Column: The Politics of AIDS
By Kai Wright
The nation’s governors have finally said uncle. Last month, they gave in to the Bush administration’s reckless plans for slicing up the nation’s health care safety net.
The National Governor’s Association summer meeting in Iowa rightly focused on the largest problem most of them face, both fiscally and politically: What to do about their states’ skyrocketing healthcare costs. Their solution was to make poor people pay for it.
Medicaid — a joint state- and federally-funded program that provides health insurance for the poor — has been a budget buster for just about every state in recent years. Nearly all of them have instituted some sort of cost-control restriction this fiscal year — at least 43 limited access to prescription drugs in some way, 15 tightened eligibility, nine cut benefits.
Medicaid is the largest single payer for AIDS treatment in America, covering almost half of people in treatment today. Positive African Americans in particular turn to the public insurance program. Only 14% of positive Blacks have private insurance, compared to 44 percent of whites living with the virus; 64% of Blacks in treatment for AIDS pay for it with Medicaid or Medicare.
Currently, the federal contribution to state Medicaid programs rises to meet their needs, with the feds kicking in a prearranged share of the costs, no matter how high they go. Since the first Bush term, the White House has been pushing a plan to turn the federal contribution into a fixed, lump sum payment — which would leave states holding the bill for the upwardly spiraling costs.
In reaction to that effort, states have in turn been urging the feds to either pay more or relieve them from a litany of long-standing federal rules designed to protect Medicaid’s beneficiaries.
This spring, Congress passed a budget plan that made it clear that Washington is in no mood to give out more money. The budget blueprint, passed at the administration’s urging, would cut Medicaid spending by $10 billion over the next five years, while handing out another $106 billion in tax cuts over the same time period.
So the governors circled their wagons and emerged with a plan to trim the program’s costs before Congress does it for them. At its core is a proposal to allow Medicaid to begin charging co-pays – the first step in devolving the safety net’s costs to the people it’s supposed to be helping, people who are already living at the poverty level.
The governors’ plan also asks for more “flexibility” in designing their states’ programs. That would mean the end of a national standard for what level of healthcare is considered a basic need in America. It would likely also mean forcing poor women to face the same sorts of bizarre hurdles and mazes that welfare “reform” presented.
One example of what states may do with their new “flexibility” can be found right in Iowa. There, a pilot program wields co-pays as incentives for healthier choices: lose weight, and you don’t have to pay anything for your care; keep packing on pounds and it’s coming out of your own pocket.
Another option, of course, would have been to invest in prevention by encouraging doctors’ office visits where patients could learn about nutrition. But then, that wouldn’t be in keeping with the declared intent of the incoming NGA chair, Arkansas’ Republican Gov. Mike Huckabee, to focus on personal responsibility in healthcare.
While some Democrats made meek noises about the co-pay proposal, all 50 governors signed onto the larger plan. That leaves nobody but healthcare advocates standing against Medicaid’s erosion.
The governors’ plan does demand greater rebates from drug companies, and some governors noted that they wouldn’t exercise their co-pay options. But as any public policy vet will tell you, the real threat is in having ceded the intellectual ground. If Congress embraces the governors’ proposals, America will have discarded a central tenet of its once Great Society – that there exists a basic standard of health care that even those who can’t pay for it deserve.