Part One

In one of his last speeches, Hubert H. Humphrey said, “... the moral test of a government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”

I would judge that we as a nation now face such a moral test. What the Republicans are attempting to pass is a craven heath care bill, called, euphemistically, the Better Care Reconciliation Act, wherein more than 20 million Americans will find that they will once again be forced to live lives of profound uncertainty as they face each tomorrow absent any health care insurance.

What is at stake involves those people mentioned in Humphrey’s eloquent list, for it is those who, in great part, live today with a modicum of surety under the umbrella of the Affordable Care Act.

So discussing just Medicaid, let’s begin by agreeing what exactly it is and the care it offers.

As explained in the New York Times, it is first health insurance offering coverage for largely low-income people. Some one in five Americans, 74 million, are on Medicaid. It was created in 1965 as part of our “Great Society” program and is today the largest health care insurer in our nation.

Medicaid covers pregnant women, children, elderly and disabled people according to specified income levels.

It covers more than a third of America’s children and pays for half of all childbirths.

It also covers some two-thirds of nursing home residents, including many who are middle class but have spent/liquidated all their savings and assets before becoming eligible. Think about that statement for a moment. In America if you are destitute then you turn to Medicaid as your only option for care and shelter.

The Affordable Care Act (Obamacare) expanded Medicaid, offering coverage to adults with income up to 138 percent of the poverty level (or $16,643) for an individual (this expansion would be ended under the Republican bill as currently written).

As of now, Medicaid is an entitlement program and anyone who meets the criteria has a right to its coverage. States are guaranteed financial support from the federal government.

In 2016, the cost of Medicaid was $553 billion. Of that, states paid $204.5 billion. The biggest costs are for the elderly and the disabled because of the required long-term care.

Under the Affordable Care Act, the federal government, at least initially, covered 100 percent of the Medicaid costs for the 11 million who took part in the law's expansion.

Today, the federal government pays 95 percent of the expansion costs incurred by the states. By 2020 that figure will drop to 90 percent.

It should be noted that a significant number of states (with Republican governors) chose not to participate in the Medicaid expansion, even though there would be no costs to their states at the outset. As a result, millions were unable to benefit from this change.

As was detailed in the Times, both the House and Senate bills would set a per-person cap on spending. The bills would effectively end Medicaid expansion by reducing the amount it pays starting in 2020. This will mean that those now eligible will be unable to qualify for Medicaid and therefore find it no longer within reach.

According to independent analysis, the results of the changes to Medicaid (a reduction of some $700 billion to $800 billion), as explicated in the House and Senate bills, would entail significant reductions in Medicaid spending by the federal government; a drop in enrollment would follow.

To compound this outcome, the subsidies that are now integral to making Medicaid affordable across a broad spectrum will gradually be reduced if not eliminated.

The money that is used to fund those subsidies is derived from a tax on the wealthy and would be eliminated. In other words, the Better Care Reconciliation Act has often been called a tax cut for the wealthy and not a health care bill.

Part two will examine why health care continues to prove so elusive for our nation.

— Chris Honoré of Ashland is a Daily Tidings columnist.