Analysis

3 People Explain How Last-Minute Medicaid Changes Make the GOP Health Care Bill Even Crueler

| Anusha Ravi
(AP Photo/Evan Vucci)

After seven years of demanding the repeal of the Affordable Care Act (ACA), House Republicans have reached their moment of truth. They have slapped together a bill to replace the law—the American Health Care Act (ACHA)—and President Trump is demanding that the House pass the bill today, or he will move on and leave the ACA in place.

That leaves House leaders in a tight spot, since their bill is deeply unpopular with lawmakers and voters. Late Wednesday night, in an effort to gain support from the ultra-conservative House Freedom Caucus, they added new provisions that make the bill’s Medicaid cuts—which already slashed the program by $880 billion—even more extreme.

The “manager’s amendment” includes a provision that encourages states to impose work requirements on adults who receive Medicaid. In theory, the provision ensures that “able-bodied adults” who receive Medicaid benefits are either working or looking for work. But in reality, this amendment could take health insurance away from Americans with disabilities or serious illnesses, and even new moms experiencing complications from childbirth—stripping them of the health care that would enable them to return to work.

Here are three Americans who would be at risk of losing needed coverage under House leaders’ latest proposal:

Robin Conrad — Center Ossippee, New Hampshire

In 2012, Robin was laid off and lost her health insurance. She went without health insurance while she worked temp jobs, until she was hired full-time nearly two years later. In 2015, she was diagnosed with Stage 4 metastatic breast cancer and was eventually forced to take long-term disability leave. Her employer terminated her job—and her health insurance—when she still had pressing health care needs.

Robin can get the medication she needs because she’s covered by the ACA’s Medicaid expansion. She noted that without it, “I probably would not have been able to get coverage even if I could afford it, because my situation would have been considered a pre-existing condition.”

Sarah Borgstede — Belleville, IL

Sarah was married and was unemployed when she became a new mom.  She and her husband decided that she should stay home with their baby boy, so that they wouldn’t have to worry about paying for child care.  Her husband continued working as a musician and a teacher, but neither job offered insurance—he either purchased private insurance went without it entirely.

Sarah’s husband passed away when he was just 28, after a long battle with sepsis. Sarah says that if she been forced to look for work within 60 days of having a child—like the new Medicaid work requirements demand—she would have needed to work full-time just to afford child care, while her husband continued working 80 hours a week to cover the rest of the bills. Then, Sarah says, “my son would have grown up without both of his parents.”

Ericka McClung — Clendenin, West Virginia

Six weeks after she qualified for Medicaid coverage under the ACA, Ericka found out she had Stage 3 breast cancer.  After chemotherapy, radiation, and a double mastectomy she’s now cancer free, but she needs to continue hormone treatments for another eight years.

“If the cancer came back I could never afford the treatments,” Ericka says. “My whole entire family put together could not afford my treatments.”

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Feature

The Republican Health Care Plan Is Already Making People Sick

| Rejane Frederick
(AP Photo/Brennan Linsley)

Thursday afternoon, the House of Representatives is scheduled to vote on the American Health Care Act—the Trump-era response to Obama’s Affordable Care Act. The vote is close, and a lot of the political news this week has focused on the last-minute deals and old-fashioned salesmanship that Schoolhouse Rock forgot to mention when it taught us how a bill becomes a law.

So far the debate on Capitol Hill—unlike the conversations taking place in town halls—has been abstract and detached. But for the millions of Americans living with the uncertainty and inevitable consequences of these decisions, these numbers are deeply personal. Congress is arguing about their health, and the stress of it all is making them sick.

Alaskan small-business owners Colleen Mondor and her husband, Ward, are two of the 24 million Americans who stand to lose coverage if the new bill passes. They have not had a single night of uninterrupted sleep since 2005—that’s when their then-3-year-old son was diagnosed with a rare form of Type 1 diabetes that requires them to wake up to check his blood sugar.

Colleen and Ward are both cancer survivors, and before the Affordable Care Act they got their insurance through a $1,000 per month high-risk pool that required them to pay $10,000 out-of-pocket before their coverage kicked in. They have the coverage they need now, but the years of fighting to get and stay insured has taken a physical toll on their health.

