How Obamacare Discriminates Against the Most Vulnerable

This post was originally published in The Federalist and has been re-published with permission from the author.

As previously predicted, many in the press have tried to define the Obamacare debate through the prism of the individuals newly insured by the law. One article has highlighted the election “through the eyes of Obamacare enrollees.” Liberal groups are trotting out studies—studies debunked years ago by a member of the Obama Administration—that claim repealing Obamacare would hasten the deaths of tens of thousands of Americans annually, due to lack of insurance coverage.

But what about Obamacare’s forgotten faces? What about the people who, instead of obtaining coverage because of Obamacare, didn’t obtain coverage because of Obamacare? What about the people with disabilities who quite literally have died on waiting lists to receive care—not despite Obamacare, but because of it?

Instead of talking about how Obamacare “ended discrimination against people with pre-existing conditions,” what about how Obamacare encourages discrimination against the most vulnerable?

The People That Obamacare Doesn’t Help

I’m talking about the individuals with disabilities—more than half a million nationwide—still on waiting lists to receive services, because Obamacare encourages states to expand Medicaid coverage to able-bodied adults, instead of serving them. They include people like Lindsey Overman and her 10-year-old daughter Skylar:

“She [Skylar] was born with a rare medical neurological condition called schizencephaly,” Overman told us.
In the past three months Skylar’s condition has worsened. Last month she had surgery to relieve pressure on her brain and her family is paying $400 per month just for transportation to and from a summer program. A Medicaid waiver would help with the costs that go along with at-home care for children with disabilities.
Skylar remains #754 on the waiver waiting list.

Because Obamacare encourages states to expand Medicaid to able-bodied adults, rather than provide services to individuals with disabilities like Skylar, the 10-year-old continues to wait—and wait, and wait—for needed care, which her mother thinks she will never see during her daughter’s lifetime.

Obamacare Favors the Able-Bodied, Not the Disabled

It’s Obamacare’s dirty little secret, and perhaps its most shocking. For the past three years, the law has provided 100 percent federal funding for states that expand Medicaid to new populations. That funding will phase down slightly beginning in January—the federal match drops to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and future years. But for the populations that qualified for Medicaid prior to Obamacare, the federal government provides a match rate that this fiscal year ranges from 50 percent to 75 percent, based on states’ relative income.

Estimates from the Urban Institute suggest that most individuals eligible for Obamacare’s Medicaid expansion are childless adults in their prime working years. Nationally, more than four in five (82.4 percent) of the would-be eligible adults are those without dependent children. More than five in six (86.1 percent) of the would-be eligible adults are aged 19 to 54.

In other words, the overwhelming majority of the adults covered under Medicaid expansion are able-bodied adults of working age. Yet Obamacare provides states with anywhere from 20 to 40 cents more on the dollar to cover these able-bodied adults in the expansion population than the individuals who qualified for Medicaid prior to Obamacare—including seniors and individuals with disabilities.

There Are Waiting Lists for Individuals with Disabilities

When serving on the congressionally-appointed Commission on Long-Term Care in 2013, I heard much about the waiting lists for care that individuals with disabilities face. Because Medicaid requires coverage of nursing home care, but considers home and community-based services (HCBS) optional, states facing fiscal pressures can—and most do—put individuals with disabilities on waiting lists to receive HCBS care. These individuals may benefit from home-based care—which could help keep them out of nursing homes—but cannot receive it, due to budget restrictions imposed by states.

The latest national estimates provide a sense of the magnitude of the problem. A total of over 582,000 individuals, in 42 different states, remain on waiting lists for home and community-based services, including:

• 349,511 individuals with intellectual or developmental disabilities;
• 155,697 aged, or aged and disabled, individuals;
• 14,128 individuals with physical disabilities;
• 58,635 children with disabilities; and
• 4,006 individuals with traumatic brain injury.

At a time when more than half a million individuals with disabilities continue to wait for access to critically important personal care, Obamacare has provided a greater federal match to states that expand Medicaid to able-bodied adults. By giving states a strong incentive to expand Medicaid to new populations—and ignore the hundreds of thousands of individuals with disabilities still on waiting lists—Obamacare discriminates against the most vulnerable in our society.

Obamacare Doesn’t Help The Most Vulnerable

A report issued on Wednesday by the Foundation for Government Accountability highlights how Medicaid rolls have exploded under Obamacare—and how individuals with disabilities have suffered as a result. In Illinois, on the same day state legislators implemented an early Medicaid expansion for Cook County, they also voted to cut traditional Medicaid, costing one patient his access to seizure medication. In Ohio, Gov. John Kasich’s administration, even while expanding Medicaid to the able-bodied under Obamacare, cut eligibility for more than 34,000 individuals with disabilities.

And then there’s Arkansas—home of Skylar and Lindsey Overman, the 10-year-old standing at #754 on a waiting list. While Gov. Asa Hutchinson pledged to cut his state’s Medicaid waiting list in half, in reality the list has grown by nearly 25 percent in the past three years—a time when Arkansas expanded Medicaid under Obamacare. According to state estimates reviewed by the Foundation for Government Accountability, 79 individuals with developmental disabilities have died on the Medicaid waiting list since the state expansion took effect. I’ll say that again: Since Arkansas expanded Medicaid to the able-bodied, 79 individuals with disabilities have died on lists waiting for access to Medicaid services.

Conservatives Shouldn’t Ignore the Plight of the Disabled

In responding to the threat of Obamacare repeal, the left seems eager to develop a “parade of horribles” revolving around individuals who fear losing coverage under an Obamacare alternative. Yet those same groups have singularly failed to notice the tragic stories already in front of them—the individuals with disabilities facing discrimination, and an inability to access needed care, because of Obamacare itself.

Conservatives who have seen the results of this law on individuals with disabilities have no reason—none— to take a back seat on the compassion front to any Obamacare supporter. Any measure that encourages states to discriminate against the most vulnerable represents a twisted view of compassion indeed.