Punish the poor

Hmm, should there be work requirements for Medicaid?

Conservatives like to assert that Medicaid somehow suppresses the desire to work, but that appears to be a fantasy. Studies have found no evidence for it. For example, a study published in the journal Health Affairs in 2016 found that “Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status.”

What the evidence does show, however, is that work requirements attached to social programs are ineffective. The best research involves TANF, or Temporary Assistance for Needy Families program, which replaced traditional welfare and added a work mandate. Several studies have shown that TANF recipients who are able to work do so whether or not they’re subject to the requirement, which suggests that it’s not necessary. Those who find employment end up in low-wage jobs, typically earning about as much as the TANF and food stamp benefits their earnings replaced.

Work had not lifted them out of poverty or increased their income relative to what they had received from TANF and food stamps,” one study found, contrary to Verma’s aspirational language. The work requirements failed to reflect that many of the program enrollees faced social, educational or physical barriers to employment, conditions that are likely to be replicated among unemployed Medicaid recipients.

Moreover, the work requirements added bureaucratic burdens that affected program administrators as well as enrollees, sometimes severe enough to discourage enrollment.

Those studies aren’t politically correct so the Trump administration ignores them and says:

Verma tried to put an uplifting spin on the new policy on work requirements: “We owe beneficiaries more than a Medicaid card,” she tweeted; “We owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty.”

Now that’s something the Republicans can believe (but they won’t actually increase funding for job training). Really they just want to punish the poor but they can’t say that so they make stuff up.

Who needs evidence?

Well, this is surprising if by surprising you mean completely expected:

The Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective “evidence-based” treatments for substance abuse and behavioral health problems from worthless interventions.

The program, called the National Registry of Evidence-Based Programs and Practices, was launched in 1997 and is run by the Substance Abuse and Mental Health Services Administration. Its website lists 453 programs in behavioral health — aimed at everything from addiction and parenting to HIV prevention, teen depression, and suicide-hotline training — that have been shown, by rigorous outcomes measures, to be effective and not quackery. The most recent were added last September.

It seems there were problems with registry:

In fact, a recent paper in the International Journal of Drug Policy found the registry contained programs with limited studies evaluating them or studies with very small sample sizes to accurately measure their success.

So there was a good reason to look at it and try to make it better, but this is the Trump administration:

However, no specific details regarding when the new program will begin and when results will be made public were provided. The current registry will remain online as of now, but will not be updated.

SAMHSA’s statement was the first public response it had provided since the email it sent out two weeks ago announcing the registry would be frozen. That announcement took mental health advocates by surprise. “It came with such a blinding speed,” said Richard Yep, CEO of the American Counseling Association. “People were initially really shocked by the whole thing.”
Without any additional information from SAMSHA, Yep said mental health professionals were left to speculate what was next and why the registry had stopped.
Yep admits that the program wasn’t flawless but said “it has stood the test of time.” He questioned why a replacement wasn’t up and running to take over the work and called the decision to freeze the registry short-sighted. “Why didn’t you start that system up and compare it side-by-side? Instead, to just cut it off, it makes no sense professionally.”
The Trump administration is, by its nature, sloppy and that’s what you get here.

Children’s Health

Ok, this is stupid:

CBO and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary estimate of the budgetary effects of extending funding for the Children’s Health Insurance Program (CHIP) for 10 years using specifications provided by your staff. Under those specifications, the provisions of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017 (KIDS Act), would be extended. In particular, all of the provisions that would be in place in 2022, the final year of funding under that Act, would continue unchanged for the remainder of the 2023-2027 period. The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period.

And yet:

Some states will run out of money by February 1 if an agreement is not made, according to estimates from Georgetown University’s Health Policy Institute based in Washington, D.C., but more conservative estimates from the U.S. Centers for Medicare and Medicaid Services (CMS) suggest several states risk burning through the federal funds by January 19.

What’s the problem?

In December, Congress provided short-term finances for CHIP, but lawmakers have not moved to give the program another five-year allotment because Democrats and Republicans disagree on how to finance it. Republicans wanted to pull money from public health programs—like Medicare—and Democrats refused. The minority party’s votes will be necessary for Republicans to pass a solution, and some politicians have predicted a deal will be struck next week before the January 19 deadline.

Now that the CBO says it will save the government money, will Republicans actually pass it? Who knows–it’s not like they care about people.

The poor don’t need healthcare

Here’s the Trump administration’s idea of helping people out:

Underpinning that effort is Verma’s belief that the expansion of Medicaid under the Affordable Care Act was a disastrous move that extended coverage to millions of low-income people who shouldn’t be getting insurance from the government.
“We’ve put more than 10 million people, 12 million people into this program where the doctors won’t see them, and the policies that are in the Medicaid program are not designed for an able-bodied individual,” she said. Verma added that the administration’s goal is to keep those people in the private insurance market, where they would not be “dependent on public assistance.”