“Luckily, nothing bad like the return of cancer, but we both experience intense, hallucinatory migraines and severe exhaustion,” Colleen says. “I think about stress all the time… I never thought as much about insurance before but now feel dread and a sick feeling in my stomach every year when we receive the letter to re-enroll. Until you face the threat of losing or not being able to get quality insurance, you just don’t know.”

The Republicans’ new health care bill will usher in insurance plans that will cost more but cover less, forcing millions of Americans to choose between the care they can afford and the care they need. When a family lacks the security of quality health insurance, it too often leads to greater financial burdens, instability, and increased stress levels that produce poorer health outcomes. That will add to the strain of an already stressed-out nation, jeopardizing the health and well-being of folks who can least afford to be sick.

Though its toll is often poorly recognized and underestimated, the cumulative wear and tear of stress leads to an increased risk of illnesses like high blood pressure, depression, and heart disease. It even accelerates aging and may cause premature death. That’s compounded by any unhealthy, inadequate coping habits, like smoking or substance abuse, which make the harmful effects even worse.

Source: HeartMath (2015)
Source: HeartMath (2015)

As the gap between the rich and the poor continues to widen, individuals and families struggling to maintain financial security are being exposed to unprecedented stress levels, and the impact is grave. People of color and individuals struggling with poverty, who bear the brunt of the growing inequality, are also absorbing the impact of the deadly stress that comes with it.

Source: Bloomberg.com
Source: Bloomberg.com

President Trump and the Republican-controlled Congress are pushing a health care plan that casts millions of already chronically-stressed Americans—like Colleen Mondor and her family—into an even more dire state of anxiety as they struggle to find new coverage (let alone good, affordable insurance). But right now, the House of Representatives has a choice: They can move forward with their destructive health care law, or they can reject it and develop a plan that doesn’t threaten the health care—and actual, physical health—of millions of people.

As for Colleen, she’s also hoping for something that should have been present all along.

“Empathy is the major missing component in this conversation,” she says. “I always say: you are fifteen minutes away from being me.”

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Analysis

Trump’s Spending Cuts Would Create the Black America He’s Been Talking About

| Janelle Jones
President Donald Trump, center, speaks during a discussion with African American business and civic leaders, Friday, Sept. 2, 2016, in Philadelphia. (AP Photo/Evan Vucci)

On the campaign trail last summer, Donald Trump tried to appeal to African Americans by asking what we had to lose by voting him into office. Exit polls showed that we had a hunch what a Trump presidency would cost us, but now that the administration has released its first budget we know for sure.

According to Trump’s “skinny budget,” African-American families and communities stand to lose billions in programs and services that touch every aspect of our lives. This budget makes it harder for black people to raise healthy children, get an education, live in a safe neighborhood, secure adequate housing, and maintain a good quality job.

From the cradle to the grave, these billions of dollars in cuts will leave black Americans worse off—especially since African Americans are over-represented as beneficiaries for many of the programs. Cuts of approximately $150 million to the Women, Infants, and Children (WIC) program—where blacks represent 20 percent of enrollment—guarantees fewer black families receive nutrition education and supplements necessary for small children. The elimination of $1.2 billion in grants to after-school and summer programs, which serve 1 in 4 black students, will leave millions of kids without opportunities that give them a chance to get ahead. At the college level, nearly two thirds of black undergrads at public four-year institutions depend on tuition assistance received through Pell Grants. Reducing the funding for this program by $3.9 billion ensures fewer black students go to college, even as the labor market demands more credentials for good quality jobs. And for blacks in the labor market, the cuts to the Labor Department—which provides training for people who decide against a four-year degree, and combats the discrimination that still plagues black workers—makes it harder to get and keep a decent job.

Trump’s campaign trail claim that black communities are “in the worst shape they’ve ever been in before” was more a prediction of his budget’s impact than a description of daily life for black people. Historic racial disparities in terms of unemployment rate, housing segregation, and wealth have remained essentially unchanged over the past several decades. But his budget calls to eliminate programs that are designed to lessen those disparities, as well as the ones that support communities that are already marginalized.

These billions of dollars in cuts will leave black Americans worse off.

