The Center for Immigration Studies’ latest report concludes that 42 percent of immigrant households, both legal and illegal, used Medicaid in 2012. Only 23 percent of households headed by a native-born American used Medicaid.
Tag Archives: welfare
Medicaid’s Poverty Trap Illustrated
The tragic story of a disabled woman trapped in poverty by the hodge-podge of ways the U.S. finances health care illustrates why we need to sweep the whole thing away and give everyone a universal, refundable tax credit: Continue reading Medicaid’s Poverty Trap Illustrated
The Human Face of Medicaid’s Poverty Trap
NCPA has long recommended a universal, refundable tax credit to replace welfare programs that impose effectively high marginal income tax rates on their dependents. A story from Chicago shows the human cost of Medicaid’s poverty trap:
McDonald’s grill cook Douglas Hunter is literally the poster child for a $15 minimum wage: The Chicago man’s picture and story are featured in the “Fight for $15” national campaign.
Hunter’s minimum pay goes to $10 an hour in July, but a steep pay raise would bring unintended consequences for Hunter, a diabetic with multiple medical conditions whose care is covered by Cook County’s program for the uninsured and poor.
So any salary gains could be wiped out by the price of his medications and supplies, including two kinds of insulin at $403 a month and drugs to control high cholesterol and blood pressure that add an extra $330 a month.
And that’s not including the syringes, health checkups and eyeglasses he receives for free, allowing him to avoid choosing between maintaining his health and providing for his teenager.
At $15, he figures he’d need to reduce his total work hours to ensure his new income didn’t disqualify him from his current benefits. (Don Lee, “For this McDonald’s cook, wage hike could do more harm than help,” Los Angeles Times, June 1, 2015)
Administration Plays “Medicaid Hardball” With Holdout States
Obamacare was supposed to dramatically increase Medicaid dependency in exchange for reducing some direct federal funding of hospitals. Now, some governors of states that rejected Obamacare’s Medicaid expansion are reacting negatively to the federal government’s cutting back hospital funding.
Governor Rick Scott of Florida is suing the federal government for proposing to cut Low-Income Pool (LIP) funding to hospitals, which he describes as retaliation for the state rejecting Medicaid expansion. Now, it looks like the Administration is issuing the same threat to Texas.
It is not clear why the Administration cares whether federal money sent to a state for health care is sent to Medicaid or directly to hospitals.
NCPA’s long-standing proposal for a universal, refundable tax credit addresses the issue as follows: If people do not claim the tax credit for health insurance, it gets sent to a safety-net facility where they reside. We haven’t gone deep into the details of how that gets executed. Although, my latest proposal is that all federal funding for welfare be bundled into unified Opportunity Grants
Medicaid Should Be Included in Paul Ryan’s Anti-Poverty Proposal
Congressman Paul Ryan has introduced a proposal, Expanding Opportunity in America, to bring together different federal anti-poverty programs into one. Ryan focuses on the Earned Income Tax Credit, housing and home-energy assistance, education assistance, food stamps (SNAP), and criminal sentencing reform. Ryan’s proposal hinges on the Opportunity Grant (OG). States would apply for OGs that would roll some or all of this federal money into one lump sum. However, it would not just be turned over to states as a block grant. States, civil-society organizations, and recipients themselves would all be responsible for measuring and achieving outcomes. The OG would have one overriding goal: To facilitate recipients moving out of dependency and into self-reliance. Ryan is looking back to the success of the 1996 welfare reform, signed by a reluctant President Clinton after a successful campaign by House Speaker Newt Gingrich. Ten years after the reform, it was widely recognized as a significant success. (In 2012, President Obama gutted much of the reform through executive action.) At a recent briefing at the American Enterprise Institute, Ron Haskins of the Brookings Institution pointed out that this proposal should have bipartisan
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appeal, and if it got to President Obama’s desk he would likely sign it. This explains the appeal of Ryan’s proposals. He doesn’t just throw out wide-eyed ideas designed to attract media attention. He develops them and modifies them until they get enough support from his colleagues that a pathway to success can be identified. This is what happened to his Medicare reform proposal. The initial version, contained in his Roadmap, proved bait for demagoguery. President Obama accused him of wanting to give seniors “some kind of voucher,” insinuating that it would be about as valuable as a supermarket coupon. Most Republican colleagues were terrified of having to vote for this. Nevertheless, after some watering down, Ryan put it in his budget and convinced his colleagues to vote for it. Continue reading Medicaid Should Be Included in Paul Ryan’s Anti-Poverty Proposal
The European Welfare State
Gross public social expenditures in the European Union increased from 16 percent of gross domestic product in 1980 to 21 percent in 2005, compared with 15.9 percent in the United States. In France, the figure now is 31 percent, the highest in Europe, with state pensions making up more than 44 percent of the total and health care, 30 percent… In Sweden and Switzerland, 7 of 10 people work past 50. In France, only half do.
