Even though it can’t get a plan past Congress to repeal the Affordable Care Act, the Trump administration is intent on resorting to other means to unravel health coverage for low-income Americans.
The administration has tried its utmost to sabotage federally subsidized, Affordable Care Act-sanctioned health insurance plans in the individual market.
It’s also set its sights on undermining Medicaid — the decades-old health insurance program for low-income and disabled Americans.
At the start of the year, the administration invited states to propose imposing work requirements on Medicaid recipients. It’s a policy that would likely have a minimal effect in exhorting more Medicaid recipients to work (most of those who can work are working already), but would almost certainly result in fewer low-income Americans with health insurance coverage. The administration seems to have acknowledged that the policy could even result in the loss of coverage for Medicaid recipients in some states who comply with work requirements and start making too much money to qualify for coverage.
The administration’s latest attempt to undermine Medicaid comes in its federal fiscal year 2019 budget proposal, where it indicates that the federal Centers for Medicare and Medicaid Services plans to issue new regulations that would allow states to drop what has been a bedrock of Medicaid coverage: nonemergency transportation services.
The thinking behind the transportation benefit is simple: Medicaid recipients who, by definition, have little money to spare need rides to the doctor. If they can’t get to the doctor, what good is their health coverage?
Multiple studies have found that transportation problems are a major reason for missed appointments among low-income patients and that a lack of transportation is a real barrier to accessing health care.
Research has also shown that the transportation benefit basically pays for itself. A Florida State University study concluded that every dollar invested in transportation for low-income patients returned a benefit of $11. If 100 rides prevented just one hospitalization due to medical inattention, another analysis found, the return would be $10 for every dollar spent.
Why else would private insurers that sell Medicare Advantage plans offer transportation as a benefit when they’re not even required to?
Medicaid recipients most often use the transportation benefit to get to behavioral health appointments, followed by dialysis and appointments for “preventive services,” according to data from the nation’s largest Medicaid transportation provider, Logisticare.
The Trump administration’s supposedly forthcoming regulations allowing states to stop providing transportation to their Medicaid recipients wouldn’t disqualify people from Medicaid coverage as work requirements stand to. However, in terms of policies that block people from accessing health care without ending their coverage, there’s likely no more efficient way than depriving them of the means to get to their doctors’ appointments.
It’s another mean-spirited move toward the nation’s low-income residents from an administration that seems to have an endless appetite for cruelty and lack of concern for the well-being of the nation’s least fortunate.
Congress shouldn’t allow the administration to continue unraveling what remains of the nation’s safety net.
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