John – This’ll be my last stab at this today. I’ve very much enjoyed my first blog session and look forward to further joint efforts – especially when we can do “simultaneous posts” (if that’s the right term) after the Justice Center launches its own blog section later this summer. Here are a few responses to your latest Medicaid and Russia comments:
Yes, Medicaid costs have risen. Yes, it’s a far from perfect program. Yes, it is covering more people today than it did in the past. While it?s easy to talk in general about eliminating “optional services” and “expanded eligibility” there’s no getting around the fact that when we do this, we impact real people with real needs.
One of the biggest expansions in the state Medicaid program of recent years occurred in 1999 when Medicaid coverage was expanded to seniors and people with serious disabilities and incomes below poverty (currently an income of about $776 a month.) This change allowed about 40,000 people in poverty to afford prescription drugs.
Or maybe (like the NC House) you?d like to cut one of the other major “optional” groups of people to whom we’ve extended health coverage — pregnant women whose family income is between 151% and 185% of federal poverty guidelines, (i.e., between $18, 860 and $23,107 for a two person family). Decent prenatal care means healthy babies, but since North Carolina has the tenth highest infant death rate in the nation, maybe cutting such care isn’t such a hot idea.
While far from perfect, North Carolina is near the middle of pack in average state Medicaid spending per enrollee. Sure, we’ve invested in our Medicaid health insurance system over the last ten years, but that has meant a healthier workforce, better educated children, and thousands of new jobs and economic activity.
Finally, I too hope that we can have further debates about the growing gap between the haves and have nots in modern America (and maybe even Russia, too!). Ultimately, no single issue goes more directly to the divide between the two worldviews of our organizations than that of what is the best and most effective means of growing and dividing the economic pie. Peace.