In many cases, the programs slated for elimination would literally take the roof from over people’s heads. Community Development Block Grants (CDBG), which fund affordable housing, economic development, disaster relief, and infrastructure for communities of color across the country are first on the chopping block. In 2013 alone, 9.8 million people lived in areas that benefited from CDBG grants, and more than 1 in 4 of them were black. More than a quarter of cases closed by Legal Services Corporation grantees, which accounts for much of the legal aid in the U.S., were tied to housing and foreclosure—and nearly 30 percent of their clients are black. And more than one third of black households qualify for help heating their houses with the Low Income Home Energy Assistance Program (LIHEAP), but Trump’s budget would force them to choose between heating their houses and paying for other basic needs.  For families left completely in the cold, the US Interagency Council on Homelessness is a last resort. Again, Trump’s budget would completely eliminate this program, in which nearly half of all families with children served are black.

Trump believes to be black in America is to live in a constant nightmare of poverty, joblessness, and inadequate opportunities. This budget turns that belief into reality for African American families and communities.

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Analysis

Trump Is Trying to Shift the Entire Budget Conversation to the Right. Don’t Let Him.

| Harry Stein
In this Feb. 22, 2017, photo, President Donald Trump speaks during a meeting on the Federal budget in the Roosevelt Room of the White House in Washington. (AP Photo/Evan Vucci)

The initial response to President Donald Trump’s budget has rightfully focused on the outrageousness of its worst spending cuts, such as huge reductions in affordable housing, medical research, infrastructure, and even Meals on Wheels. But even if Congress rejects some of these extreme cuts, President Trump’s budget may still set the stage for working families to get a raw deal.

The president’s budget doesn’t have the final say on how much money is spent on each agency and program—that’s Congress’s job. But it does frame the debate around government spending for the year. By putting out a budget that includes draconian cuts to the programs that Americans rely on, President Trump is trying to lower the standards for an acceptable outcome from Congress—and shift the entire conversation about federal spending to the right.

Even without the Trump budget’s $54 billion in cuts, next year’s spending levels are already too low due to the sequestration caps imposed by the Budget Control Act of 2011. Congress actually designed these caps to be terrible; the threat of sequestration was meant to force Republicans and Democrats to compromise on a “grand bargain” to reduce deficits. They never made that compromise, so lawmakers have been using short-term budget deals to mitigate sequestration’s worst impacts—but now Trump’s budget could make sequestration look reasonable by comparison.

As a reminder—because memories can be painfully short in politics—sequestration is not reasonable. In fiscal year 2018, it will limit nondefense discretionary spending—the same part of the budget targeted for cuts by President Trump—to roughly match its lowest level ever as a share of the economy since the federal government began tracking this category of spending in 1962.

The only way to get a good deal for working families is to increase the spending caps above sequestration levels.  Otherwise, Congress will continue to underfund programs that support basic living standards and invest in the middle-class, while rigging the system even further for wealthy and corporate elites.

Sequestration is not reasonable.

Two years ago, Congress demonstrated what sequestration would mean for jobs and working families when they tried to use those caps to write spending bills for FY 2016. Like President Trump’s budget, these bills took money out of the Pell grants that help students afford college. The House of Representatives proposed huge cuts that nearly eliminated infrastructure grants funded by the Transportation Investment Generating Economic Recovery (TIGER) program—which President Trump’s budget proposed eliminating completely. Similarly, huge cuts in a Senate spending bill would have nearly eliminated the HOME investment partnerships program to support affordable housing—another program targeted for elimination by the Trump budget.

In FY 2018, the sequestration caps in current law would cut nondefense discretionary spending by $3 billion. A $3 billion cut may seem insignificant next to the Trump budget, but even flat funding would be grossly inadequate for many nondefense discretionary programs. Lawmakers have already provided a $3.1 billion increase for the Department of Veterans Affairs in FY 2018, since they fund veterans’ medical programs a year in advance. Accommodating this increase will require deeper cuts to other programs, where funding requirements are also generally increasing because of inflation and population growth. For example, flat funding for rental assistance programs could cause 100,000 families to lose their housing vouchers.

