Dr. Michael Forster

MSW student Anderson reflects on travesty of jeopardizing CHIP funding

This blog entry is by Moira Anderson, one of our many fine MSW students attending the Southern Miss Gulf Park program.  

Lapse in Federal Funding Imperils Children’s Health Coverage

http://www.npr.org/sections/health-shots/2017/10/03/555166767/lapse-in-federal-funding-imperils-children-s-health-coverage

Reading this headline was disappointing to me, if not anticipated. On September 30, 2017, Congress let funding lapse for CHIP, the Children’s Healthcare Insurance Program. CHIP is a federally funded program which helps lower and middle-income families who earn too much to be eligible for Medicaid. This program covers 9 million children across our nation. CHIP covers mostly children up to age 19. In nineteen states CHIP covers pregnant women as well. Approximately 370,000 pregnant women are covered each year through the program. Families who improve their lives and move out of Medicaid have used CHIP as an affordable option to ensure health coverage for their children.

CHIP is mostly paid for by federal funds, although state funds are also used. Authorization for spending has expired, however states are still able to continue their programs temporarily, using their unspent federal funds. Unfortunately, some states anticipate running out of funding by the end of 2017.

Historically, CHIPS has been supported by both Republicans and Democrats. However, funding renewal has not gotten priority from Republican leaders who have been focusing on working to replace the Affordable Care Act, and on overhauling the Medicaid program.

Since this headline was published, the Finance Committee has taken an important step toward extending funding for CHIP. Currently the program is authorized through October 1, 2019. However, further legislative action is needed in order to reauthorize funding.

When considering how many families, children and pregnant women would lose their healthcare without this program, the impact of not refunding it could be devastating. What frequently astounds me is that the people who want to cut health insurance assistance consider healthcare an unnecessary federal expense. Yet, lack of healthcare is probably exceedingly more expensive than providing the assistance in the first place.

I equate health with wealth. I see it as an incredible resource in myself, my family, my community and my nation.  If people lose healthcare plans, local hospitals will be stressed, as emergency rooms fill with people who cannot pay their bills. Economically speaking, our country will bear the burden. Families will be stressed, afraid to take their children to the doctor because they cannot pay for it. Social service agencies will be overwhelmed with people needing additional services. Stress and mental health challenges will be exacerbated when communities cannot provide medical care for vulnerable individuals.

The ripple effect, a decision like defunding CHIP has will not only affect people who directly lose their healthcare plans. Economically, the disaster is clear. However, I always, also imagine the impact on our hearts. Being a cold, heartless nation that doesn’t take care of its sick children creates an emotional deficit which is difficult to bear. It has come to my attention lately that as social workers, we have a duty to protest, organize, vote, inspire, as well as change the policies and legislation that puts vulnerable and minority people and communities at risk.

An article I read by columnist Parker J. Palmer states, “In times of deep darkness we not only need light—we need to be the light for one another. There’s the light of courage to walk the path no matter who says, ‘Stop!’ No one of us can provide all the light we need. But every one of us can shed some kind of light.”

Dr. Michael Forster

Frustrated by failure to repeal, Trump tries to blow up Obamacare on his own

Unable to push through a repeal of the Affordable Care Act, president Trump belligerently proclaimed that he would just let it (the “horrible,” “collapsing” Obamacare) “implode” on its own.

Well, not quite.  “Explode” is more like it, with the Insane Clown President (journalist Matt Talibbi’s choice term) himself tossing IEDs along the path to enrollment everywhere he can.  Among the major sabotaging actions taken to date:

