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GOP Set to Tamper with Safety Net
By Don Flynn
WASHINGTON--Two government social programs—bravely won in the tumultuous civil rights struggles of the 1960s for the poor, the elderly and minorities—appear targeted for drastic overhaul by tea partiers and Republican conservatives in Congress.
Despite various Polls declaring that Americans support Medicare and Medicaid, Republicans led by House Budget Chairman Rep. Paul Ryan (R-Wisconsin) are stubbornly forging ahead to rewrite, water-down or privatize them.
Deficit-cutter House Republicans and right wing hawks plan several conferences, including the National Medicaid Conference scheduled for June 19, to formulate ways to revamp Medicare and Medicaid to slash millions in health care assistance and end the entitlements as they have existed.
"There’s no question that those programs became the fundamental part of the human support network for people of low income and disabled, regardless of any other background, and were fundamental to their lives," health expert Harvard Professor Robert Blendon told The Spiritual Herald.
"And also for seniors, Medicare played a big role in getting seniors actually out of poverty because you removed the payment of medical bills from their lives," he said.
"They’re really establishing an agenda for the 2012 election," he said. "The 2012 election is going to be a very big election for health care in the United States.
“These issues are going to be on the table with one party saying that if we win the Senate and/or the presidency, we’re going to change spending in this country for those programs, and the other party is saying, yes, there has to be some reductions because of the deficit and we’re going to keep those programs mostly intact."
In the run-up to the 2012 election, the Republicans agenda is to defeat President Obama by any means possible and trashing, privatizing or destroying the Affordable Care Act, which improved Medicare and Medicaid, is their Trojan Horse to discredit him.
"Its opponents call it ObamaCare," commented James Tallon of the United Hospital Fund to The Herald. "I think that’s inappropriate and unfair. Congressman Ryan put out a proposal that really did three things. It repealed all of the expansions of coverage under the Affordable Care Act and most of the other provisions.
"It took the existing Medicaid program and converted it into a block grant for the states, repealing what had been a key provision of Medicaid since 1965 that was really an entitlement to services for people and that the states would be paid the costs of that service. In Congressman Ryan’s proposal, it’s been made into a block grant where the states would get a fixed amount.
"And the third thing he did was to propose that Medicare be changed pretty dramatically in the year 2022 for people who retire then, moving forward. It wouldn’t have any effect on current retirees or people over 55."
The two programs were enacted by Congress in 1965 during the Great Society administration of President Lyndon Johnson and provided government health care for the first time to millions of the elderly and the poor and disabled.
Medicare for Americans 65 and older was funded through Social Security deductions and is fully financed. Medicaid for the poor and disabled was funded half-and-half by the Centers for Medicare and Medicaid Services (CMS) and the individual states.
The two health care entitlement programs responded to a national health emergency that ignored the care of millions of Americans too poor to see a doctor or go to a hospital, damned by a famous study that found a two-tiered country -- one white and rich and one black and poor.
Medicare and Medicaid brought hope and a chance at a better life for millions of Americans from all levels, from Inner City people of color to poor whites, to impoverished mothers with sick children to the aged who were both poor and old.
Together with Social Security, the programs are the social foundation of the majority of Americans and the reality of a national effort to help provide a semblance of equality. Medicaid in particular, although not inclusive and manipulated by states to deny eligibility, has been and is a vital lifeline for those with no other option.
For Medicare, the Republican push is to privatize it, end it as an entitlement and hand it over to private insurance companies to provide or deny care at their own prices. For Medicaid, it is to set fixed rates for the states to provide as much care as it can afford, and no more.
"The ultimate goal is to reduce government spending, reduce the deficit without raising taxes," said Blendon. "There is a preference for encouraging particularly in Medicare, future private options. The biggest part of Congressman Ryan’s proposal is to reduce federal spending on these programs in a world where people are getting older and living longer, without having to raise taxes and reduce the deficit.
"This debate is around whether or not—in order to keep these programs going—people would pay more taxes to keep them going. Their argument is low-income people can’t afford more taxes, and therefore these programs have to shrink. The privatization, which is in there, is a smaller part of their argument.
"The biggest concern they have is reducing overall spending without raising taxes and cutting back on Medicare and Medicaid any way you get there. They don’t want to spend what has been put under the President’s new bill for any of those programs."
