their time on billing. This new system would also be vastly more efficient than the current system.
Under the changes resulting from the Trump Administration and the Congressional majorities, people will lose their health coverage, all to help finance tax benefits for the wealthy. It’s up to states to blaze a different path. Scores of countries provide universal health care to their residents. It’s about time that the U.S. join them. New York should lead the way.