My testimony prepared for Medicaid expansion hearings at the Ohio statehouse on behalf of Ohio Rising:
For many years and in multiple states, I worked in the healthcare industry for a company that specialized in care of medically fragile children in the home. Our primary payer source for this type of work was Medicaid. I negotiated contracts, worked with care providers and built operations teams all designed to facilitate the best possible care for medically fragile children. For this reason, I am extremely familiar with Medicaid from a variety of perspectives.
This experience further informed my views on the largely negative role of government in people’s lives, and can be summed up in a story about a real family and a real little girl who for privacy purposes, we’ll simply call Chantelle. Her story can be told time and again as it is representative of so many children and families across Ohio and the United States.
Chantelle was born prematurely because her mother made the mistake of doing drugs before and during the pregnancy, leading to a very problematic pregnancy and doing irreparable harm her child in the process. Like many children whose mother’s make the wrong decision with regards to drug and alcohol abuse, Chantelle was born severely premature. Her lungs were underdeveloped at birth, facilitating months in the hospital before she was even strong enough to go home.
Underdeveloped lungs normally give way to two horrible realities – first, the child, as was the case with Chantelle, will be ventilator dependent for an extended period of time (sometimes their entire life), and as a result of this dependence they are often forced to receive nutrition from a g-tube in addition to being particularly susceptible to all types of infections and disease that will result from this medically fragile state.
In Chantelle’s case, despite the fact that she was born to a mother with some drug problems, she did have a father, which quite tragically is far too rare in these stories. With that said, it was nice to have a father involved. At this moment in time, mom was not employed and dad was employed in a rather low paying job looking for more stable work.
Our company provided a variety of services to Chantelle for an extended period of time, and a number of things became infinitely clear in Chantelle’s story as in countless numbers of stories just like her.
1. Chantelle was a tough little critter capable of beating many of the challenges to which she was born. She was a fighter, and an adorable child.
2. But, mom resented being in this situation and created a horrible destructive environment which regularly ran nurses and a variety of care providers away. She refused to follow care plans designed by her doctor and our clinical director. She was regularly non-compliant with doctor’s orders, and was on multiple occasions reported to social workers by our clinical team as that was our course of action when we saw non-compliance or threats to our patient.
This back and forth became all too common. As an ongoing fight, and against doctor’s orders, Chantelle’s mother would regularly move away from prescribed nutritional regimen and feed her daughter horrible food in high quantities via g-tube. This resulted in an unnecessary case of childhood diabetes further complicating care in the home.
In fact, anytime tough little Chantelle showed significant signs of improvement, mom stepped in to (consciously or unconsciously) sabotage the progress. I truly wish this was not true, but it ended up being the reason Chantelle was discharged from our care – non-compliance and endangerment.
Over months of time, as our staff talked to mom about why she was doing all of this – it became clear that she didn’t really want her daughter to get better. She’d come to rely on staff at her home all the time, regularly leaving the house unexpectedly and for hours at a time using our staff like babysitters for even her other children.
Chantelle’s mother was a user, and not just of drugs, but of people. She was using Medicaid to perpetuate a lifestyle that would be gone if her daughter’s health improved. Chantelle’s health could have improved and she could have beaten her childhood COPD and her life of g-tube feedings, but mom’s behavior and lack of responsibility and self-ownership made this impossible.
And, the sad thing is – Chantelle’s father was not much better. At one point he had an opportunity to take a job that had much better pay and solid benefits including insurance, but the insurance wouldn’t cover the around the clock nursing care and he wouldn’t have qualified for some additional need based benefits currently supplementing family income, including Medicaid, so he passed.
The mother had the skills and training to take care of this child, and the father could have embraced another life which would have provided greater prosperity for his family with a little extra work and sacrifice. But neither wanted to do this. They had become dependent on this system. It was a way of life they were unwilling to give up.
I lived and breathed every part of this story and many like it for years talking to families, doctors, care providers, case managers and everyone else involved in complex care of this kind. The story of self-destruction and terrible and costly health outcomes is all too common. The abuse of the system is even more common – doing just enough to remain qualified for care, but never enough to require discharge. Parents often know the right answers to the important questions that always keep them eligible for the respective benefits.