Full article on the threatened sustainability of the European social model.
We Don’t Call People on Welfare “Employed”; So Why Do We Call People on Medicaid “Insured”?
Post-ObamaCare, 18 million of the newly “insured” will actually be on Medicaid, according to the Chief Actuary of the Centers for Medicare & Medicaid Services, who will suffer from limited access to care. And this blog has previously discussed research indicating that Medicaid dependents have worse access to quality care than the privately insured. This is not surprising: Medicaid is a welfare program, and it’s incorrect to categorize Medicaid recipients as “insured,” which is what universally happens in the public dialogue over health reform.
The California media has noted — with alarm — results from the UCLA Center for Health Policy Research’s California Health Insurance Survey. According to the March 16 Los Angeles Times, “nearly 1 in 4 Californians under age 65 had no health insurance last year.”
So how can 58 percent of Americans want the new federal health-care take-over repealed, according to a recent Rasmussen poll? If one quarter of us were homeless, for example, support for reform — any reform — would surely be close to universal.
Is Health Care Different?
What should determine who gets what in health care?
With respect to other basic needs (food, clothing, shelter, physical safety, etc.) all developed countries have safety net institutions that — often very imperfectly — ensure that the least well-off have some minimal provision. Beyond that, whether people get more or better depends on their income, wealth and personal preferences. No one seriously argues that we should all eat the same kind of food, wear the same kind of clothes or live in identical housing.
But with respect to health care, attitudes are often very different. Here is what the founders of the British National Health Service (NHS) had to say:
Aneurin Bevan, father of the NHS, declared that “everyone should be treated alike in the matter of medical care.” The Beveridge Report, the blueprint for the NHS, promised “a health service providing full preventive and curative treatment of every kind for every citizen without exceptions.” The British Medical Journal predicted in 1942 that the NHS would be “a 100 percent service for 100 percent of the population.” The goal of NHS founders was to eliminate inequalities in health care based on age, sex, occupation, geographical location and—most importantly—income and social class. As Bevan put it, “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.”
In the modern era, here is Uwe Reinhardt saying much the same thing. Yet as I have written previously, Britain has not only fallen short of this goal, its own internal studies suggest that inequality of access to care in Britain is greater today than when the NHS was started after the end of World War II. So here are three questions to help us think about this problem:
- Is it possible even in principle to make access to health care independent of income, wealth, social status and other patient characteristics?
- Even if it were possible, is it always desirable?
- If it’s neither possible nor always desirable, why do so many people insist on talking about it?
Think of this as being introduced to a socialist high, followed by the real downer of coming back to earth.
httpv://www.youtube.com/watch?v=7Cru2ld06-A
Sunday Morning Coming Down
Health Alert: War on the Poor
What is the worst feature of the stimulus package and other legislation being considered by Congress? It is the systematic attempt to undermine 25 years of reform of social institutions — reforms designed to liberate the lowest-income families from welfare state programs that trap them and make them perpetual wards of the state.
httpv://www.youtube.com/watch?v=KhHwo3pxOB8
She Works Hard for the Money
Stimulating Health, Education, and Welfare
This is Alan Reynolds, writing in today's Wall Street Journal:
The December unemployment rate was only 2.3% for government workers and 3.8% in education and health. Unemployment rates in manufacturing and construction, by contrast, were 8.3% and 15.2% respectively. Yet 39% of the $550 billion in the bill would go to state and local governments. Another 17.3% would go to health and education — sectors where relatively secure government jobs are also prevalent.