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Medicaid misunderstood

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Program does not deserve barrage of attacks.

By Chris Fitzsimon

[06.18.04] — The next time you hear a political candidate or an anti-government think-tank pundit attack Medicaid as too generous, ask them if it is poor pregnant women, the blind, the disabled or poor senior citizens to whom they want to deny access to health-care services.

Then ask them which of the alleged “optional” services they want to end for those groups of people, such as ambulance services, psychiatric care or prosthetics for children — optional services that North Carolina covers as part of its Medicaid program.

Candidates don’t generally worry about the facts when they are searching for a target for their attacks on state government and their simplistic demands that North Carolina dramatically reduce taxes.

One candidate recently said Medicaid spending is out of control.

Another parroted an anti-government think-tank that says the program should tighten its eligibility standards and reduce the benefits it offers to save millions of dollars.

Several candidates promise to crack down on fraud in the program, but offer no specifics about their plan or any evidence of massive fraud in the program.

Every year in the legislative halls, proposals abound to slash Medicaid spending and reduce the services it provides. This year is no exception. Several weeks ago, House members discussed a long list of possible cuts to Medicaid, including covering fewer children and pregnant women.

Medicaid is now the human-services program of choice to attack by people whose passion seems to be a blind allegiance to shrinking government and cutting taxes, regardless of the consequences for people’s lives.

It makes a convenient target. It is big, complicated and widely misunderstood.

Medicaid is simply a federal health-care program that provides services to certain groups of poor people.

The federal government requires states to cover certain services and provides of list of other services that states have the option of including in their plans.

Total spending for the program in North Carolina last year was $7.4 billion.

The federal government paid roughly 60 percent of that last year.

The state paid just over 27 percent, or $2.19 billion.

It is not much of a surprise that the cost of Medicaid has increased in recent years: It is a health care program, and the cost of health care has gone up across the board.

Despite the rhetoric of demagogues, Medicaid is not a program that helps virtually anybody who wants to see a doctor for anything.

In fact, it does not help most adults, even if they live in poverty.

It is very targeted, primarily to help the elderly, the blind, the disabled, poor pregnant women and poor children.

There are strict eligibility limits. A seven-year-old child with a single parent, for example, is eligible for Medicaid coverage only if the parent makes less than $12,200 a year.

Fifty-seven percent of the people covered last year were children, and 70 percent of the money spent on Medicaid goes to the blind, the disabled, and poor senior citizens.

The problem with Medicaid is not that it does too much; it is that it does not do enough.

Under current restrictions, too many poor people make too much money to qualify for help, and too little to afford insurance on their own.

You won’t hear that much on the campaign trail. It’s easier to attack a program most people do not understand than it is to have an honest debate about how to help people who can’t afford to see a doctor.

The demagogues know that when that discussion starts, their rhetoric is harder to defend.

That’s exactly why that debate needs to start now.


Chris Fitzsimon is director of NC Policy Watch, a program of the A.J. Fletcher Foundation, which publishes the Philanthropy Journal.

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