You can’t mess with the social safety net

You have to be pretty damned rich to think you never have any possibility of ever needing Medicaid. You have to be so secure in your wealth that there is no possibility that job losses, illnesses, faulty genetics, or bad luck will land you, one of your parents, grandparents, ne’er-do-well cousins, fallin’-on-hard times-brothers, or a veteran sister with shrapnel in her knee and PTSD (turns out: the VA covers a little of this, a little of that) in the social safety net.

You really can’t predict rough patches and most of us don’t think we will have them. That’s why we need a social safety net. Medicaid is a major part of our social safety net, along with other anti-poverty programs. In addition to the people who already need it for routine health care, any one of us could need this program for ourselves or our family members.

Over the last few months, I have seen many, many, many pieces on the faces of Medicaid. Here is one from yesterday’s New York Times op-ed pages. I wrote one myself a couple weeks ago. Here is a Twitter user that collects stories. Virtually every single piece about Medicaid features the very real human element of this program and the tragedy of the impact cuts will have to these people’s lives.

But many of these people are already on Medicaid. What about the people who are never on Medicaid… or never expect to be on it? Sometimes people are on Medicaid for long periods of time, sometimes it’s just during a rough patch or for the birth of a child, then they are back off.

Yesterday, I attended a discussion about healthcare where a panelist showed the slide below, reflecting a Kaiser Family Foundation poll taken in February 2017. Over a quarter of people surveyed said they did not feel Medicaid was at all important:

Medicaid covers approximately half of the nation’s births, and of that, a higher proportion of preterm births. This is just an average though, and includes over 64% of the births in states like Arkansas, Louisiana, Mississippi, Nevada, New Mexico, and Wisconsin. According to the Centers for Disease Control, almost half of pregnancies are unintended.

Medicaid pays for 51% of the nation’s long term services and supports, which is another way to refer to nursing homes and the services to keep people out of nursing homes, like meals on wheels, home health, transportation, and respite care. These services are used by elderly and non-elderly people (including children) — people with physical and intellectual disabilities such as dementia, autism, traumatic brain injuries, and other chronic disabling conditions that may or may not require nursing home care, but may permit people to live in their homes with additional help.

Medicaid pays for more than a quarter of the nation’s behavioral health expenditures — which includes substance abuse and mental health services. Furthermore, Medicaid pays for an estimated 30% of people with an opioid addiction. Our nation is in the midst of an opioid epidemic — drug overdose is the leading cause of accidental death (with opioids driving this), even surpassing car accidents.

There was another related Kaiser Family Foundation survey question that was tracked in February 2017, that shows that 44% of people responding have no connection to Medicaid. They probably probably do not know that Medicaid pays for all of these things.

Pregnancy, long-term care needs, and addiction: These are three major health expenditures you can’t always be prepared for, yet the social safety net is currently there for… most of us. We need to protect (and expand) the safety net so it stays intact for the people who currently rely on it and for the people who might need it — which might be any of us, or our families, friends, or neighbors… but shhh! because apparently 44% of survey respondents are real hush-hush talking about it.

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