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Romney's health plans could hurt poor and minority communities

News analysis: Leaving critical programs to states and turning federal funding into block grants has a history that worries experts in the state.
Doctor and young patient

Doctor and young patient U.S. Government, via Wikimedia Commons

Soon after the U.S. Supreme Court’s ruling to uphold the Affordable Care Act this year, GOP presidential nominee, Gov. Mitt Romney, and party strategists agreed on one overriding political imperative. In their bid to rally, and mollify, their conservative base, Romney issued an unequivocal statement: “What the court did not do on its last day in session I will do on my first day if elected president of the United States. I will act to repeal Obamacare.”

Senate Minority Leader Mitch McConnell, R-Kentucky, echoed that sentiment in a speech on the Senate floor: “There is only one way to truly fix Obamacare, only one way, and that is a full repeal.”

As the presidential race tightens, with less than a month before the Nov. 6 election, voters are faced with the daunting task of fact-checking fiction from reality about health care. While both major party presidential candidates have made questionable claims about the full impact of the Affordable Care Act  (ACA), Romney appears to be the less forthcoming.

In the first presidential debate last week, Romney made a number of questionable claims with regard to the issue of health care.  First, he believes that the ACA is a federal takeover of health care. Second, cutting Medicaid growth by more than half would restrain federal spending. And third, giving each state the power to craft their own health care reform plans would fix a broken healthcare system.

Those dubious assumptions aside, it is clear that dismantling the social-safety net would have devastating consequences not only for 48 million uninsured Americans, but also a significant proportion of minority communities as well. To cite one example, Seattle City Councilmember Bruce Harrell says: “Estimates suggest that 2.5 million Asian Americans would be uninsured in the absence of President Obama’s Affordable Care Act. Obamacare represents the opportunity to level the playing field in terms of protecting healthy communities.”

Romney has said that, as president, he would issue an executive order to provide Obamacare waivers to all 50 states, work with Congress to repeal the full legislation of the ACA, and give each state the power to implement its own health care reform plan.

Pamela Clouser McCann, assistant professor at the University of Washington Evans School of Public Affairs, said, “What’s important to remember is that before the Act, states already were left to come up with their own health insurance reform plans — some did, but most did not."

Romney proposes to turn the Medicaid funding stream into block grants and limit federal standards and requirements on both private insurance and Medicaid coverage. How would that affect minority communities? The answer again depends on how each state implements Medicaid, McCann explained. “The racial distribution of Medicaid enrollees varies tremendously by state due to differences and populations and state politics. In some states, a block Medicaid grant could disproportionally harm minority communities, and since in all but six states children make up the majority of Medicaid enrollees, minority children might bear the brunt of this choice.”

Gunnar Almgren, UW associate professor of social work and social welfare, makes the same point.  “Repeal of the Affordable Care Act would likely extend further the disparities in health care access for the poor and low-income populations in states that have historically been less able or willing to reduce their uninsured,” he said. Block grants would also place a cap on the federal dollars that are available to provide health care for the low income. 

According to Almgren and other national health policy experts, repealing the ACA would have broader implications. States that experience higher levels of unemployment and growth of the population of adults and youth without health insurance will not have the matching federal dollars to help offset the deterioration of employment-based insurance, he points out.

“Also the history with federal block grants is that they are very vulnerable to drastic reductions by Congress,” Almgren said. Emphasizing the long-term impact for low-income communities, Almgren is clear: “The reduction in federal standards for Medicaid allows states to lower the quality of services for poor populations and communities.”


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Comments:

Posted Wed, Oct 10, 11:17 p.m. Inappropriate

Excellent piece by Collin Tong, exactly right. If anyone wants to read more on Romney's health care proposals, which actually are a short set of bullet points, see my article in Medscape (free login required) and an excellent LA Times piece by Noam Levey.
http://articles.latimes.com/2012/apr/23/nation/la-na-romney-healthcare-20120423
http://www.medscape.com/viewarticle/764555
One thing Collin didn't mention in this article is that Washington and other states already are hard at work reducing costs and improving quality of care for low-income and disabled Medicaid beneficiaries, in both blue and red states. Obamacare has given them lots of valuable new tools and funding to work with to transform and improve Medicaid. Here in Washington, the state will be launching Medicaid health homes in January.

Posted Thu, Oct 11, 5:42 a.m. Inappropriate

Meanwhile, the current Medicaid program as administered by the Washingon State DSHS is continuing to illegally provide Illegal Aliens and financially ineligible people Millions a year in benefits. Giving that Agency any more latitude to provide Medicaid Services through a Romney block grant style program or even a more flexible Obama plan would not doubt result in waste, fraud and abuse. The State Auditor has had findings against the agency going back over a decade. So yes, even a properly run Medicaid program that functions within the law would result in "hurting those in the poor and minority communties" who are not eligible. Currently, the Medicare/Medicaid programs nation-wide lose 60-90 Billion Dollars a year in Waste, Fraud and Abuse, if it was totally eliminated,it too would "Hurt the poor and minority community".

Cameron

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