Democrats’ health care expansions leave the most needy behind

June marked a dark anniversary for Chase Brown and his mother, Lisa. It has been 11 years since the partially paralyzed 29-year-old autistic first applied for community services through Medicaid. He is still waiting.

A recent Chronicle of Houston article examined Brown’s story and the grief of so many other people with disabilities and their families who remain on Medicaid waiting lists for services across the country. As Lisa Brown said of her son, “I just… feel like I don’t know what to do. You know, what can I do for him? I don’t know how to keep it safe.

Yet as the Brown family waits to receive care through Medicaid, Washington Democrats have spent billions of dollars extend “temporary” increases to Obamacare grants that pay insurance premiums for individuals earning hundreds of thousands of dollars a year. The contrast seems stark, but sadly consistent, as Democrats have, over the past decade, put the needs of able-bodied adults ahead of people with disabilities like Chase Brown.

Waiting begets waiting

At 29, Brown’s disabilities stem from autism and the aftermath of a stroke he suffered several years ago. His mother takes care of him as best she can, but after Chase’s father died, she became even more desperate for him to come off the waiting list and finally qualify for the services of Chase. Medicaid. But because community services like respite care — as opposed to institutional nursing home care — remain optional for state Medicaid programs, states can, and most do, impose waiting lists due to of limited resources.

Two factors influence waiting lists, one practical, the other ideological. On a practical level, creating a waiting list can paradoxically lead to more waiting. If people think they might need care in the future, they will often immediately put themselves on the waiting list, so that if they need services, they will be closer to the head of the line. waiting line.

The Chronicle story discussed this dynamic in detail. For example, a publicly funded website encourages Texas parents of children with disabilities to put their names on the Medicaid waiting list “even if you hope your child will never need these services,” saying because of the likely length of the wait.

Unfortunately, Texas and six other states who currently have waiting lists for care assess eligibility and need for care only when people on the waiting list reach the top of the queue, rather than when they seek services for first time. Thus, at least some of the people on waiting lists in these states are likely not eligible for services. It also means that individuals could wait years – or, in Chase Brown’s case, more than a decade – thinking they will eventually receive care, only to discover after all that waiting that they are not eligible. .

Screening all patients on the waitlist for eligibility would impose additional upfront costs on Texas and the other six states that do not assess patient needs at the time of application. But in each case, it would give families and the state a more accurate picture of the total needs within the state.

The role of Obamacare

Another factor looms over the waiting list issue, but receives no mention in the Chronicle’s long history: Obamacare. Because even though Chase Brown and many others like him continue to wait for care, the left has devoted far more attention in recent years to extending Medicaid to able-bodied adults than to treating patients like Chase.

Overall, the most recent data indicate that more than 665,000 people with disabilities, living in 39 separate states, are on waiting lists for care. Most of these people (more than 464,000) have intellectual or developmental disabilities, like Chase Brown. Individuals spend a average of 44 monthsnearly four years on the Medicaid waiting lists before having access to care.

Although Texas has not extended Medicaid to able-bodied people on Obamacare, most of the 39 states with waiting lists for care have. Those who received a greater match (90%) to cover their able-bodied adults than to eliminate their waitlists for patients like Chase (normally 50-75%, but increased by 6.2% as the Biden administration retains its public health emergency linked to Covid).

You don’t have to be a rocket scientist or an accounting degree to understand that states have a greater financial incentive to extend Medicaid to able-bodied adults rather than devoting additional resources to reducing their waiting lists for the disabled. Yet left-leaning think tanks continue to try to deny that these obvious financial incentives have perpetuated waiting lists for people with disabilities, going so far as to publish junk studies claiming there is no correlation. between expansion under Obamacare and waiting lists.

The Chronicle notes that Texas has taken some steps to reduce its waiting list, increasing resources in its latest budget to open up new “slots” for patients with disabilities. As welcome as this progress is, many patients in other states could benefit if their Medicaid programs focused resources on these most vulnerable populations, rather than providing coverage to able-bodied adults.

The next time someone asks why Texas didn’t expand Medicaid, policymakers in that state should point to Chase Brown and his family. Unless and until every disabled Texan has access to the services they need — not a waiting list, but access to real care — the left shouldn’t even think about spending taxpayer dollars to extend coverage to able-bodied adults.


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