The President's Column: Fighting for Healthcare Fairness

December 17, 2023

Medicaid reimbursement policy is a racial justice issue.

6653.jpegWe 1199ers know as well as anyone that the healthcare system in our country is broken. Broken into so many different parts that it is more accurate to say that we don’t really have a healthcare system.

If you break your leg and go to the hospital in Canada, Costa Rica or France—they ask your name, assign a medical team to fix you, and send you home when you’re good to go. In the United States, you go to the hospital, they first ask you about your insurance—Medicare, Medicaid, private, whatever—and ask to see your card. In Canada, Costa Rica or France (or many other countries) there are no cards. There is no “insurance.” Everybody is covered by social insurance (the government.) Now that’s a healthcare system.

In our country, healthcare has become a consumer item — not a birthright. And the healthcare “market” is dominated by private insurance. Those with wealth can obviously obtain what they pay for. But for working-class and poor people, it’s a different story. Medicare is a federal program that pays the hospital bills (and other healthcare costs) for those who have reached the age of Social Security eligibility. Medicaid dollars go to pay for the healthcare needs of our poor and elderly. Our home healthcare industry is nearly entirely paid for with Medicaid dollars, which are shared by the federal and state governments. Our nursing homes also rely on Medicaid for 75 to 80 percent of their revenues.

Depending on their patient population—that is, the finances of their patient population— hospitals are also dependent on Medicare and Medicaid dollars for anywhere from 25 to 80 percent of their revenue.

The “system”, such as it is, is clearly skewed to favor wealth like every other aspect of life in these United States. But because Medicaid is run by the states, it is also politically determined. Medicaid rates are determined by what states want to pay. More than a dozen states, dominated by rightwing Republican governors and legislatures, have hugely restricted Medicaid programs limited to those in dire poverty and/or severe disabilities such as blindness. Others, like Florida, subcontract Medicaid to private insurers who market it as “Medicaid managed care.” It goes without saying that for private insurers—profit, not care—is the primary goal.

Most American workers cannot afford private insurance out of pocket. It is very costly and often of poor quality. Employersponsored plans often aren’t much better, unless the workers have a union. Big hospitals, like academic medical centers and their satellites, are in a position to negotiate rates with insurers. But smaller community-based “safety-net” hospitals cannot. They primarily serve poorer communities and are dependent on Medicaid reimbursements.

Medicaid is the largest public health insurance provider in the United States. As such, Medicaid policy has significant implications for the health of people with low incomes.

Medicaid reimbursement policy is a racial justice issue: low payment rates reduce access to quality care and contribute to poor health outcomes for Medicaid patients, many of whom are people of color. A 2022 report by the prestigious Commonwealth Fund underscores that Medicaid reimbursement rates are, indeed, a racial justice issue.

The thing is, Medicaid rates are determined by what the states are willing to pay. In New York, for example, Medicaid reimbursement rates are 30 percent below private insurances. And when Medicaid rates are too low, doctors don’t want to accept patients. So, it becomes an issue of access. This is the contradiction between capitalism and healthcare shown in bold relief. Medicaid is chronically underfunded. States—even those not hostile to Medicaid—have many competing priorities. Which is why every year, we 1199ers have to campaign for adequate funding. When we mobilize in our state capitals every spring, we are there to protect the communities we serve, and in which most of us live.

So, once again, we 1199ers will be campaigning, organizing, lobbying and marching to force our states to do the right thing— bring Medicaid up to speed so that our patients (and our family members) get the healthcare they need and deserve. Until our country finally gets it together to have a rational, modern and compassionate healthcare system, e.g., Medicare for All, it’s up to us to carry the fight to the powers that be. Let’s go do it.