Sequestration doesn’t just cut programs that are essential to average Americans—it actively hollows out safeguards that are meant to level the playing field, giving even more power to corporations and helping the rich get richer. The Environmental Protection Agency (EPA) and Internal Revenue Service (IRS) were targeted for cuts in both the Trump budget and the FY 2016 sequestration spending bills. Preventing the EPA and other agencies from enforcing environmental laws is great news for big polluters who can increase profits by cutting corners without getting caught, but it leaves ordinary Americans to live with the consequences of unsafe water, toxic air, and catastrophes such as chemical explosions. And cutting the IRS budget makes its customer service even worse for ordinary Americans, as seen with the particularly “abysmal” problems caused by lack of funding in 2015. At the same time, IRS budget cuts also make it easier for wealthy households and big corporations to use complex accounting maneuvers to overwhelm the IRS and avoid paying their fair share.

The Trump budget provides a stark illustration of what steep cuts to domestic programs mean for working families. But it should not lower the standards for an acceptable budget deal. To the contrary, after seeing President Trump’s plans to attack programs that help maintain basic living standards and create ladders into the middle-class, it is more important than ever for Congress to support a budget that adequately funds these programs.

Failing to lift the sequestration caps would mean starting down the same path outlined in the Trump budget, and working families deserve better than that.

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First Person

The Trump Administration Is Confused About Meals on Wheels. My Grandma Could Teach Them A Thing or Two.

| Mara Pellittieri
Josephine DiGiovanni, 93, expresses her thanks for the meal brought to her by Meals on Wheels driver Maria Suarez, right, in the Ridgewood section of Queens, New York. (AP Photo/Jason DeCrow)

Last week, White House budget director Mick Mulvaney defended the Trump administration’s proposal to cut funding for Meals on Wheels by arguing that the program is “just not showing any results.”

That claim is objectively false.

Meals on Wheels serves more than 2 million seniors every year who aren’t able to shop and cook for themselves. Research on home-delivered meal programs shows that they improve diet, nutrition, and quality of life, and reduce food insecurity among participants. In short, when seniors get meals, they’re healthier. My casual field research—otherwise known as every conversation I’ve ever had with my grandparents—also backs this up. If you don’t feel well, you should eat something.

I’m guessing, based on Mulvaney’s argument that cutting the program’s funding is the “compassionate” thing to do, that he hasn’t watched someone nearly die from malnutrition. But I have.

My grandmother had the dubious honor of being the only person to check into her hospice house two separate times.

The second time she was admitted, she spent a month fighting off the beleaguered staff’s attempts at kindness while she settled into an uncharacteristically peaceful death. She wasn’t an easy woman to care for during her life, and she wasn’t any different when she was dying. Once, when a hospice worker took her outside to spend some time in the sun, she dismissed the house’s small garden as “prissy bullshit.” When a volunteer dropped a curler during an attempt to wash and set her hair, she snapped that she “didn’t have that much time left, and didn’t want to waste it fumbling around.” When a grief counselor asked her what she’d miss about her life, she answered “gimlets and a fucking cigarette.”

We held her memorial service in the same room that she died in—another first for the house’s staff. When the nurse leading the service offered us the opportunity to share a warm memory about her life, we all shifted uncomfortably in our seats as we struggled to think of one. My aunt finally broke the silence with a long story about my grandmother’s legendarily mean tortoiseshell cat, Cleo, who lashed out at anyone within striking distance.

My aunt didn’t mention her plan to have Cleo euthanized shortly after the service.

I hope Meals on Wheels would have been there to show a mean old lady some compassion.

Two years earlier, when my grandmother was admitted to that hospice the first time, she only stayed for two weeks. What we had been convinced were signs that she was nearing death—exhaustion, weakness, confusion—turned out to be malnutrition. After a few healthy meals, they sent her back home, and we made sure someone went to her trailer at least once a day to check that she ate and to ration out just enough scotch to keep her withdrawal tremors at bay.

My grandma survived those two years between hospice stays because my aunts split up the responsibility of taking care of her. If they hadn’t been able to do that, I can only hope that Meals on Wheels would have been around to help her before she slipped back to the place where hunger made it impossible to finish a sentence, or stand up from the kitchen table, or put in her dentures.

In other words, I hope Meals on Wheels would have been there to show a mean old lady some compassion.

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