Interestingly, “let them eat cake” is an “alternative fact” about Marie Antoinette and the French Revolution. The story goes that when the French queen was told the people of France were struggling with bread shortages and famine, her response was “let them eat cake.” However, there is no evidence Marie Antoinette actually said those words.
Nonetheless, “let them eat cake” has become associated with contempt, particularly from ignorant, cruel people with more power than they should have. That’s the type of contempt in the Senate’s version of Trumpcare, the so-called Better Care Reconciliation Act (BCRA). It’s also the kind of contempt White House advisor Kellyanne Conway demonstrated on Sunday, June 25 during an interview about BCRA.
On ABC’s “This Week,” George Stephanopoulos tried to get a straight answer from Kellyanne Conway on how $800 billion in cuts to Medicaid (as proposed in both the House and Senate bills) does not result in people losing coverage. Conway said able-bodied adults “will have employer-sponsored benefits like you and I do.”
She more or less said “let them get jobs.”
This ridiculous talking point totally ignores the fact that most American adults qualifying for Medicaid earn $30,000 a year or less (138 percent of the federal poverty level for a family of three). There are barely any jobs paying such low incomes that provide employer-sponsored health insurance.
The people struggling to get by on $30,000 a year or less are the kinds of people Kellyanne Conway takes for granted: the barista making her coffee; the valet driver who parks her car; the retail worker at her favorite mall store; the waitress serving her table at a gala; and so on. In southeast Washington, D.C., my patients are children whose parents are working at several of these jobs in any given week. “Let them get jobs” is a cruel response to my patients’ families struggles. Almost none of them have employer-sponsored health insurance. Almost none of them are paid enough to buy good health insurance with comprehensive benefits. Adding insult to injury, the Republicans’ plans to repeal the Affordable Care Act do not offer enough support to make private insurance affordable.
The overwhelming majority of Americans who qualify for Medicaid are either working or belong to households where someone is working. Currently, there are no work requirements for patients and families on Medicaid, but the House and Senate versions of Trumpcare want to change that. Besides being a counterproductive waste of resources, we need to stop connecting health care to any person’s work status. For far too long, Americans have been misled by a culture of contempt where health care should not be “wasted” on “those undeserving people.”
Let’s be clear: going to the doctor, dentist, or therapist are not privileges to be earned. Health care is a basic human right, regardless of a person’s work status. Medicaid provides that dignity to millions of patients and families nationwide.
There is another reason we must stop contempt for Medicaid. If you are like Kellyanne Conway and do not use Medicaid for your personal health care needs, you are still benefiting from the program’s incredible work:
Medicaid is crucial to every hospital ― including YOURS.
Prior to passage of the Affordable Care Act, hospitals across America struggled with uncompensated care. Services provided to uninsured patients were not paid for by private insurance companies, Medicare, Medicaid, or the patients themselves. Uncompensated care may seem charitable, but it hinders a hospital’s financial ability to improve or expand its services. Also, the cost of uncompensated care is sometimes recovered by increasing the bills to other patients with coverage. In 32 states that opted to expand Medicaid under the ACA, there were dramatic reductions in uncompensated care because hospitals were finally being reimbursed by Medicaid. Under those financial conditions, hospitals expand services, create jobs, and improve the lives of everyone in the community. People who do not use Medicaid for their personal health care needs benefit from the economic growth created by expanded Medicaid.
Under the Senate’s so-called Better Care Reconciliation Act (BCRA) or the House’s American Health Care Act (AHCA), the Medicaid expansion is phased out and the program is decimated with $800 billion in cuts. If these plans become law, state governments will be stuck with extremely low, restricted federal funds to run their Medicaid programs under per capita caps. With such harsh budgetary constraints, hospitals will likely see their uncompensated care costs rise, leading to fewer jobs and services for communities that need them.
Medicaid is vital to nursing homes for YOUR parents and grandparents.
Almost two-thirds of nursing home costs are covered by Medicaid. Seniors who spent their working lives at low income jobs have few personal financial resources to help them afford nursing home care, which tends to be expensive. Similarly, middle class seniors often spend most of their savings on basic necessities during retirement. Fortunately, Medicaid offers all of these seniors peace of mind by covering nursing home care.
As the children and grandchildren of our fellow American seniors, we have to appreciate just how much Medicaid helps our families. If the destructive per capita caps in the BCRA or AHCA bills become law, state governments will be forced to make tough decisions on how much and what kind of nursing home care will be available for our seniors in Medicaid. Without the support of nursing home care, more Americans will opt for working less and staying home more to provide care to an elderly or disabled family member. That decision will be economically painful for millions of families and communities.
Medicaid is a first responder to disasters ― in YOUR community.
Under current law, the federal government has an open commitment to each state’s Medicaid program, which is incredibly important during public health challenges like natural disasters, the opioid crisis, or disease threats like the Zika virus. By providing health care, coordinating between agencies, and educating the general public, Medicaid proves its reliability when times are tough. Thanks to Medicaid, the uninsured rate for children actually decreased during the recent recession while that rate increased for adults (there was no Affordable Care Act to help people at that time).
Medicaid is similarly indispensable to fighting the opioid epidemic sweeping across the country. Opioid abuse hurts families from every economic background, not just “those other people” with low incomes. Medicaid is America’s largest provider of mental health and substance abuse services. The program currently enables health care providers and public health experts to develop effective strategies to help patients and families struggling with opioids. This work is severely undermined by freezing Medicaid expansion under the ACA and slashing the program’s funding.
The Senate’s BCRA bill pretends to make up for its assault on Medicaid by creating a $2 billion fund for treating substance abuse disorders. This is a distraction and a disgrace. Even if this money were doubled or quadrupled, it would not be enough. Furthermore, our fellow Americans struggling with opioids need Medicaid to be fully funded without the limitations of per capita caps or block grants. Patients with substance abuse disorders need the kind of comprehensive care Medicaid currently provides, where both physical and mental health are addressed; and where the connections between housing, nutrition, employment, and health are optimized for recovery.
We have a long road ahead to turn the tide against opioids. The BCRA’s attacks on Medicaid prove the bill and its supporters do not take the work seriously.
According to the Congressional Budget Office (CBO), 22 million Americans will lose health care under the Senate’s so-called Better Care Reconciliation Act. Our response must not be “let them get jobs.” When we save Medicaid from the BCRA or AHCA versions of Trumpcare, we not only save our fellow Americans from unnecessary cruelty but we also save ourselves. All of us are vulnerable. None of us should be expendable. We must disconnect a person’s work status and income from the basic human right of health care. In the richest country on earth, no one should be unworthy of wellness. This summer, we must continue to remind Congress that attacks on Medicaid patients are attacks on all of us.