Umm, Verma, the whole reason they are on Medicaid is they don’t have and can’t afford private insurance so keeping them in the private insurance market means keeping them without insurance. I know that’s the Republican ideal but you would think she might want to circumspect when she says people don’t deserve insurance.

Republicans care

Let’s look at how Republicans care about the people.

First, they’ve so busy trying to take medical insurance from tens of millions of people they let medical insurance for children lapse:

Congress has allowed the Children’s Health Insurance Program, which provided low-cost health insurance to 9 million children, to expire.

If action is not taken soon to restore the funding, the effects will become obvious in schools across the country, with many of the children in the program unable to see a doctor for routine checkups, immunizations, visits when sick, and other services.

Second, they will probably get rid of a program that made it so students scammed by fake universities didn’t have to repay their loans:

Relief seemed to be on the way last year after she learned the Obama administration would forgive her Department of Education loans if she could prove she was defrauded by the for-profit college. But President Trump has brought the worries back.

Trump has thrust Cabrera Garcia and more than 65,000 other student borrowers across the country, including about 1,500 in New England, into a new state of financial limbo by suspending applications under Obama’s program of loan forgiveness.

I wonder why? Oh:

DeVos has investment ties to the for-profit education sector. She also has installed former executives and other officials from the for-profit education industry in her department.

Among them: Julian Schmoke Jr., as the Education Department’s top cop looking for schools that are cheating taxpayers and students of federal aid dollars. Schmoke is a former dean at DeVry University, a for-profit school that, along with its parent company, last year agreed to pay the Federal Trade Commission $100 million to settle allegations it lured students with false job and salary information. Critics also say he has little to no experience running investigations.

It’s obvious that DeVos just doesn’t care about public education.

Ruth Pfau

Now that I’m older, I look at the obituaries more often. Sometimes you run into ones like this:

Dr. Pfau, while not widely covered in the Western media, was renowned in Pakistan for her efforts to stop the spread of leprosy, a bacterial infection also called Hansen’s disease that when untreated can cause disfigurement and blindness. Around the world, its victims have often been relegated to “leper colonies” and regarded as outcasts.

The Express Tribune of Pakistan once credited Dr. Pfau with having “single-handedly . . . turned the tide of leprosy in Pakistan and won the gratitude and personal attentions of people ranging from military rulers to elected ministers to the general public.”

She has a couple great quotes:

But diverted to Pakistan while waiting for her visa in 1958, she was to stumble upon leprosy, a disease she had never heard of in a country she did not know existed.

“Well if it doesn’t hit you the first time, I don’t think it will ever hit you,” she recalled, after first seeing leprosy during a visit to a makeshift dispensary built on a disused graveyard in Karachi.

“Actually the first patient who really made me decide was a young Pathan.

“He must have been my age, I was at this time not yet 30, and he crawled on hands and feet into this dispensary, acting as if this was quite normal, as if someone has to crawl there through that slime and dirt on hands and feet, like a dog.”

and:

“Not all of us can prevent a war; but most of us can help ease sufferings — of the body and the soul.”

After helping Pakistan to become the first Asian country to have leprosy under control, she also:

She has also assisted the country’s many forgotten displaced people and rescued victims from the 2005 earthquake and floods of 2010.

Like Mother Teresa, she was a European nun working for decades among people with leprosy but she thought they weren’t all that similar:

She said her focus was on removing the root of the problem – not just dealing with its symptoms – the same ethos that has served her so well over the years in Pakistan when dealing with poor, displaced and marginalised people.

“The most important thing is that we give them their dignity back,” she insisted.

We need more people in the world like her.

More about Medicaid cuts

The CBO has extended their estimate of what the Republican tax cut … errr healthcare plan will do to Medicaid:

In the Congressional Budget Office’s assessment, Medicaid spending under the Better Care Reconciliation Act of 2017 would be 26 percent lower in 2026 than it would be under the agency’s extended baseline, and the gap would widen to about 35 percent in 2036 (see Figure 1). under CBO’s extended baseline, overall Medicaid spending would grow 5.1 percent per year during the next two decades, in part because prices for medical services would increase. under this legislation, such spending would increase at a rate of 1.9 percent per year through 2026 and about 3.5 percent per year in the decade after that.

In CBO’s extended baseline, Medicaid spending is projected to be 2.0 percent of GDP in 2017 and 2.4 percent by 2036. The 35 percent reduction in that spending that CBO estimates for 2036 under this legislation would result in Medicaid spending of 1.6 percent of GDP.

That sure seems like a big cut.

Via here, Avalere Health looks at the impact for each state, for example my state of Massachusetts will see a decrease of 17% in funding for Medicaid by 2026 for a total cut of $9.7 billion. Thanks Republicans.

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