A Manichean battle is raging for America’s soul. Think Dr. Faustus resisting Mephistopheles. Think our better angels warring with Lucifer. Today’s battlefields are the state legislatures, as they ponder America’s poor. Do voters try to keep the poor healthy? Or do they condemn them to a Darwinian struggle?
Voters are torn.
On the side of “better angels” are states that elected to extend health insurance to the children of immigrants — regardless of legal status. The states (Connecticut, Maine, New Jersey, Rhode Island, Vermont, California, Illinois, New York, Oregon, Washington, Massachusetts and Washington, D.C.) decided that compassion trumps costs. (Maine insures pregnant women as well.) The costs are substantial: New Jersey’s analysts peg the tab at $15 million a year. Of course, in the long run the expenditure is cost-effective: a state needs a healthy work force, and immigrants comprise a huge percentage of that force. But politicians rarely look to the long run when their upcoming election is in the short run. So these states merit kudos for resisting the short-term gain of saving their Medicaid coffers.
Now on to Georgia. Like the song, “Georgia on my mind,” Georgia is on the minds of health care wonks because this November their work-requirement for Medicaid cleared a major hurdle. The notion of holding “work” (or, now, community service) as the carrot for Medicaid has lingered in the minds of conservative legislators for years. The objections are obvious: the people who need health care, and consequently health insurance, often are sick and/or disabled. Indeed, they may be physically or mentally unable to work. Perhaps, with care, they might recover enough to work, but the recovery would presage the work. Perhaps a person with diabetes would be more productive if treatment lowered blood sugar. Ditto for asthma, cancer, glaucoma. Yet that argument pales against the fiscal bottom line.
In 2023, the better angels will battle with state accountants: to drop, or keep, enrollees on Medicaid? At the start of COVID’s Public Health Emergency (PHE), in the Families First Coronavirus Response Act Congress required states to keep Medicaid enrollees enrolled continually throughout the PHE — no “churning” of the rolls. From 2020 to 2022, enrollment rose roughly 27 percent.
In 2023 when optimists predict the end of the PHE, the poor will once again risk losing Medicaid in those states eager to cut the rolls. How many people will end up uninsured? A soul-searching, not just an economic, decision. Ironically, the “red” states that have banned abortion have been especially torn: on the one hand, legislatures want to stop women from aborting fetuses; on the other hand, legislatures want to stop paying for healthcare for those mothers.
Prisoners test the humanitarian mettle of legislators. What kind of healthcare must we provide? At what cost? Hepatitis rages in prisons. Treatment can cost more than $20,000 per patient. As many as 30% of those affected will get better without treatment. And cirrhosis can take 20 years to develop. How to ration the drugs? Public health experts urge prisons to treat patients immediately, to stop the spread of the disease, to ward off cirrhosis. But treatment can swallow up most of a prison’s health budget. While many states have worked valiantly to treat inmates, negotiating for lower drug prices, and asking their legislatures for more money, others, like Florida, Oklahoma, and Wyoming, haven’t. Prisoners are not the “deserving poor” beloved of do-gooders.Do we want to help them live?
During these abortion wars, pro-lifers hold up the non-negotiable value of life, whether conceived by rape or incest, whether harboring grave fetal anomalies that may prove fatal, whether the mother risks death.
The poor raise the question to another level. Do we value the life of an undocumented immigrant or a poor person or a prisoner? Or do we let them live, but live in sickness and pain?
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, February 1, 2023
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