Once upon a time, politicians showed compassion for the poor. To quote the late Sen. Robert Kennedy: “I believe that, as long as there is plenty, poverty is evil.” President Lyndon Johnson declared “War on Poverty” in his 1964 State of the Union Address.
The Social Security Act of 1965 — creating the Medicare and Medicaid safety nets — was a key battle in that war. It passed with bipartisan support. More House Republicans supported it than opposed it!
Today we only seem to hear about Medicare, which is available to all 65-and-older and isn’t means-tested. It’s the subject of bitter, demonizing political battles sometimes called “Mediscare.”
We are inundated with rhetoric over the “middle class” — that ill-defined status predominant in political discourse. Words like “poverty,” “poor,” or “disabilities” were unmentioned in President Obama’s 2012 State of the Union Address. And I doubt they’ll get play at either party’s convention.
So what about Medicaid? Setting aside the politically-charged question of its expansion under the Affordable Care Act (ACA) to the uninsured, the existing program is the lifeline for the impoverished with long-term care needs at home or in facilities. And it serves those needs more efficiently than private long-term care insurance. Why, then, does no one fight for it?
In a little-noticed 5-4 U.S. Supreme Court decision in February, Medicaid narrowly dodged a bullet.
Confronted with a lawsuit brought against California by providers over Medicaid cuts, the Court punted on the invitation by the Obama administration and states to rule Medicaid providers and beneficiaries cannot sue over state Medicaid cuts. Instead, it gave the case back to the Ninth Circuit Court of Appeals for re-argument.
This reprieve may not last. In dissent, joined by three other justices, Chief Justice John Roberts wrote, “Nothing in the Medicaid Act allows providers or beneficiaries (or anyone else, for that matter) to sue[.]”
Under Roberts’ interpretation, only the federal government — rubber-stamping state cuts in the federal-state Medicaid partnership — determines whether Medicaid payments support efficient, quality care.
Democratic U.S. Rep. Henry Waxman was among those “bitterly disappointed” with the Administration’s position, and had joined Senate Majority Leader Harry Reid, House Minority Leader Nancy Pelosi, and others in a brief opposing it.
There’s a lot at stake. Democratic states like Washington have hacked Medicaid as much as Republican states.
As if cash-strapped states were not enough, Medicaid faces further threat under the Republican House budget crafted by U.S. Rep. Paul Ryan.
Ryan would halt Medicaid expansion for the uninsured under the ACA. However, he would go much further — even after ACA repeal, his plan would cut another $750 billion from states through 2021. The Kaiser Family Foundation found this “would be about a 31 percent cut” for doctors, hospitals, and nursing homes — especially significant, they found, for nursing homes’ high Medicaid populations.
Our state would lose $12.9 billion through 2021 under this plan. Such a cut could not come at a worse time, given the state’s unmet “paramount duty” to fund K-12 education — a duty the Washington Supreme Court means to enforce.
In a sort of cruelly bi-partisan handshake, the Obama Administration’s legal position would leave Medicaid providers and beneficiaries unable to sue over further suffering state-level effects of Ryan’s cuts would inflict.
Perhaps this reflects the shift of political dialogue to the right, as Republicans moved the center and Democrats followed. Yet no matter our best intentions, there will always be poor among us whose disabilities prevent them from transcending poverty and entering the middle class (and political consciousness). What will it take for us, again, to have the bipartisan morality to acknowledge, and honor, these vulnerable citizens’ needs?
Olympia attorney and former state representative Brendan Williams is a long-term care advocate.
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