“We have met the enemy and he is us.” — Quote attributed to Pogo in the comic strip by the same name
There is a move in the California Legislature to protect the “survivor’s assets” as they relate to Medicaid.
Federal law allows the states to recover part of the costs of providing care for those they cover by seizing their assets after they die. The only caveats is the seizure doesn’t take place during the lifetime of a surviving spouse or when there are permanently disabled offspring or if they have children under the age of 21.
There is nothing new about this. California and other states have been going after assets when they can for more than 20 years.
What has changed is the unprecedented expansion of those covered by Medicaid under the auspices of the Affordable Care Act. California is one of the states that bought into that aspect of the ACA. Medi-Cal — the state’s version of Medicaid — has expanded by 2.7 million beneficiaries under the ACA to 12 million covered individuals. California accounts for 17 percent of all Medicaid beneficiaries even though the Golden State has only 12 percent of the nation’s population.
Nationally, 9.7 million more Medicaid beneficiaries have been added bringing the total to 68.5 million people or one out of every 4.5 Americans. And since the rolls have exploded, the federal government is giving serious thought to slashing reimbursement to primary care providers that see Medicaid patients by 40 to 50 percent.
It is little wonder why there are no physicians in Manteca, as an example, taking additional Medi-Cal patients. That has prompted the newly insured to flood emergency rooms for non-emergency care. In case you forgot, one of the primary selling points of the ACA was that it was supposed to reduce the pressure on emergency rooms by giving those who weren’t covered insurance so they could see primary care physicians instead for non-life threatening maladies.
You can’t blame physicians. Medicaid reimbursement prior to the ACA rarely covered the full cost of treatment. It’s one thing to work for nothing; it’s another to have to lose money by working.
Which brings us to the latest outcry among those who apparently subscribe to the theory life should be a free ride.
The new Medicaid beneficiaries are indignant to find out that if they have surgery that the government will — after they die — go after their estate to help recover the costs providing there is no surviving spouse, child under 21 or permanently disabled child still living.
Some Medicaid beneficiaries are electing not to have surgery because they believe it is immoral for them not to be able to determine who gets their assets such as their house when they die.
Adult children that survive are angry that a $150,000 procedure that kept their mother alive for another 18 months means they won’t be able to sell her house and pocket the proceeds.
That is why they are demanding the rules be changed.
In other words they want free health care to go along with a free lunch.
But just like with lunch, there is no such thing as free health care. Someone has to pay for it.
Say what you like about the ACA, but it never was about free health care. It was about paying for health care and placing the onus for help covering the bill on individuals. No one was denied health care prior to ACA as emergency rooms were forced into that role by the government to address the needs of the uninsured.
While it is far from perfect, ACA is moving toward that goal especially as penalties start cranking up this year for those who the government determines should be able to pay for some or all of a monthly insurance premium.
If lawmakers — especially those who embraced the implementation of the ACA — move to eliminate the ability for states to get what reimbursement they can from the estates of deceased Medicaid patients that benefitted from expensive surgeries, it will undermine the entire reason for the paradigm shift in how medical care is financed.
Prior to ACA, medical providers and/or the taxpayers via the government got stuck holding the bag.
You can’t upright the ship if half the crew is working to pull it back under.
As for those who are upset that their house may be sold after their death to pay off just a part of the costs they incurred having surgery through Medicaid or if they are survivors that won’t be able to get an inheritance, welcome to reality.
The reason taxes are so high and the cost of medical care is even higher is because we want everything but we don’t want to pay for it.
Pogo nailed it.
This column is the opinion of executive editor, Dennis Wyatt, and does not necessarily represent the opinion of The Bulletin or Morris Newspaper Corp. of CA. He can be contacted at firstname.lastname@example.org or 209.249.3519.