Proposed Medicaid Cuts in Debt Debate Concern Ethnic Health Activists

Proposed Medicaid Cuts in Debt Debate Concern Ethnic Health Activists

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OAKLAND, Calif.—Ethnic communities, especially ethnic women, may have a particular stake in negotiations over the National Debt now dominating the headlines.

One such woman is Laifi Puni, a middle-aged Samoan-American, who visited the La Clinica De La Raza Clinic in Oakland’s Fruitvale district last Thursday with her young daughter.

The Medicaid program (called MediCal in California) covered her child’s care, providing assistance that Puni said is critical to her family. Puni, a mother of four daughters, said she relies on the insurance program for low-income people to cover her medical expenses.

“If I run out of food, there is always someone I can go to and get something to eat,” Puni explained. “But I can’t go to my friends and family and say, ‘Can you find out what’s wrong with my daughter?’”

Sizeable Medicaid Cuts

But Medicaid may become less generous in coming years, and advocacy groups are paying close attention to austerity measures being proposed in federal and state legislatures. Almost all include sizeable cuts to Medicaid, the health insurance program jointly funded by the federal and state governments to cover low-income Americans.

Several recent studies indicate that ethnic families, especially Latino women and children, would be disproportionately affected by cuts to the program.

Hispanics account for over a quarter of Medicaid’s rolls. Medicaid or the related Children’s Health Insurance Program, according to 2009 data from the National Council of La Raza, a leading civil-rights advocacy group, covers nearly half of Latinos under age18.

Also, the National Latina Institute for Reproductive Rights says that women account for 70 percent of Medicaid enrollees.

Activist groups are particularly concerned about proposed debt-ceiling legislation, which needs to pass in some form before the Aug. 2 deadline for the United States to avoid defaulting on its debts.

“It’s kind of hard to say what’s happened in the last few weeks other than to say it’s a mess,” said Deborah Reid, a senior attorney at the National Health Law Program. She spoke during a teleconference last Wednesday and noted that whatever passes will likely “not be a clean bill.” That is, she said, negotiated cuts between Republicans and Democrats in Washington could result in reduced services or the introduction of copayments for Medicaid patients.

Reid said she is particularly concerned about proposals to transform Medicaid into block grants to states, instead of the current variable adjustment system in which funding levels are allocated based on states’ needs.

This proposed change to the entitlement structure may free states from federal requirements that tie funding to specific services, such as maternity care and birth control or care for seniors or people with disabilities.

Block-granting Medicaid – simply giving each state a lump sum each year, an approach favored by governors of both parties -- could lead to service cuts, such as multi-language services and neighborhood clinics that are important to ethnic patients, Reid said, especially immigrants.

Most commercial insurance plans include co-payments. However, Reid said, even amounts as small as $5-$10 are often out of reach for people in low-income communities.

“That $5 or $10 is the difference for people getting food or providing for their families,” she said.

GOP Would Cut Medicaid by a Third

Families USA, a consumer health care advocacy group, crunched the numbers on some specific legislative proposals. For example, the organization says the budget plan proposed by Rep. Paul Ryan’s, R-Wis., and which passed the House in April, would cut funding for Medicaid by one third in 2021.

The Cut, Cap and Balance bill that passed the House last week -- a spending cap proposal popular with Tea Party Republicans -- would cut Medicaid spending by more than a half trillion dollars through 2021, according to Families USA research, based on a prior draft of the bill. Even though the bill stands no chance of passing the Senate, GOP pressures to cut costs without tax increases are affecting negotiations over the federal budget and the debate over raising the debt ceiling.

Reid said that she is concerned about the so-called Gang-of-Six plan proposed by a group of three prominent Republicans and three Democrats, in the Senate. Their proposal calls for $3.7 trillion in deficit reduction and, according to Reid, is sure to make cuts to Medicaid benefits.

Even though the health care reform (Affordable Care Act ) passed last year is set to expand access to Medicaid significantly, Reid said she worries current proposals are likely to undermine this bill.

In California, Gov. Jerry Brown, a Democrat, is currently seeking permission from the federal Centers for Medicaid and Medicare Services (CMS) to cut spending on MediCal by 10 percent.

Legislators in both parties contend that reforming entitlement spending, including programs like Medicaid, is necessary, if painful.

Nationally, CMS says that Medicaid spending grew nine percent in 2009, reaching $373 billion, and is projected to grow an average of 6.9 percent per year through 2019.

At the La Clinica De La Raza Clinic in Oakland, cuts are sure to impact a large portion of their clientele. Of the 68,000 patients who visited their Northern California offices last year, 43 percent paid for services using MediCal. Two in three of those patients were Hispanic.

Despite the concerns and protests of advocacy groups, the debates in Washington remain abstract to most patients

“Some of our patients are aware, some of them are not as conscious,” said Yanet Luna, Communications Specialist at La Clinica De La Raza. “While they do hear in the media about proposed cuts, they don’t really understand it will directly impact them,” she said.

But Puni said she’ll be paying attention.

“I just think they need to find something else to cut back,” she said.