The Big Medicaid Mistake

I’ve always felt lucky to live in a “blue” state. Considering what has happened to the people of Wisconsin, Michigan, Indiana, Ohio, Arizona, Florida, South Carolina, and Maine after, in a fit of pique, they elected fascist right-wing governors, I was grateful I had no “voters’ remorse.”

I also know some of my state legislators and the battles they’ve fought to keep the kind of destructive budget cutting that destroys lives from being imposed on Illinois’ most vulnerable people – the elderly, the sick, and the increasing number of those living in or near poverty.

But when Rahm Emanuel became Chicago’s mayor, he began shutting down community mental health clinics – like there aren’t enough mentally disturbed people walking the streets already.

Now we hear about how Chicago’s taxpayers are going to be socked with a $50-million bill from the private company that controls the exorbitant parking meter racket in the city. I am once again thankful that I don’t own property I have to pay taxes on, but am pretty sure that a chunk of the “entertainment fees” (on the rare occasions that I can afford to go to the movies or out to eat) and sales tax I can’t avoid will go to pay that bill when $50 million might have helped to keep at least one of those clinics open.

And speaking of taxes, Sears followed up on the $150 million tax credit deal the governor cut with them in order to keep them in Illinois by firing 100 Illinois taxpayers while paying their CEO $9.9 million just in salary. Seriously??? It’s time that corporations in Illinois and the nation paid for the privilege of doing business here by paying their fair share of taxes instead of making us carry their load. Perhaps Governor Quinn should adopt the “never negotiate with terrorists” approach.

But the news that has me doing the E-Trade baby’s shocked face is that a bill cutting $1.6 billion from the state’s Medicaid programs was passed by the general assembly on May 24. Hundreds of thousands of people could be kicked to the curb. The Illinois Rx Program, which helps seniors and others, including HIV-positive people, afford prescription drugs is being eliminated. Families with disabled children will no longer be able to care for them in their homes, but will have to institutionalize them. And the HIV/AIDS community is looking at the very real possibility of this disease once again becoming a death sentence instead of the chronic manageable disease it is now.

The CDC estimates that 70% of the HIV-positive population in the U.S. depend on Medicaid for basic healthcare—quarterly doctor visits, lab work to monitor medication side effects, viral load and CD4+ cell count, along with any other conditions they may have—and the AIDS Drug Assistance Program (ADAP) for their antiretroviral drugs. According to recent data, only 20.4% get into care and treatment and stay there. With these cuts, many of them may not be able to get the medical care and medications they need to stay alive, let alone maintaining undetectable levels of the virus, which also cuts down their risk of transmitting it to someone else.

One of the many things that seems to be missing from our legislative process, both at the state and federal level, is foresight, or at least consideration of a shut-off point when the results of such measures are deemed a price too high to pay for the fleeting goal of debt and deficit reduction.

As I asked my state legislators, how many additional uninsured emergency room visits are going to have to occur, how many more people becoming unemployed and/or homeless, how many more elderly, disabled, and sick people will have to die before this policy is considered a failure? Have there even been such “triggers” discussed, let alone set? We frequently hear about the “sustainability” of Social Security and Medicare – what about the sustainability of a healthy, productive society? It would seem to me that removing access to even minimal healthcare will make that close to impossible.

I suspect Illinois is not the only state that has or will impose such sanctions on its neediest and most vulnerable citizens. There is, after all, a prevailing mentality among conservative lawmakers that these people are living the high life on the dole, defrauding safety net programs, not working as hard as they could, buying “luxury” items like refrigerators and toasters with taxpayer dollars, sick because of their own behavioral choices, never paying a cent of taxes. Yeah, sure.

Legislators should try living with diabetes (that they inherited from their gene pool or developed from their HIV meds) on even $20,000 a year, two times the poverty level. Actually, they should try living on $20,000 a year with NO chronic medical conditions and see if they can do it without ending up with high blood pressure from the stress, weight gain from the crappy food they can afford, and frequent colds and other infections from lack of heat in the winter and no relief from it in the summer. Then throw in some HIV, cancer, diabetes, asthma, liver disease, and back problems from the two jobs they work and see how that goes.

Those of us living with HIV or other chronic conditions need to pay attention. We need to note when measures like this go into effect and how healthcare data reflects the results. We need to keep track of what happens in our communities as more and more people are denied access to care and treatment. Write it down, report it to AIDS agencies, health departments, and news sources. Blog about it. And then start demanding single-payer healthcare. No more Medicaid, ADAP, co-pays, deductibles or ever-rising premiums. For a fraction of what we and our employers pay to insurance companies now, everyone would be covered 100%. This is a DUH moment, in more ways than one.

The HIV community needs to wake up, quit being complacent about an Affordable Care Act that will never be allowed, and even if it were, would only exacerbate the problem of for-profit insurance companies holding us hostage because we have nowhere else to turn.

Get out those old faded (or create new) ACT UP t-shirts and remember (or learn about) when AIDS patients were the bad-asses of activism who, even in skeletal, weakened, and feverish states, managed to get the pharmaceutical companies to change their deeply-embedded, torturously slow research and development processes and the FDA to adopt accelerated approval of drugs that were the only hope for the dying.

This time, if I have anything to say about it, it won’t just be the AIDS activists. As one single-payer advocate said, “You can’t opt out of healthcare. You got a body? You’re involved.” October 6, the National Mall – get more involved. Go to www.duh4all.org to register or find out more. Or come to TPAN on July 19, from 7:00 - 9:00 pm to see "The Healthcare Movie" and discuss what single-payer healthcare would mean for you. RSVP to Jessie Mott at 773-989-9400, ext. 232 or j.mott@tpan.com.