Arkansas Playing Gotcha with the Poor to Cut Them Off of Medicaid

New Orleans  In a sordid and shameful episode a few weeks ago Arkansas Governor Asa Hutchinson pridefully announced that the state had managed to bar 4300 people from health care support through Medicaid because of its new work requirement policies.  Seema Verma the head of the federal Center for Medical Services (CMS) who had approved this draconian attack on the poor played clueless cheerleader.

As more information come forward the real evil that underlies this shame emerges.  Let’s look at the facts.

Arkansas began the experiment by exempting two-thirds of the eligible recipients from having to report work hours, knowing this was going to be a problem.  30,000 people were then required to report.  16,000 didn’t report any qualifying activities to the state, either work, training or volunteer time.  In fact, according to the New York Times, “only 1200 about 2% of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.”  That’s pickle-poor!  It screams to a state failure not a people failure, and it foretells thousands more that will be denied coverage.

State officials tried to cover their rear ends, claiming they had done everything possible:  mailings, calls, and even putting out fliers some places where Medicaid patients congregate.  Even more ridiculously they touted the fact that they send emails and posted on social media sites.  Who are they trying to fool?  Arkansas ranks 48th among all of the states in the US in terms of connectivity and 30% of the population is underserved.  230,000 people in Arkansas don’t have any wired internet providers available where they live.  Who wants to guess whether embedded in these sorry statistics lie most of these lower income Medicaid recipients?

Shockingly, the Times then quoted Amy Webb, the chief communications and engagement officer for the Arkansas Department of Human Services saying, “If there’s something we are not doing to reach people, if someone will tell us how to do that, we will do it.”  Yeah, really?  She doesn’t mention that the state legislature forbade any use of media to increase enrollment under the Affordable Care Act.  Nowhere do they claim they were on the television or radio airwaves.  As the manager of KABF, a 100,000-watt noncommercial smack dab in the middle of the state with more than 50,000 listeners per week, more than half of them lower income, I can absolutely tell you we never received a public service announcement from them, much less any support for a real information promotion of the program.

Every other indication is one of abysmal failure.  The state conceded even when they had email address, only 20 to 30% opened the email.  Call centers said many didn’t answer their phones.  A professor from New York visited three counties in August and interviewed 18 people and 12 were unaware that work requirements even existed.  Other experts noted that an incentive system, even a punitive one trying to get more people into the workforce, won’t work if people don’t know about it.  Duh!

Adding injury to injury, all of the work hours are required to be submitted through the internet.  That’s the same internet thing that hundreds of thousands of Arkansans are not able to access, and even with access are not necessarily all-pro at using the state’s clunky website.

State officials in Arkansas need to start some truth telling.  These so-called work requirements are nothing of the kind.  This a pure and simple way to push eligible people off of Medicaid.  Hopefully a coming court hearing will stop this hypocrisy.

In the meantime, this is a scandal that none of us should be able to stomach.

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Please enjoy Johnny Guitar from Twisted Wheel.

Thanks to KABF.

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Surprise, High Health Deductibles Defer Treatment and Kill People!

New Orleans     Sometimes the gap in understanding the impact of wealth differentials, or what in the old school we called class differences, is so stark that it just blows the top of my head off.  An example today in The New York Times was so clear that it forces me back to beating a drum I was hitting all too recently about the impact of high deductibles for so called “skinny” health plans that were allowed by Congress and the Obama administration to qualify under the Affordable Care Act.

The headline was promising: “High Deductibles, Deferred Treatment.”  Ok, it was a “no, duh” thing, but sometimes there’s no harm in stating the obvious until people get the point.  Then reporter Reed Abelson provides this assertion about deductibles, writing, “High-deductible plans have become commonplace, a deterrent used by companies to lower health care costs by discouraging unnecessary tests or treatments.”  He doesn’t challenge that claim.  He offers it for all of us to swallow whole, hook-line-and sinker!  No, Reed, high-deductible plans are not a “deterrent” to “lower health costs.” Among other things they are a way being used by companies to force their lower waged workers to elect NOT to take the measly, but “qualified” health policy they offer their workers, so that they have NO insurance whatsoever saving the company 100% of the costs and allowing them to avoid 100% of the penalties.  Wakeup and look around at what is happening to lower income, service-based workers in nursing homes, home care, mental health facilities, janitorial, wait staff and other jobs, please!

The story tries to recover.  Since the reporter can’t fathom the millions of workers priced out of health coverage by their low wages and their companies’ draconian health plan, he does understand some random study since it has a Harvard connection and, lo and behold, finds that women with insurance deductibles of at least $1000 will delay or defer treatment.  I could provide the names of literally thousands of women working in nursing facilities under contract with our union that would jump at the chance to have health insurance with only a $1000 deductible.  Instead, the economics of the situation make it more financially attractive to pay the penalty for not having health insurance than to pay 9% of their gross wages and thousands of dollars in deductibles before they access any health benefits.  Need I mention once again that this is all about the company avoiding 100% of any health care costs for its hourly workers and not about “discouraging unnecessary tests and treatment.”

Abelson helpfully notes that half of all “covered” workers are enrolled in plans with a deductible “of at least $1000” and that 11% of covered workers have a deductible of $3000 or more.  The phrase “covered workers” is the critical one here.

The tragedy in the failure of our national health program and the loopholes it allowed employers is in the uncounted millions of workers and their families who are deliberately priced out of care.  Perhaps you can imagine the intended consequences for millions of working families who have deferred necessary tests and treatments because there are caught in the gap between not qualifying for Medicaid and their companies’ skinflint policies.  We could start with the hundreds of thousands of headstones in the nation’s cemeteries of men and women dead before their time of preventable causes.

Write that story in the New York Times!

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