Some weeks, it feels like the most topical, water-cooler talk has to do with the cutest kitten video on YouTube, or the craziest weather snap. This week, however, was a week of momentous stories. King Bevin finds himself in yet another lawsuit (that makes at least seven in his first six months). Britain loses its collective brains by Brexit-ing the European Union. Donald Trump makes Scotland great again, and the Supreme Court reaffirms that abortion is a private, constitutionally protected right. This has been a crazy week.
Most important to Kentucky, however — Gov. Matt Bevin’s insulting proposal to hundreds of thousands of the poorest, sickest Kentuckians.
Bevin’s “transformative” Medicaid proposal treats the health of poor Kentuckians as if it were a commodity to be bought and sold — something the poor are not entitled to as a basic human right, but must earn. I could focus on the specifics of his plan, such as the 86,000 people he expects to lose coverage because of his proposal. Instead, I want to focus on how his proposal is symbolic of a larger, scarier ideology of how he, and the Republican Party, view healthcare.
While American capitalism treats a number of life’s necessities as bargaining chips and political footballs, the one thing that should be non-negotiable is healthcare. Republicans look at healthcare as they do other issues: free-market, business. But health is not a business.
Bevin is treating the poorest, sickest Kentucky families, and their health, like something that can be incentivized, or penalized.
And it’s shameful.
Just listen to some of what he said at his press conference, when he announced his Medicaid plan last week. It was littered with hyperbolic, misleading and empty promises. Bevin demonstrated how his world-view excludes the poorest and the sickest. “We are robbing people of the ability to do for themselves,” he said. “The intent is … restoring a sense of dignity that comes with people having some stake in their own health outcomes.”
People want dignity, but they want health first, and they’re fully aware they have some stake — or, in their case, skin — in their health outcomes.
Some of how he intends to restore dignity is by making poor people pay at least some monthly premium to get Medicaid. The money that the poor would have to pay is nothing more than a teaching opportunity, he believes. “Do we really think that one- and two- and four-dollar copays are going to pay for the program? Of course not.”
And to earn extra care benefits — crazy things like dental and vision — they would be required to work or volunteer or do other “community engagement” to get benefits if they are deemed to be “able-bodied, working age adults” with no dependents.
Of course, people want dignity. Of course, they want to be in control of their own health decisions and outcomes. But what Bevin’s proposal says to Kentuckians is simply: “You’re too dumb to make the right healthcare decisions for yourself.” (By voting for Bevin, they may have proven his point.)
One of Bevin’s top advisors in crafting this proposal, Mark Birdwhistell, said, “It’s not about the money for the premiums. It’s about the learning experience.”
Wrong. It’s about caring for the sickest and poorest in Kentucky. Everything else is secondary.
The starkest illustration of Bevin’s priorities — or how he views the haves versus the have-nots — is in his explanation of the cost savings. Follow me here: His proposal would cover nearly 18,000 fewer people in 2017, and 86,000 fewer in five years. He has said that his proposal will save $2.2 billion in taxpayer dollars over five years (that’s $1.9 billion from the federal government, and only $0.3 billion of Kentucky taxpayers’ dollars, or $60 million per year … but $2.2 billion sounds better). That’d be an amazing deal for taxpayers, who do not have to worry about losing healthcare insurance. So Bevin is choosing to save taxpayers money over providing basic healthcare for the poor.
Sure, Bevin’s stated goal of improving overall health outcomes is appropriate, and one that everyone supports. The problem is he is risking people’s health to achieve that goal.
He can experiment with all of the incentives and penalties to encourage healthier choices and living, without risking the health of Kentucky’s poorest and sickest. That would be a Medicaid proposal with some dignity.