NEEDED NOW:COVID19 TREATMENT COVERAGE FOR UNINSUREDS!
A quick access/quick issue medicaid card for the 29 million uninsured, for treatment of Covid 19 & Predisposing Conditions — We can have it too, for about as much as Boeing demands we pay to bail it out from making a flying disaster
By Peter Munsing
Currently, there are more than 44 million men, women & children with no health insurance. Adding the millions who have filed claims for unemployment, whose health insurance through work will likely terminate, and the figure could well be more. (When I first wrote this story the number was 29 million and I expected the figure to rise to 33 million. I was wrong. So as more became uninsured, little has been done ).
Add in those who can’t get any health insurance — those who are not citizens and don’t have a green card and social security number; those who are released from prison (because even though they have paid their debt to society, we say they can’t get Medical Assistance). Let’s also remember those who have medical insurance, but with a $5,000 to $7,000 deductible and high copays, so they are fearful of racking up medical bills they’ll have to pay at a time of economic crisis.
None of these people can or will get treatment for Covid 19 symptoms until it gets near terminal, nor will they get treatment for the underlying conditions. That is part of the reason why all studies have shown that there is a much higher rate of Covid19 deaths among black and Latino patients than for the general population. This is so bad that some are calling the failure to address it a black and Latino genocide, “genocide by default” according to Yale epidemiologist Gregg Gonsalves https://www.huffpost.com/entry/epidemiologist-coronavirus-genocide-by-default_n_5eb2a5ebc5b63e6bd96f5d81
The reason is that those with hypertension, poor medical care, and diabetes or a pre-diabetic condition are more likely to die from a Covid19 infection, and black and Latino patients have higher rates of hypertension, diabetes, poor medical care, and as a result have untreated predispositions to death from Covid 19. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/#Race_Hispanic https://www.pewresearch.org/fact-tank/2020/05/05/financial-and-health-impacts-of-covid-19-vary-widely-by-race-and-ethnicity/ This is also true of young blacks & Latinos: https://www.latimes.com/california/story/2020-04-25/coronavirus-takes-a-larger-toll-on-younger-african-americans-and-latinos-in-california
The rate of deaths among blacks is so disproportionate, one analysis of the statistics noted: “To put it plainly: If Black Americans had died of COVID-19 at the same rate as White Americans, about 9,000 of the nearly 15,000 Black residents who have died in these states would still be alive” (emphasis in the original). https://www.apmresearchlab.org/covid/deaths-by-race
At this time, every infected person — whether they are rich or poor, white or black, citizen or migrant, can give off viruses that can infect any one of us. So the gain from denying the uninsured medical care, is at best a gain of smugness, that someone who is “not deserving” has not been “given” free medical care.
For the sick person with no access to medical care, it can be a life or death situation. But what happens is that they, and those with huge deductibles, wait until their health becomes an emergency-room-gotta-admit-to-hospital situation, in which case we all end up paying through increased health insurance costs. That isn’t a policy that makes sense, especially in a pandemic.
Also note that having people who can’t pay results in less care for all of us, not because the poor are clogging the hospitals, but because hospitals have had to close –especially in rural areas — and others have had to reduce staff — -due to lack of Medicaid expansion. https://www.statnews.com/2017/04/30/hospitals-layoffs-national/
This trimming hospital staff means that the nurses and healthcare workers we claim to applaud and support are under even greater pressure as they pick up the slack of those laid off. Lay off an orderly, and a nurse or other person has to do some of the cleaning up, now added to all the other very demanding, stressful tasks that staff person already has. https://www.npr.org/2020/05/08/852435761/as-hospitals-lose-revenue-thousands-of-health-care-workers-face-furloughs-layoff
There’s a significant reluctance in America to provide care without charge. So let’s play “what if,” as in “what if someone with a Medicaid card got “free” medical care. Well, they get better. We don’t get infected. Also, they can then take care of themselves and their family. Heck, they may get a job bringing us the groceries we don’t want to go out for.
There’s also the added bonus that if they can get care before they go to hospital, then they may not have to be admitted, or may be inpatient for a shorter period of time. https://www.ncbi.nlm.nih.gov/books/NBK154484/ As a result, the hospital that was going to close because of the financial burden, now it may not face further cuts and closures.
The real holdback seems to be a belief that “we just don’t give handouts in America — it’s bad, it saps drive and willpower.”(though those concerns don’t seem to apply to Boeing, or to CEO’s whose salaries go well above the million dollars it seems to take a CEO to live a decent life these days). For that matter, speaking of handouts, see what could be done with the $56 billion or more Boeing says we should pay because….well, just because it should get a handout for digging itself a financial hole…(not including tax breaks we GAVE to corporations and the rich, starting with the George W. Bush tax cuts, that Boeing got as well).
