My current social work course for my Masters in Social Work, is Social Policy 2. Social policy 1 was a history of social policies in the United States, from child protective laws to voting laws, to Medicare and Medicaid, to civil rights and food stamps. The current course, though, is about advocacy: learning how to advocate for changes in policy when you notice a problem in the system. First we have to choose a particular problem area, then we research endlessly, and articulate the problem and who is impacted by it, and then (we haven’t gotten to this part yet) we figure out who to badger to successfully make change.
I have been overwhelmed by the research part so far. In one week, I read thirty articles, wrote eighteen pages, and did at least ten drafts to whittle that down to a two (and a half) page proposal for my project. My focus: the gaps in Medicare, both as a result of the 80/20 split between what Medicare covers and what the beneficiary is responsible for, and in what is covered (not dental, vision, hearing aids, or long term care). Why is long term care designated to Medicaid (the health coverage meant for low-income individuals), rather than to Medicare (which is meant for the elderly and disabled)?
This all led me into the weeds of Medicaid, which is one of the primary targets for budget cuts, both of the current presidential administration and the Republican House and Senate plans to replace Obamacare. Many of the billions of dollars they plan to cut from Medicaid will inevitably come from long term care services for the elderly and disabled.
This led me to the backdoor legal schemes people are allowed to use to hide their income and/or assets, in order to qualify for Medicaid, and the difficulty of those low income people, who are not low-income enough, to afford the elder care lawyers who can competently advise them on the different types of trusts available.
If you have absolutely nothing ($845 a month income, for 2017), Medicaid will catch you when you start to fall through the safety net. But if you have even a drop more than nothing, you are screwed. There is the option of a spend-down plan, where you must incur medical bills in the amount of the difference between your income and the Medicaid income cap every month, in order to get Medicaid coverage, a month at a time. But publicly financed advisors (AKA Free) are not allowed to advise you on the trusts that could hide your extra income, and don’t have enough hours in the day to help each person who needs help to organize a viable spend down plan.
This leaves a lot of seniors without dental, vision, hearing aids, long term care or medical transportation, and in fear of the 20% of any doctor visit or procedure that is not covered by Medicare. Which leads people to skip even the services that Medicare covers, because they can’t afford the fifteen dollars for a cab, or the fifty dollar copay for even routine appointments.
There is a campaign slowly going around the United States called Medicare-For-All, with a version that passed in Vermont, and one that made it through the New York State Assembly three or four times now (but has not been able to pass the state senate), and one in California too. What interests me is that what they are calling Medicare-For-All is really not Medicare as we know it. Someone decided that in order to create universal health care, we’d have to fill in the gaps in Medicare as it is, adding dental, vision, and long term care, and limiting co-pays.
So my question is, even if we as a country are not ready to pursue universal health care for everyone in the form of Medicare for all (and it seems obvious that we are not there yet), could we be ready to fill the holes in the health care system that covers the elderly and disabled among us? Is that a step we could tolerate?
Once I fix Medicare and Medicaid, my next project will be to figure out how to add pets onto our existing health insurance plans. Because, really, my dogs are family members. If human children get to stay on their parents’ health insurance until age 26, to make sure they can earn a living on their own before they have to buy their own insurance, surely my puppies, who will never be allowed to work for a living (anti-puppy prejudice!), should be covered by their family’s health insurance too. No?