The Poor: Attention Must be Paid

In a country as wealthy as ours, the poor are a glaring reminder of inequity. Their tents clog up downtowns; they stand in food lines; they hold out cans on street corners. Some are too old, too sick, or too disabled to work. Others work in low-wage jobs serving meals, cleaning offices, driving Ubers. They wait for an eviction letter to crowd out the dunning letters. Or they languish on years-long waiting lists for housing subsidies. They are a broken-leg away from catastrophe.

It is easy to overlook them. Unemployment is down; the media bleat out stories of racism, sexism, crime — not poverty. And the war in Europe now claims the nation’s attention, anxiety.

Yet even now, to cite the fictional Linda Loman, who urged her children to honor their vulnerable failing father in “Death of a Salesman”: “Attention must be paid.” The responsibility is moral.

The President’s promise to “Build Back America” offers scant hope for the poor. Urban schools remain abysmal; neighborhoods remain blighted; and health care — the promise of government since Medicaid, since Obamacare, since President’s Biden’s Pandemic Act — is in jeopardy.

As the pandemic winds down, so does the federal government’s commitment to keep people on the Medicaid rolls. Under the Families First Coronavirus Response Act, the federal government gave states money to keep enrollees on those rolls. Indeed, participation in Medicaid grew during these past two years.

Today the pandemic-born largesse is ending, and the federal government will no longer subsidize people who are not properly certified. Roughly 80 million Americans must be “re-certified” as “income-eligible” for Medicaid.

In that time, many have moved. One reason that Medicaid recipients have gotten vaccinated in low numbers is that much of the outreach has ended up in dead letter offices, returned as undeliverable. Tenants move as rents rise; homeowners move with eviction notices; troubled families move as their troubles escalate. As for email, the “digital divide” is real: poor families often have no steady access to wifi, no email addresses, no computers. With unemployment down, some of the 80 million may no longer be eligible for Medicaid, may be eligible for an employer’s plan, or for an Affordable Care Act subsidy. The challenge for states is to figure this out.

States are hard-pressed to do so. Colorado estimates that 500,000 people must be certified: 30% are at risk of losing Medicaid because they do not respond. Utah estimates 120,000 (60,000 of them children).

A key barrier is the poor “information technology” systems of states. In 2018, before the pandemic, 1.5 million people lost coverage in a complex paper-driven system. States know that they must modernize their electronic outreach, while they must make the paper forms easier to understand, with help for people who cannot fathom how to fill out the forms. States, if they choose, can use COVID money to reach out to “stakeholders,” like pharmacies, medical offices, church groups, and community associations. They can hire “community-based navigators” as liaisons. Many state officials are hashing out the logistics in endless meetings.

Eventually, states will work through the backlog. And the poor are used to waiting. Consider California’s move to save $414 million by transferring pharmacy benefits for Medicaid recipients from managed care plans to Magellan Health (Medi-Cal Rx). The delays are foreseeable to everybody but the politicians proposing the shift: poor data transfer from the plans, call center staff absences, glitches in prescription codes. … The upshot is that many people wait for medications they desperately need.

So too 80 million Americans dependent on Medicaid are waiting for states to figure out how to update their outreach, simplify their forms, and staff call centers.

At the same time, state budget offices recognize an implicit savings in these delays, in these people dropped.

It is hard being poor in this country. But the 19th century advice from British Prime Minister William Gladstone remains true today: Nothing that is morally wrong can be politically right.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 1, 2022

Populist.com