[Lest you think I’m being hyperbolic about the fear of “giving” people heathcare, note that Governor Abbott of Texas again refused to change Medicaid eligibility even though that would increase would be paid for by the Federal Government for the first few years, and thereafter at approximately 90% — and before him Governor Perry had done that. No cost to the state but refuses to do it because somehow it’s wrong to let more people have access to health care. ]
All of the major religions agree that people should be able to get basic medical care regardless of whether they can pay for it. There are really no downsides to it, other than financial –but even here it boils down to “why should we pay for someone to go to get themselves treated?” The pandemic makes the answer clear, we should pay for treatment, if for no other reason, that the infected won’t be a source of lingering re-infection, because we were too cheap and purse-lipped-parsimonious to do what all faiths say we should — care for the poor.
And we can.
For a fistful of dollars
I realize that in the Senate the view that the poor should pay their own darned way predominates, and that a Medicaid card for all won’t pass (let alone the dreaded Medicare4All concept). So how to square that circle?
For a bit more than the $56 Billion Boeing wants from us –in fact for that money plus what it’s reaped in tax benefits — you could provide a temporary Medical Assistance card good for Covid19 treatment and treatment of diabetes and hypertension to all the uninsured! (The purse lipped Senators were apoplectic about Medicaid expansion for the poor, so for the sake of formulating a plan that could be acceptable to the Senate as well as the House, I’m limiting this proposed Covid treatment card to what we need for our own Covid19 protection).
The reality is that the cost of medical treatment under Medicaid is darned cheap for what you get — ask any medical provider. If you pay $440 cash for an MRI (credit card self pay is $600–800, insurance price is $900-$1,200), Medicaid may pay even less, around $300. Likewise for other services. The plus is that with a Medicaid card, at least the hospital or doctor treating the otherwise uninsured patient has a paying person, rather than someone who is a no-pay.
So let’s say we are looking not at Mayo Clinic level concierge treatment, but just bargain basement treatment of diabetes and hypertension at Medicaid rates. Add in coronavirus treatment. Chances are that Medical Assistance bill will come out to about $10–25,000 in Medicaid payments, tops.
I would add to that treatment for cancer patients and others who are immunosuppressed, that is the medications they take damp down the immune system of the body which provides resistance to germs and viruses (for instance, certain courses of treatment for transplants, rheumatoid arthritis, use drugs that suppress the immune system).
However, not every uninsured person who could get the proposed Covid Medicaid card would need any of those treatments, and even the few who would need treatment would not all need Covid19 inpatient level treatment. And again, remember, if the patient can get the treatment for the conditions of diabetes and/or hypertension that make Covid 19 mortality more likely, they may have a milder case or a shorter stay. So not all of the 29–33 million uninsured would need any of those three treatments, and of those who did, not all would need hospitalization.
The Boeing $56 billion divided by 29 million would be $1900 in Medical Assistance Covid 19 benefits for each uninsured person. That’s right, you could cover each uninsured person if they needed it with that card. Right now!
Again, those uninsured people would not all have hypertension, diabetes, pre-diabetes, or Covid19 infection. So on balance, you would be able to give them the knowledge that if they were sick, from those issues, they would be covered. If they didn’t need much treatment, no problem. Out of the total number of uninsured, with all that did not need any of those treatments there would likely be enough to cover those that needed the treatment. [What if the medical exam finds other conditions that could, if untreated kill them? Well, I’d say we should ask that question to the Senators who feel no person, especially a poor person, has a right to medical care. Go on — some of us are represented by those folk — go ask them! ]
So which would you rather see — Boeing being paid, in a most uncapitalist way, with a handout — the anathema to conservatives? For having dug their own hole with a plane that was out of balance to begin with, and whose CEO and executives got huge salaries all the while ? Or would you rather see over 29 million uninsured people in this country, including children, at least be in a better position to avoid death from Covid 19? If you were to add in some of the billions from the no-strings-attached loan-ish programs for large corporations that Congress enacted this year and last, you’ve got a heckova health care program, for relatively little money.
Git ‘er done — fast!
With the pandemic, and the continuing wave of infections as states “open up,” and the number of uninsured people, we need a fast rollout. By using the Medicaid structure, there is already a lexicon of health issue codes and reimbursement rates all medical providers are familiar with. There are offices that ride herd on those programs in all fifty states and territories.
So here’s how it might work — each state or territory’s Medicaid office would have a number generator. Someone needs medical care for one of the conditions, and the hospital clinic makes the person give them information on general income/assets, sign the same document Medicaid requires saying they agree, if they fib it’s fraud. Then the hospital calls up the State, gives them the person’s identity information, gets a number, a card could be issued on the spot, and the person is good to go.
