A Medicaid Purge is Under Way

With the pandemic crisis passed, the government has ended special provisions that allowed millions to be covered by Medicaid. Until recently, 93 million people—one in four Americans—were on Medicaid or on the Children’s Health Insurance Program (CHIP). Since pandemic protections ended on April 1, more than 600,000 people have lost their Medicaid coverage. The vast majority lost their coverage because they failed to complete and submit paperwork, as required by state policy.

For example, in Indiana, 53,000 people lost coverage during the first month after the end of pandemic provisions. Almost 90 percent were taken off Medicaid for things like failing to return renewal forms. Many forms were mailed to out-of-date addresses. Activists have urged state officials to give people more than two weeks’ notice before losing coverage. In Florida, 250,000 people lost coverage, 82 percent of them for failing to complete paperwork.

It is clearly unfair to penalize people for failing to fill out and mail in forms. The poor, and especially vulnerable people of color among them, are not adept in dealing with often complicated forms. For those whose first language isn’t English, the process is still more difficult—most forms offer only limited foreign language options. What’s more, many people on Medicaid simply did not know they had to fill out lengthy forms to renew coverage, because during the three years of pandemic provisions renewals weren’t required.

Data from14 states that began cancellations May 1 show that 36 percent lost Medicaid upon review of their eligibility. Most people will get coverage through their jobs, or they will quality for coverage through the affordable care act. Nonetheless, millions of others, including children, will become uninsured, losing access to preventive care and basic prescriptions. The uninsured rate will rise from a historical low of  8.3 percent today to 9.3 percent next year.

Going without access to medical care for many will result in untreated chronic illnesses—diabetes, cardiovascular conditions, hypertension—spiraling out of control. These patients will eventually end up in emergency rooms and costly hospital beds, at the expense of state taxpayers. This is ironic given that states looking to purge Medicaid rolls do so to save money.

There is an alternative. The experience of a unique network of inner-city physicians in New York City—most of them primary care providers—demonstrates that affordable, superior care for Medicaid recipients can produce significant savings. The 2,500 doctors are part of SOMOS Community Care and provide care for some 1 million of New York City’s most vulnerable and needy Medicaid recipients, mostly African Americans, Asian Americans, and Hispanic Americans. 

SOMOS doctors operate under the Value-Based Payment (VBP) system. VBP stipulates that providers are paid according to longer-term health outcomes of their patients. The healthier the patients, the greater the compensation for the doctor. SOMOS has put in place a model of healthcare that enables and encourages physicians to do their best. The key to success is doctors really knowing their patients and responding to their needs—medical, behavioral, and social. This comprehensive understanding of patients cultivates a strong doctor-patient relationship, with the doctor assuming the role of a trusted figure—not unlike the traditional role of the family doctor who was recognized and respected as a community leader.

Community Health Workers play a critical part as the eyes and ears of SOMOS doctors. They visit patients’ homes, reminding patients of doctors’ appointments and assessing their living conditions. The home may have mold issues, or money is scarce due to unemployment, and there is no access to education. These factors are known as Social Determinants of Health, which have a significant impact on medical and behavioral health.

Overall care of patients is carefully coordinated and kept track off. SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, serving as a portal for patients to access the care that they need. The primary doctor can monitor patients’ progress, for example if they must go for treatment to specialists.  The patient is never left to wander alone through a labyrinth of difficult to access care, as is the case with traditional Medicaid. Finally, many SOMOS doctors share the background and culture of their patients, another element that builds trust.

Functioning as a part of an innovative health care initiative launched by the New York State Department of Health called the Delivery System Reform Incentive Payment (DSRIP), SOMOS proved superior care produces significant savings. SOMOS succeeded in reducing by 25 percent both unnecessary visits to the emergency room and costly hospitalizations. This accomplishment saved New York State taxpayers $330M.    

Reforming Medicaid—especially by introducing the Value-Based Payment system—would obviate the purging of Medicaid rolls, and instead make for healthier patients and significant saving.

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Immigration Reform Now!

