Bill Clinton, in his address to the Democratic convention this month, decried the effects of the proposed Medicaid restructuring on the elderly, the poor, and families with children who have autism, Down syndrome, or other severe disabilities. Clinton, who said that he didn’t know what these families would do under these cuts, asserted that he knew what he would do: “I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen.” We as parents of children with disabilities and those that care about children with disabilities need to vote for the vital interests of our children, and make sure our children with disabilities, who are over 18, register to vote and do vote. Medicaid is just one of the many issues that must be on the radar of voters for this election.Approximately 60 million Americans—including 29.5 million children, 15.2 million adults, 8.2 million people with disabilities, and 6.1 million seniors--rely on Medicaid to meet their health care needs. These numbers include 40% of our nation’s poor, 20% of those with severe disabilities, and nearly two thirds of residents of nursing homes.
The Congressional Budget Office is not buying this efficiency agreement, which stated “even with significant efficiency gains (by states), the magnitude of the reduction in spending . . . means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility for Medicaid and CHIP [Children’s Health Insurance Program], coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries—all of which would reduce access to care.” A very bleak outlook at best. To suggest further streamlining of Medicaid is ironic, given that The New England Journal of Medicine reported last month that expenditures for Medicaid (as well as Medicare) are growing at a lesser rate than those for private insurers. According to the Journal, the Romeny-Ryan proposals for cuts in both programs are not justified by the data. States are already successfully containing costs.
The flip side to this statement is that due to low reimbursement rates or untimely receipt of payments, many physicians decline to accept Medicaid patients. Primary care physicians who accept Medicaid are paid only 66% of what Medicare doctors earn. The Government Accountability Office (GAO) in 2010 found that only about 47% of physicians will see children enrolled in either Medicaid or CHIP. Thus, just because someone is enrolled in Medicaid doesn’t always mean it is easy to obtain services. According to 2003 data compiled by the Kaiser Commission on Medicaid and the Uninsured, children comprised 50% of all Medicaid enrollees; adults, 25%; the disabled, 16%; and the elderly, 9%. Of expenditures by enrollment group, children cost 18%; adults, 12%; the disabled, 43%; and the elderly, 27%. Most of the elderly costs are the result of nursing home care; two thirds of all nursing home patients receive Medicaid. According to the Kaiser Foundation, Medicaid is vitally important for children with disabilities. Of the 1 million children with severe disabilities from birth through age 4, half receive Medicaid. Another 30% of children with severe disabilities aged 5 through 17 also receive disability benefits. So what will happen to these individuals without Medicaid?
A study by the National Bureau of Economic Research compared medical care for Medicaid enrollees with that of low-income citizens without insurance. The results are perhaps not surprising: those with Medicaid were 30% more likely to be admitted to hospitals, 35% more likely to visit a physician or clinic, and 15% more likely to receive prescriptions. Simply put, they had better health care. Just this month a study from The New England Journal of Medicine revealed that states which had expanded their Medicaid coverage had significantly reduced mortality rates compared to those of neighboring states which had not expanded Medicaid. If Medicaid enrollees will be hurt immediately by the proposed budget, seniors on Medicare will be buffered from cuts. Mr. Romney has promised to not impose changes in Medicare for seniors who are currently enrolled or who are nearing retirement. Of the $5 trillion in proposed spending cuts from Medicaid and Medicare for the next decade, only $200 billion will come from Medicare.
According to Congressman Henry Waxman, whose committee oversees both programs, Romney and Ryan are offering a double standard. “They care about the votes of seniors who are not poor and they don’t care about the votes and the consequences to seniors who are poor,” Waxman has said. Mr. Waxman’s comments extend to students with disabilities who largely cannot or do not vote. It appears that the calculus is that families with disabilities do not vote enough to an important voting bloc. There is an upcoming candidate's forum on issues related to the needs of the disabled; it is important to view that debate and participate online.
The direct consequence for special education from a cut in health care for the disabled and the poor cannot be overstated. Prenatal care is vital to improve the health and outcomes of infants to lower the numbers of children with disabilities entering the system. As just a few examples, rates of asthma and obesity are rising quickly and without good health care and medical counseling these children will likely need the support of 504 or IEPs. [OCR Memorandum, 307 IDELR 17 (OCR 1989) children with obseity may qualify for 504 plans] The most ominous result of a significant cut in Medicaid is the high probability that poor and disabled children will have increased rates of mortality. It is time to vote for our interests in this next election and all elections thereafter.
