This week there was a flood of news about the disgusting abuse of a white man with intellectual disabilities who was beat and abused by four teens of color from Chicago. The offenders saved the police serious leg work by broadcasting their odious activity on Facebook. Do not get caught up in this one incident. I do not excuse their behavior because the real crime spree against people with disabilities was unfolding in Washington D.C.
This week, Republicans, in the House of Representatives, will reveal their plan to disassemble the Affordable Care Act (ACA), while simultaneously destroying Medicaid. If the lawmakers are successful in pulling off this audacious caper, they will be sentencing hundreds of thousands if not millions of Americans with disabilities or pre-existing condition to a premature death. Some will accuse me of hyperbole, but in truth I am probably understating the true impact of the cabal being hatched.
First, let's consider repeal of the ACA. Over twelve million people have signed up through the exchanges. Of these, nine million are receiving help through partially funded premiums. If there are no subsidies, how many of these individuals will still be able to afford their premiums? How many of them did not have insurance because they had a pre-existing condition that made insurance extremely expensive? Do not forget that with pre-existing conditions, even if someone could afford insurance, it still did not cover their limitation or disability. They were often forced into "high risk pools" which have very high premiums because everyone in them has a disability or has been treated for something like cancer or heart disease.
There are also 1.5 million young adults who now have insurance because they are on their parents plan. Many of these individuals will probably not buy insurance either because they cannot afford it or because when you are under 27 years of age you believe you are invincible.
Now, consider Medicaid (MassHealth in Massachusetts). Under the ACA anyone under 134% of the poverty level became eligible for Medicaid. Prior to the ACA, each state set their own guidelines for the program. In some states, your income had to be under $4,000 to qualify. Indeed, this is still true in some states that never accepted the ACA. Under the ACA seven million more people joined Medicaid in the thirty-one states that adopted the ACA.
It is highly likely that the Republicans will propose block granting Medicaid to the states. The states will get a set amount from the Federal Government and will be free to set their own standards. For consumers, it will mean a mish-mash of programs that vary by state. Right now states decide which programs to run (i.e. PCA) and the Federal Government reimburses the state a set percentage. That has allowed some states (such as Massachusetts) to have generous standards and programs. Under block granting each state would get a set amount of money. It is highly likely Congress would cut Medicaid funding before block granting.
For our community, cutting federal standards and block granting Medicaid would be extremely bad news. For those not on Medicaid, being forced into an expensive high risk pools will force many to drop their coverage. One estimate is that as many as twenty-four million Americans could lose insurance coverage.
The events in Chicago were appalling. Four young people will likely spend considerable time behind bars, which they richly deserve. But sometimes the greatest danger lies away from the limelight. The danger lurks away from the glare of the klieg lights because they are complicated, and not easy to cover in 45 second sound bites. But they can be much more deadly.