By Marvin Malek, M.D.
VTDigger.com, July 13, 2023
Thanks to Dr. Jane Katz Field for pointing out some of the implications of the Medicaid “unwinding” precipitated by the end of the Covid-related public health emergency.
During the emergency, Medicaid programs around the country were prohibited from disenrolling anyone already in the Medicaid program. With the end of the public health emergency, Medicaid eligibility determinations have resumed, and millions of Americans — including thousands of Vermonters — will lose their coverage.
Dr. Katz Field points out that many individuals who lose coverage actually are eligible, but are unable to properly collect and file the information.
But that doesn’t apply to millions of others. These individuals have been able to increase their earnings, and if their incomes rose to 38% above the poverty level or more, the letter will arrive in the mail: “Your Medicaid coverage is terminated.”
The best option for these individuals is the Obamacare exchanges: For a couple earning $50,000 annually — hardly swimming in money — the average Obamacare policy’s premiums add up to $2,970 annually. That wouldn’t be so bad, but before their coverage kicks in, the deductible will average $3,200.
So, aside from some preventive care, you have to spend $6,170 before you can actually use the coverage. And if it turns out that you require a lot of care, you will face ongoing expenses until you’ve reached $18,200. It’s easy to see why so many people simply choose to take a chance and go without any coverage.
For generations, Americans have prided themselves on our work ethic. If that’s the case, then why are we punishing people who return to the workforce by taking away affordable health coverage?
The Medicaid unwinding is expensive: Tens of thousands of employees of state governments around the country will spend uncounted hours poring over applications, and making their declarations: You can remain in, you’re out, or bring in more info. The cost of this institutionalized cruelty will total several hundred millions of dollars nationally.
How about if we try something new and different in the U.S.? How about if we redeploy these government workers and have them say yes to everyone? Enroll every single American in an improved Medicare with minimal copays, and, once and for all, put an end to this organized cruelty that passes for a health care system?
It’s absurd to punish people for returning to the workforce by providing them with that uniquely American version of health insurance: The kind that works well — unless you actually get sick.
There has never been a reason why Americans wait until age 65 to enroll in Medicare. Let’s start enrolling all Americans at birth.
This commentary is by Dr. Marvin Malek, an internist and member of the executive committee of Vermont Physicians for a National Health Program.