Concern over new Medicaid proof-of-citizenship law leads White House to talk of exemptions

Rivka at Respectful of Otters is blogging again, which I learned via Feministe.

Last Sunday, she analyzed the new law requiring future and current Medicaid recipients to provide proof of American citizenship to get (or continue getting) benefits. It went into effect July 1 and causes concern because many of the 55 million current recipients will find it difficult or impossible to provide the paperwork state governments now need in order to keep their federal funding. All to avoid the problem of illegal immigrants ciphoning off tax payers money for medical care although, according to The Washington Post, a "federal inspector general's report conclud(ed) that there was little fraud by noncitizens." Rivka says:

This rule affects homeless people who have only a garbage bag full of posessions to their names, and no idea where any of their relatives might be. People institutionalized because of mental illness or mental retardation. Elderly people born before all births were recorded - particularly elderly black Southerners, who were likely to be born at home due to Jim Crow hospital policies, and the rural elderly poor. People who are no longer able to communicate clearly due to disability. They don't have passports. They may not know where they were born, or be able to communicate it to their caregivers.

The trouble of administrating all this falls upon already over-burdened state agencies. Can you say "Republican unfunded mandate," three times fast? Rivka again:

We all know that the Bush Administration and their allies in Congress have never signed on to the maxim, "better that ten guilty men go free than one innocent man be punished" - their Guantanamo policies make it clear that they believe the reverse, many times over. On the domestic side, it's clear that they also believe that it's better for ten deserving people to go unhelped than for one "undeserving" person to receive benefits to which they are not entitled. And yet they, the majority of them, call themselves Christians.

Well, lawsuits have been filed, of course. And yesterday the White House announced it would exempt about 8 million people, mostly developmentally disabled citizens who have never worked and some nursing home residents. It's been noted, however, that homeless people and many foster children will still be among those likely to fall through the cracks and lose health care because they lack documentaion.

I'm always fascinated by the comments when blogs write about policies affecting disabled people and Rivka's post doesn't disappoint, though I don't believe anyone has yet thrown out the always ironic "you'd have to be blind to not see..." as part of their argument. Rivka and others do a fine job covering the interests of those most affected by this policy, but here's a sampling of comments:

Here (in the UK), somebody not getting adequate medical care is headline news, and it provokes embarassing questions for the politicians.

and

I also wonder whether this could be a defensible form of triage. By which I mean: You will always make some sacrifices in treatment. You might deny people lifesaving surgery at age 95, to save money for immunizing 6 year old kids. We do this because the OVERALL benefit is positive, and public health is generally concerned with the overall benefit.

So if this plan is implemented, even if some folks slip through the cracks, if we do a fairly good job of catching most of them, you might attain an overall benefit.

and

As someone who has worked in a public hospital for over a decade, all I can say is "ha!" We're lucky when the private hospitals stabilize properly before sending the patient. Actually, no, we're lucky when they send the patient via ambulance instead of dumping them in a cab and sending them unmonitered and unannounced.

and

We spend quite a bit of money doing expensive procedures on people who have fairly limited life expectancy. As an example, we spend an extraordinary amount of money on trying to keep old, sick, people alive; we also spend an extraordinary amount of money on each ultrapreemie. But I don't want to even discuss good/bad specifics until is is excruciatingly clear that we're talking only on theoretical grounds. And I'm not yet comfortable in that respect: this isn't a theoretical healthcare blog, and I have no desire to be misrepresented as a babykiller.

While I can respect the desire to debate the extremes to see where it will lead you, the theory of sacrificing the old, sick and disabled for the public's greater good (Singer? Anyone? Anyone?) doesn't have to be theoretical. It's been done before. (At that last link, note the second link on righthand sidebar estimating money saved in foodstuffs when those marked as "useless mouths" no longer need to be fed.)