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What is Medicaid and how would reforming it affect Utahns?

What is Medicaid and how would reforming it affect Utahns?

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SALT LAKE CITY — When Heather Thomas’s insurance provider refused to pay for behavior treatment that her now-14-year-old son with autism needed, she turned to Medicaid for help.

Thomas said her family waited for a year before her son received the help he needed, and she says the care her son receives now may not be enough. That’s why following the status of health care reform in Washington, D.C., has been nerve-wracking for the Eagle Mountain mother.

She’s afraid of what a new health care reform could mean for her family and her son. While she said the current Affordable Care Act and Medicaid system certainly has its flaws, she wrote both Utah Sens. Mike Lee and Orrin Hatch, to say that what is best for the families across the country should be placed ahead of any political agenda.

“It’s not about politics, it’s about people,” she said.

A new health care plan

Lee and Hatch both voted to pass a motion Tuesday to push forward the health care legislation debate, as Republican Congress members look at the possibility of repealing the ACA and then creating a new plan afterward. Lee has voted against Republican measures, voicing support for a full repeal of the ACA; Hatch, on the other hand, has favored a repeal-and-replace approach.

The differing opinions have led to a health care reform stalemate with Republicans only having a few votes to spare in order to push across any ACA repeal or replace measure. Regardless of what ultimately happens, reducing Medicaid spending is on the table in an effort to cut costs of the federal budget.

A nonpartisan Congressional Budget Office report found that the Obamacare Repeal Reconciliation Act proposed this year would increase the number of uninsured people by 27 million in 2020 “after the elimination of the ACA’s expansion of eligibility for Medicaid and the elimination of subsidies for insurance purchased through the marketplaces established by the ACA.”

In June, the CBO also reviewed the Better Care Reconciliation Act, which failed to meet a vote when Lee and Sen. Jerry Moran, R-Kansas, refused to support it.

That report noted the number of people who would become uninsured would rise by 22 million in 2026. It also noted a reduction of $772 billion in federal outlays compared to what the ACA would have cost by 2026.

“We still think something can be done. We still think the right bill can pass. What we’re trying to get to is the right kind of bill. The one that can pass and the one that can provide this kind of relief to the American people,” Lee told KSL Newsradio host Doug Wright the day after informing colleagues he would not support the bill.

Hatch’s office was unable to be reached after multiple attempts for comment.


“In order to qualify for Medicaid, you have to be poor and something else. You can’t just be poor, you have to be poor and a child, or poor and disabled, or poor and a pregnant woman, or poor and elderly … It isn’t really the same as Medicare at all."

How Medicaid is used in Utah

Children are the overwhelming majority of individuals on Medicaid in Utah. Sixty-three percent of Utah’s more than 418,000 Medicaid recipients in 2016 were children under the age of 19, according to the Utah Department of Health’s Medicaid data collection. The next biggest group is persons with disabilities at 14.6 percent.

“In many ways, it’s a children’s program,” said Jessie Mandle, a senior health policy analyst for Voices for Utah Children, which is a health care advocacy and public policy organization based in Salt Lake City. She added Medicaid provides preventive care for children, including dental and vision coverage.

She believes cuts or caps to the Medicaid would harm Utah families, arguing it plays a “huge role” for pregnant women and young children.

“When they are just starting out and getting on their feet, Medicaid has really helped families make sure their kids get a healthy start,” Mandle said.

But another problem Utahns are facing is following the twists and turns of the health care debate in Washington and exactly how it would affect them. As Thomas anxiously awaits what happens, she said she finds the discussions confusing, which points to a trend spotted in a recent survey.

A Dan Jones & Associates survey released on July 14 found 35 percent of Utahns trusted Republicans with health care plans, while 30 percent said they trusted Democrats. That left another 35 percent that responded they didn’t know or that they trusted leaders from another party when it came to reforming the American health care system.

The difference between Medicaid and Medicare

Scott Williams, a pediatrician and board chairman of the 4th Street Clinic in Salt Lake City, said in a recent KSL and Deseret News joint editorial board meeting that it’s important to know the difference between Medicaid and Medicare, particularly with the health care reform debate.

Williams said how Medicaid works is often misunderstood.

“In order to qualify for Medicaid, you have to be poor and something else,” he said. “You can’t just be poor, you have to be poor and a child, or poor and disabled, or poor and a pregnant woman, or poor and elderly. … It isn’t really the same as Medicare at all.”

Related:

Medicaid is a “federal-state health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments,” according to the Social Security Administration website.

It is vastly different from Medicare, which is the federally-funded insurance program for people who are 65 or older, individuals with certain disabilities, individuals with permanent kidney failure and people with amyotrophic lateral sclerosis (commonly known as ALS or Lou Gehrig’s Disease), according to the SSA.

For individuals like Thomas, help from Medicaid is how she was able to get the help her son needed.

“Before that, getting any behavior help — anything like that — was next to impossible because insurances hadn’t come up with what they have now with the autism waiver,” she said. “By the time they came up with that, which is up to age 7, my son was too old and insurances wouldn’t cover anything, so we were just swimming all the time just trying to figure out how to help this boy.”

With the funding, her son was able to receive behavior therapy and behavior helpers for five days a week. Without it, she believes that wouldn’t be the case and that’s where she said she feels like her family lucked out.

“There’s all these families out there on this wait list that need this help because to pay for it is thousands of dollars a month and they just can’t just get help,” she said.

For now, the debate and voting on a new health care bill continue, with GOP leaders unable to win enough votes for a broad revamping of Obama's law now focusing on a far narrower bill repealing a handful of the least popular provisions.

The Senate is expected to finish the legislation by Friday.

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Carter Williams is an award-winning reporter who covers general news, outdoors, history and sports for KSL.com. He previously worked for the Deseret News. He is a Utah transplant by the way of Rochester, New York.

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