When I think about it, even in these moments, it breaks my heart. Why?
Because it’s an unnecessary story.
Drug abuse was the beginning of the problem, a riddle which government law, oversight or funding has been unable to solve. Because of the horrible personal decisions made by Chantelle’s mother, and the enabling environment in which they lived where this type of behavior is far too common and far too accepted – a series of events was set in motion. Crisis and higher cost pregnancy, extended and regular hospital stays, incredibly high need for care, staff, treatments and much more.
And maybe the most heartbreaking part of all is that when a little child could and should get better, her mother pushed against improving her health to perpetuate the government funded world on which she had come to depend.
Medicaid and welfare dependence for them wasn’t a safety net that helped them through a tough time – it was a way life. It was a way of life for them, and far too many in their community. Frankly, I’m not sure they knew any different. I never saw any sense of guilt or remorse over the scenario, and what became crystal clear over a year as Chantelle’s mother became more and more demanding was that she felt like these services and this care was owed to her.
So let’s talk about the really difficult things that no one wants to talk about. Government has become an enabler of these terrible scenarios. I just explained how Chantelle’s family had problems before she was born, but her life made those problems even worse. She later became the means to facilitate such behavior in her family for a much longer period of time.
Chantelle’s mother had lost all incentive to take over permanent care for her own daughter and see her future to its fullest potential. And with mothers and fathers like this as role models, what do you think will be the course of action for Chantelle’s siblings?
Medicaid is supposed to be a temporary welfare program, and we all hope that it isn’t a way of life for anyone. But it is, and it has become a way of life for so many. We understand when people are caught by a temporary social safety in the worst of times, but must always be facilitating an environment that is conducive to long term prosperity and growth for as many people as possible, so they rarely – if ever – need such a system.
By putting more people into an environment with no incentive to improve, prosper and change – we are creating a dependent, not independent society of people. Government dependence is an absolute last resort, not a way of life or anything people should embrace. Higher numbers of people less dependent on government in their day to day lives creates a healthy and vibrant society, not the other way around.
Only through personal responsibility and self-ownership can one create the pride, skills and ambition to lead a successful life and break the shackles of poverty.
A brilliant scholar who, to use his own words, was raised in the “ghetto,” understands and articulates the horrors of long term government dependence better than most. Walter Williams wrote a book called “The State Against Blacks” where he outlines in horrible detail the abandonment of individual and community responsibilities that long term government dependence has facilitated in black, urban neighborhoods.
He argues that expansion and extension of the welfare state since the 1960’s actually prevented black communities from making the logical and expected socio-economic jump in a post-civil rights era that should have taken place. Many black communities, entrepreneurship and home ownership were on the rise until the welfare state was introduced. He chronicles the difficult but eventually successful launch of countless rounds of other minorities that always made the leap to prosperity after a generation of struggle.
He shows how long term government dependence is a personal and economic suicide pact. It literally eats await at the soul, for what is left of a person when they have ceded every bit of their pride by allowing someone else take on their responsibilities. What is left of a community who has lost the will to control its own destiny?
If you don’t think this world exists, it’s because you have not sought out the real plight of so many people in our world. Go to the areas with the highest Medicaid populations. Talk to the local care providers and social workers about non-compliance, enabling and destructive behavior and they will tell you the real story. Money does not solve this problem. Expanding already failed programs does not solve this problem.
This does not make the work of any us who have battled in this arena any less noble or any less necessary. It just means we need to give these individuals a better chance at winning – a chance at leaving that world and life behind. That requires incentives for leaving the system and making those who qualify for the care temporary, not long term recipients of that care, and it certainly does not mean putting more people in the cycle of destruction.
Qualifying more and often healthy and able bodies into a system that will enable the abandonment of personal responsibility perpetuates the destruction of society and is both suicidal and unsustainable. The moral reasons to stop investing into a bad system are crystal clear.
