On Saturday, January 13th, 2018, PBS News Hour shared the information that Kentucky is the first state to have Medicaid changes approved under the Trump administration’s recent plan. The changes will require Kentucky residents who receive Medicaid to pay a monthly premium and to be able to show proof of employment, employment activity (such as seeking work), or community service activities. A few segments of the population are expected to be exempt from this: children, the elderly, pregnant women, or the “medically frail.”
The Problem
The problem is that these limitations are merely suggestions. One objection to the plan is that none of these things are clearly delineated. Does “pregnant women” extend beyond the baby’s birth? When would a mother be expected to return to the workforce? Some versions of the plan, from some states (because several are expected to follow Kentucky’s example), add an exemption for those who are care-givers. Does a new mother fall into this category?
What is the definition of medically frail?
More than that, how is “medically frail” defined? Does it extend to those with opioid addiction? What about recovering meth addicts? Will that term cover cancer victims? (One certainly does hope that to be true.) What about chronic conditions, such as diabetes, Parkinson’s Disease, and many other debilitating diseases, to say nothing of those who are mentally ill? People who were around in the 1960s and 70s might recall the increase of indigent homeless after funding cuts closed a number of facilities for the mentally less able.
How can help be given?
What can the indigent do to help themselves and each other? If both the federal and the state government bail on medical assistance, citizens’ first efforts must be to keep themselves as healthy as possible. Websites such as Allison Owens’ Unsullyd Health Page, where wellness information is shared, can be of assistance.
In addition, seeing more activities from groups such as Neighbors Helping Neighbors can turn out to be helpful as well. If one is living in a state considering adopting similar changes, be on the lookout for the elderly, families that are marginally employed in the neighborhood and for those less able to help themselves. If “Big Brother” is only going to stand back and watch, it is up to the rest of the Kentucky citizens to help.
The fears
The primary fear is that many such people will now fall through the cracks opening in the system. Cracks that include increased paperwork requirements to prove lack of ability, penalties for late payment of fees, and the added workload that is going to be presented to social workers who are already over-burdened with paperwork.
Where theory meets reality
If this were not enough, the age that the world is in now demands a changing workforce. Many jobs once available as menial labor are now done by machines. Availability of materials, demand for goods, all these things shift and change – it is part of a free commerce system.
What happens if a factory closes, a mine runs out, or a material is no longer in demand? What kinds of “community service” jobs will be manufactured for the able-bodied poor? During the era of Herbert Hoover, work was created by building dams or setting up monuments and many people are wondering if they will ever see that kind of work created again. Among employers of private businesses, the term “WPA worker” was not a compliment. Many dark and murky things lie down that path.
Regardless of the financial health problems that are facing Kentucky today, the challenge still remains that the citizens need a proper medical plan, one that has no holes showing. Therefore, if Trump’s Medicaid plan can make a difference in the lives of most Kentuckians they might as well try it.
