A public option, if implemented, would not be in force until 2013. In the nearly four years until we begin to see a reform law in action, lawmakers in both Washington, DC, and in every individual state or district that provides Medicaid for its poor and disabled residents would be wise to make significant changes to the current way it is run, particularly regarding allocation of tax dollars to fund services and relaxing often draconian, stringent eligibility requirements on those who should, by all means, qualify to have at least some health care coverage.
In this video I discuss my own trials and tribulations with the Medicaid program in my home state. I've talked about such things before on other diaries, but this is an attempt to pull everything together. There is some good news. Reform is being proposed that would add close to a quarter of million people onto Alabama Medicaid rolls, but like usual the Federal government is being forced to pony up most of the money, and the state itself might not be able to close the gap, no matter how minor it might be. Much of this is because in red states like Alabama, people are reluctant to allocate enough tax dollars to make the system run with enough funding. While it is still a very poor state, I can't imagine the existing low tax burden would be too much of a drain upon working Alabamians. But as for me, it's too late. I've already lost my Medicaid and it will be very tough to get back. Even if I could re-qualify, the money simply might not be there and the regulations to re-obtain might disqualify me.
To highlight some pertinent points from the column hyperlinked above:
At least 237,000 Alabamians could gain health coverage through the state Medicaid program under legislation now moving through Congress, according to an official agency estimate, and the expanded rolls could end up costing state taxpayers tens of millions of dollars a year.
The estimate, provided at the Press-Register's request, is based on raising the state's stringent income eligibility cutoffs to match the federal poverty level, now $18,310 a year for a family of three.
Even the more modest increase would represent "a tremendous leap in coverage for Alabama," said Jim Carnes, spokesman for Alabama Arise, a Montgomery-based coalition that lobbies on poverty issues. "Right now, we leave parents and working adults at low incomes out in the cold."
Rawls put the cost of increasing eligibility in Alabama at $371 million annually, not including administrative expenses. Under the House measure, the federal government would pick up the full tab for new participants through fiscal 2014, Solomon said, and 90 percent annually after that. But even 10 percent of the tab would be more than the program could handle, Rawls said. "The money is just not there."
At present, the state's income eligibility limits for working adults are among the nation's tightest, according to the Kaiser Family Foundation, a California-based research organization. Childless adults are generally not eligible; those with families have to be near destitution to qualify.
In the health care debate, public attention has been centered on proposals to add a government-backed "public" health insurance option. Less notice has been paid to plans to expand existing government programs to lessen the ranks of the uninsured.
I favor a public option, but let's not make the same mistakes as before when we design it and put it into place.