[What about fraud you say? Well, the uninsured person or family that sould get this type of Covid Medicaid card would, at best “get away” with having a medical treatment paid for. Provider and recipient fraud is already covered by existing law. If the person did get medical care and it was needed, even if they got the card lying about something, a sick person is made well. Is the overarching concern that decides if we have a program that one person got well when they should have paid? We may wish to consider whether that’s how to decide on a health care stop-gap measure at a time of pandemic.]
It’s a rough proposal. It’s far from perfect. But to do nothing is to condemn many to needless death. It’s as if a boat is sinking, and we have available life preservers, do we play Deity and say “oh, I could toss one to you but you are not deserving — -you haven’t paddled far or hard enough” — when we know there are many who can afford good health by no sweat of their brows, but by luck, inheritance, or being elected? [After all, all of those snorting-look-down-their-noses-at-the-poor-and-dying Senators & Congresspeople have their health insurance paid by us, the taxpayers. And don’t forget, it’s one of those terrible ACA policies they want to take from all of us].
If you agree, please tell your Congressperson & Senators you want this or a better program enacted NOW! Do this most effectively by writing them a letter, send that hard copy after you have faxed it, block and copy for an email if you want, then calling them. Tell your friends to do the same. Please — no petitions! Politicians don’t read them or care much about them, and they are disempowering. Politicians fear people who care enough to write — because they may care enough to vote…..and vote them out!
If you disagree, at least have the uprightness to further a policy that will provide for treatment for the uninsured, now, not 20 years from now. If it works I shall commend it with glee. With brio, even. [And yes, I realize the figures are very rough approximations. But consider, also rough estimates are the assumed expectations that given money or tax breaks— with no strings attached — that large corporations will do the right thing. Costs for Diabetes care per person are around $4–15,000 per year depending on the state, and not all would have full blown diabetes https://www.cdc.gov/pcd/issues/2018/18_0148.htm Figures for hypertension vary, but all agree that if those at risk get treatment costs are reduced].
NOTE: This article was originally published in the Spring of 2020. As I type this it is now May, 2021. One year went by, and I ask “imagine if this plan had been pushed through last year, how many lives could have been saved? “ Given the sums of money being authorized in Washington, at a minimum something like this should be included. Ideally, a more comprehensive plan, but SOMETHING NEEDS TO BE DONE FOR THE UNINSUREDS! All uninsureds, for if we have pockets of Covid that go untreated, we all will be effected.
It’s now June 2021. We know that even kids get “long haul” post covid infection symptoms and need care. But nothing is done and the Delta/BostonAreaCode Variant/B1617 is bearing down on us and more people will be needing treatment, and yet only some ACA expansion has happened. No massive help for the working poor to get healthcare. No Medicare For All passed. And yet the number infected with Covid who may have long haul symptoms if vast and increasing, and will increase drastically with the B1617 variant.
And for those who think it’s not their problem, the 1617 variant causes “breakthrough” infections in at least 10% of those fully vaccinated. In other words, take the millions who have been vaccinated, divide that by 10, and you get the number of possible infections occurring in those fully vaccinated!
Maybe we’re not sure to say that access to healthcare is a right. But when not providing it not only causes suffering that is preventable, but a source of infection that we all may face, it elevates a political aversion to government benefits to a self-defeating theology.
So do write and call your Congresspeople and Senators, and ask them to include the uninsured, all of them, and if they don’t feel they can then suggest that something like this in a time of pandemic makes sense for all of us.
Be well, vaccinate, and call your elected officials!
Have questions, comments? There’s a comment bar below this, or you can write to me at: issuedujour@gmail.com
[update — since I wrote this nothing has happened for the uninsured, especially those without papers. Medicaid may expand but in most states the paperless are not covered. So it’s vital to write your Congressperson and both Senators, because otherwise it won’t happen.
BY WAY OF MATERIAL THAT USUALLY APPEARS IN FOOTNOTES, the following:
On numbers of uninsured for health coverage: https://policyadvice.net/insurance/insights/how-many-uninsured-americans/
from later in 2020: https://www.latinorebels.com/2020/08/24/covidlatinosaugust/
Then in 2021: https://www.latinorebels.com/2021/04/15/amilestoneofmisery/#comment-132324
For the uninsured in general, being uninsured lead to higher rates of Covid and higher death rates: https://familiesusa.org/wp-content/uploads/2021/03/2021-37_Loss-of-Lives_Report_AnalysisStyleB_Final.pdf
So if you think this is wrong, please do 1) write and call your congressperson and Senators, 2) ask friends to do the same 3) share this with them.
I’m not invested in this — but we need something that can be implemented quickly. We did nothing to help those with the B117 surge. Now before the next B1617 driven surge will we act?
Peter Munsing is a lawyer who has represented the indigent and also injured workers & their families in a number of states, since before there were VCR’s. He currently makes good trouble in Reading, Berks County, Pennsylvania.
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