Both of the experts see the battle as a titanic political confrontation that will only climax in the next national election in 2012.
"I think there will be a lot of skirmishing between the two parties, between the White House and the Congress in the short term over deficit issues," said Tallon. "And I think they will get to some sort of short-term agreement; they kind of have to.
"But I do think that the real debate about the future of Medicare and Medicaid will be very active in 2013 after the Presidential election in 2012, and we see whether President Obama leads us in a second term and see what the makeup of the Congress looks like. I tend to think that all of these issues will come into focus in 2013."
"Health care will a very big election issue, and what they are fighting for are some concessions now, but setting up for a much bigger battle in 2012," suggested Blendon.
"In my view, these kinds of fundamental debates are going to be settled through an election, it’s not just going to be settled through arguments and committees. Voters will see stark differences between the parties and they’re going to have to make a decision about which direction they want to go."
The urgent push to get health care for the majority of deprived Americans came out of the courageous and dangerous Civil Rights struggle of the 1960s to desegregate the nation. Spurred by the 1954 Supreme Court decision that "separate but equal" segregated public schools were unconstitutional, Little Rock, Arkansas, desegregated schools behind National Guard troops.
A decision that segregated federal interstate travel was also unlawful sent Freedom Riders through the South to challenge it despite beatings and murders.
The gallant struggle not only affected African Americans and other people of color but inspired demands for equality from women, gays, poor whites, labor, and overlapped the Vietnam anti-war movement.
The momentous, decades-long battle for health care for all that changed the racial, social, and economic face of America and offered a more equal chance at life is now in the bull's eye of Tea Party radicals and callous Republican deficit hawks.
Medicare and Medicaid are the two major government programs that provide medical coverage for the elderly and the poor. Formally enacted in 1965, they were added as amendments to the Social Security Act of 1935. The programs went into effect in 1966.
In 1965, Congress passed legislation enacting Medicare during Johnson’s administration. It represented the end of a two decade-long debate over a program originally sponsored by President Harry S. Truman.
The amendments to the Medicare program passed in 1972. They extended coverage to long-term disabled persons and those suffering from chronic kidney disease.
Medicare’s growth prompted the federal government to legislate various cost-containment measures, starting in the 1970s. In 1983, it set standard payments for the care of patients with certain diagnosed conditions.
On the other hand, Medicaid is a health insurance program established for low-income persons under age 65. It is also used by senior citizens who have gone over the limit on their Medicare benefits.
Medicaid is a state-run program jointly funded by the federal government and the states. Participants are required to offer Medicaid to everyone on public assistance.
Based on federal guidelines, the individual states may determine their own standards for eligibility for Medicaid. However, it is usually offered to those whose incomes and assets fall below a certain level.
The federal government pays the states from 50 to about 80 percent of their Medicaid costs. It also pays for hospital care, physicians’ services, skilled nursing facility care, home health services, family planning and diagnostic screening.
Medicaid, similarly to Medicare, grew rapidly after its enactment than at first expected.
The federal government in 1972 initiated the first of several sets of cost-containment measures in an attempt to lower the program's cost.
Beginning in the early 1980s, rising numbers of physicians refused to treat Medicaid patients because of the low reimbursement levels.
Recently, many states have begun to change rules concerning Medicaid. In May, President Obama issued a directive that state Medicaid programs must abide by federal law to provide health care for the poor at least equal to the general population.
The new rule stops states from cutting Medicaid payments to doctors and hospitals. Some of these providers have recently stopped taking Medicaid patients, and this rule seeks to end this practice.
Obama’s mandate requires states to document access to patients at least every five years, to keep track of the number of doctors accepting Medicaid, and to compare how Medicaid reimbursements compare to Medicare or private providers.
In effect, the Obama rule would preserve or restore Medicaid to its original purpose and make it clear that federal funds to the states are not a free ride but money to provide the health care to the poor that they must have and are entitled to.
Clyde Anderson, executive director of Clergy and Providers for Racial Health Care Equality, called on the clergy, civil rights activists and health care providers to join with his organization to prevent the destruction of both Medicare and Medicaid.
“These programs evolved from out of the Civil Rights Movement and they must be treated on the same footing as the Voting Rights and Public Accommodation laws,” he said. “Prior to the arrival of both programs, minorities, the poor and the elderly suffered unbelievably from health ailments.”