But once we are past the moral reasons, we at some point must discuss hard numbers and real policy. And in this area, we have tremendous problems as well. The discussion to expand Medicaid is occurring on a flawed premise for 2 major reasons.
1. With regards to taking money to expand Medicaid with a hybrid/federal exchange program, the legislature is assuming the PPACA provides a loophole that doesn’t exist. There is no such language of legislation in existence for this flexibility, which will necessitate creation of policy through bureaucratic means. This has no place in a society whose foundation rests on rule of law.
2. With regards to sustainability of a multi-billion dollar program, the legislature is looking at taking federal money that doesn’t exist. This is hard, simple and unfortunately very cruel math.
A flaw in this hybrid model people are discussing using the federal exchange is that – the federal healthcare bill does not provide a path to taking the money under outlined terms and conditions and then building your own customized solution. There is no law, definitely not PPACA, that provides this path.
That solution is predicated on the idea that we should trust the federal government and massive bureaucracies to do the right thing – bad idea. History shows us the flaw in that type of trust as bureaucratic lawmaking is always subject to the latest round of appointed bureaucrats, not rule of law with definite expectations, legal foundation and predictability.
But, even if it was possible, and even if Ohio could customize the program and funding in the way it saw fit, it would still be morally wrong as it would not incentivize independence, but enable more dependence.
And, maybe the easiest point to understand if it was legally possible and morally appropriate – there is no federal money for any form of expansion. Regardless of the model or perceived effects, America is broke. Ohio does not have an account with the federal government just filled with money. Ohio taxpayer dollars are not sitting on a mythical lock box waiting to be reclaimed. We are not missing any mythical fair share of money we have saved up.
These proposed expenditures and expansions are being financed with debt and my children’s future. My children did not ask for this and don’t deserve it.
The national spending problem has grown so out of the control, that the Federal Reserve literally pushes for printing of additional dollars out of thin air to help fill the gaps. It then buys the US treasuries, effectively monetizing and financing debt through inflation, which is even more destructive to the economy and average person’s way of life as this effects the buying power of the dollar – cost of gas, food, etc. The debt burden isn’t being picked up by “the rich,” – it’s being picked up by working people most effected by the costs of daily goods in the market.
This can be more easily described as the debasement of the US dollar since there are literally trillions more dollars in circulation since the printing of the dollars and the monetization of debt that started occurring on a massive scale thanks to President’s Bush and Obama both. Working class people are hurting more than anyone else because of horrible spending decisions by elected officials.
Bottom line on Medicaid expansion – stop trying to figure out a way to take money that doesn’t exist without massive debt.
After you’ve said absolutely NO NEW FEDERAL DOLLARS (because we are broke and will only increase our debt), and you stop relying on a nod and a hand shake deal with bureaucrats that have no legislative authority – then and only then, can we begin discussing fixes to Medicaid, which almost everyone acknowledges is broken.
Pull the damn thing out of the budget, and let’s have all those discussions over administration, formulary, eligibility criteria and health outcomes in a much more substantive way.
Trying to hang this mess on the budget, as if it’s the only time to discuss Ohio’s single largest long term liability, stinks of strong arm tactics from Governor Kasich. You are good, independent thinkers and should not be forced to make a decision on someone else’s timeline or for someone else’s political career.
Is it even responsible to make a world changing decision for millions of people in a few weeks with all the wrong motivators driving you?
This legislature has options. Do not let Governor Kasich force you into false choices. Do not add any form of Medicaid legislation to the budget right now, and let’s have this discussion for as long as it takes.
Half-completed solutions made on an artificial timeline never end well. This is no reason to rush or make a decision we will regret.
A few weeks to discuss a change that will affect millions of people for decades to come, most Ohioans would advise you to – slow down. Breathe. Let’s actually get serious about this and not just slap something together for the sake of expedience.
For moral and societal reasons – I urge patience.
For legal and procedural reasons – I urge caution.
And for financial and sustainable reasons – I urge more consideration.
We all agree the existing system needs to be fixed, but this is not the way to do it. Don’t steal from our future.