We all recognize the images in recent news. Buses transport people to discard and abandon them in some “sanctuary” city or anywhere else, relegated to the whims of leaders, in Florida or Texas for example, as if they are dealing with cattle, viciously, mockingly and with contempt for the most rudimentary human rights and to satisfy partisan whims – as if they were playing some disgusting, macabre game. The news and the images leave us somewhere between perplexed and indignant and show us the serious, shameful deterioration and moral and social degradation that the political management of the immigrant situation has in this nation.

This is a nation that presents itself to the world as a model of democracy and respect for human rights, without considering the enormous suffering that takes place in a thousand different ways on long journeys and that awaits all who want to achieve “the American dream.”

In our world and times, human immigration is culminating into an unsuspected drama and the human tragedies (separation of families, diseases, violence, displacement, hunger, death, etc.) this causes fall beyond the control of governments and nations. This results in a Dantesque and catastrophic situation, with thousands of human lives in subhuman conditions, and speaks very poorly of our human spirit while we boast of our times of globalization and scientific and technological advances.

Material progress is of little use if we do not advance or, worse, we regress in humanization, solidarity, and justice. All this speaks ill of our degree of civilization and the search for the common good—and not for individual and corrupt interests—that must guide us. This also speaks ill of our leaders here and in the countries from which these migrants come.

Since the most recent IMMIGRATION REFORM, we have been hearing for decades in this nation about the urgency of this issue. Unfortunately, today’s politicians manipulate, politicize, and exploit the issue of Immigration Reform, not for the desire to do justice and seek humanity, but with the electoral interest of one side or the other.

Each political party blames the other in this petty and perverse electoral game; they change the subject; they block it indefinitely. They leave important issues unresolved, causing suffering and uncertainty for the millions of people who—already within our borders and residing here for many years—seek to legalize and normalize their status as citizens in this nation, with all the duties and rights that this entails, so they can stop living in fear, ostracism, in the shadows and at the mercy of so many of those who abuse human and civil rights. These abusers find in undocumented immigrants the opportunity to pay cheaply for labor, exploit labor and persecute those who do not submit to their violence and injustices.

But there are interests that must rank above partisan, demagogic and electoral interests that we must reclaim and prioritize to resolve stalled and urgent immigration reform. These issues include the recognition of human and civil rights, the recognition of the valuable cultural contributions and work that immigrants have contributed in the construction of the development and progress of this great nation, the right to a dignified life and homeland and the need for the stability of this nation to be based on respect for the human being and values such as equity, justice, social peace and respect for life.

 Through humanitarian actions and other contributions, social organizations and churches, among others, seek to relieve this pain and reduce the human drama of migrants inside and, awaiting entry, outside our borders. At SOMOS Community Care, a medical organization where I serve as CEO, for example, we offer medical care needed by newly arrived migrants to our city of New York.

But these are all “first-aid bandages” that do not solve the root of the problem and that—perhaps—achieve the opposite, unwanted effect: that of prolonging the nightmare suffered by millions of our brothers and sisters.

The solution to this serious, complex human problem lies with legislators. Enough of postponing a strong, definitive legal solution for undocumented migrants in our nation! Those who have taken up the task of legislating for the common good must find their political will and determination!

We must remember that this resolution also involves joint work with the governments of the countries from where these migrant majorities originate. These governments—almost always—shoulder blame for this multitudinous exodus, through administrative corruption that impoverishes and creates all kinds of social inequalities, injustices and violence that force so many to leave everything they have and have earned to seek better living conditions.

In the United States, within our communities, our political, social and religious leaders must solve this enormous human, social and international problem, and it occurs to me, right now, that this includes, especially, Hispanic community leaders. IMMIGRATION REFORM as a political and legal action requires commitment, organization, the unification of all forces and demonstrations as an instrument of social pressure before our lawmakers.

Our present-day migratory phenomenon differs from that of decades ago. Humanity and its history are dynamic and ever-changing. Therefore, the IMMIGRATION REFORM that we need right now must consider today’s new realities and cultural and social changes.

When a human being suffers, humanity suffers. So, no one is without blame or disconnected from the phenomenon of migration and its sufferings. We all bear responsibility, and we can and must do our best, invest our best efforts, to find a definitive legal solution that will restore the right to a dignified life and hope for a better tomorrow to millions of men and women who need and deserve it.

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