  1. Drastically reducing advertising for enrollment.  In August the administration announced a cut to the advertising budget for open enrollment by 90%, from $100 million to $10 million.
  2. Shrinking the open enrollment period.  The 2018 45-day enrollment period – Nov. 1 – Dec. 15 – is only half the length it was last year.  Moreover, the enrollment website will be operational for far fewer hours, especially during busy weekends; Healthcare.gov will be “down for maintenance” for 12-hour blocks on all but one Sunday.
  3. Pummeling the Navigator programs.  Navigator groups in the 34 states using federal insurance marketplaces (because the states didn’t set up their own exchanges) work to link eligible residents with appropriate insurance opportunities, and have been critical to expanding coverage.  (Mississippi is one of those 34 states, and the College of Health at USM operates one of those navigator programs, the Mississippi Health Access Collaborative, under a grant, for which I’m co-Principal Investigator.)  The total amount of funding for the third year of multi-year grants was cut by the administration – on the day before the new grant year began, no less – by more than 40%.  Individual states were cut at various levels (it remains a mystery just what metric the administration used) – some not at all, some as much as 80%, and Mississippi at nearly 60%.  As a result, a few navigator groups have shut down entirely; virtually all are having to substantially curtail their consumer assistance activities.  (USM’s program suffered a relatively modest cut of under 10%, avoiding staff layoffs, but will still likely need to trim post-enrollment period outreach.)
  4. Restricting Health & Human Services from supporting local enrollment efforts.  In years past, Mississippi navigator grantees have enjoyed visits from HHS staff, promoting collaboration and sharing experiences, developments, and perhaps of most value, encouragement.  A similar event was anticipated for this year, until the lead planner, the Mississippi Health Advocacy Program, was notified that no HHS staff would be participating.
  5. Destabilizing the insurance markets by killing low-income subsidies and authorizing new forms of bare-bones insurance products.  This may be the biggest, most destructive bomb of all.  The complexities are myriad here, and we won’t try to tackle them in this space.  Leave it to cite Mississippi insurance commissioner Mike Chaney, who anticipated Trump’s decision to kill subsidies for low-income enrollees by approving a 47% premium increase for marketplace plans two weeks ago.  Chaney guesses that between 5000 and 10,000 Mississippians will fall out of the federal marketplace as a result.  Many more will maintain coverage only at the cost of significant damage to personal and family budgets.

It seems evident that president Trump and the Republican majority in Congress will use every means available to undermine the Affordable Care Act, regardless of consequences for the people affected.  When they finally succeed, no doubt the narrative will focus on how bad Obamacare was, how it hurt people, how nobody really wanted it, and that’s why it eventually “imploded.”  But that narrative will be then what it always has been – a lie.

Dr. Michael Forster

It may not set you free, but the truth is at least refreshing

It’s nice to hear the rich and powerful tell the truth, at least once in a while.  So many of them seem to adhere with religious fervor to Adam Smith’s “vile maxim,” i.e. “everything for me, nothing for you,” and don’t shy from twisting the truth to advance the cause of Numero Uno.   So it was quite refreshing indeed to see back-to-back truthful revelations reported recently in the New York Times.

First, the nasty squabble between retiring Senator Bob Corker of Tennessee and the president erupted both on Twitter and in an interview Corker gave to a Times reporter.  The president treats his office like “a reality show,” he told the reporter, making bombastic and reckless threats (toward N. Korea, Iran) that risk launching the country “on the path to World War III.”  Corker had already blasted Trump in a tit-for-tat Twitter exchange, calling the White House “an adult day care center,” in which “somebody obviously missed their shift this morning.”  According to multiple news sources, a majority of Republican lawmakers agree with Corker, and think as bad if not worse of the Disruptor-in-Chief and the mess he’s making, but no one else (including the courageous senators from Arizona) is willing as yet to take a public stand questioning the president’s fitness for office.

Second, Marcus Ryu, a Silicon Valley CEO of a $5 billion software company, spilled the beans on the president’s proposed corporate tax cuts, a salient feature of Republican “tax reform,” in an October 9 Times opinion piece – Tax cuts will NOT spur economic growth.  They never have, even when in times past companies were not already awash in cash, as they are today.  Companies start up, and/or expand, when they see opportunity and market demand for their product, not because they have more coins jingling around in the piggy bank.  As of late, flush companies have in fact used their excess cash to boost executive pay and bonuses, buy back their own stock (thereby pumping the value), and paying bigger dividends to shareholders.  (Paul Krugman has been making this case for longer than I’m sure he’d care to admit, but, you know, he’s a “liberal,” so why listen to him?)  Ryu points out that a number of highly admired entrepreneurs – Bill Gates, Steve Jobs, and Jeff Bezos among them – launched their blockbuster ventures when tax rates were much higher than they are today.  He quotes guru-super-investor Warren Buffett – “I have yet to see,” says Buffett, anyone “shy away from a sensible investment because of the tax rate on the potential gain.”

Telling it like it is.  Not always pleasant, but refreshing nonetheless.  We could use a lot more of it.

Dr. Michael Forster

Local voters miss an opportunity to check Mississippi slide

Alas, Missy McGee won a lopsided victory over Kathryn Rehner in yesterday’s low-turnout runoff election to fill the vacant House District 102 legislative seat.  While I have nothing against Ms. McGee (we’ve never met, and her bio looks impressive), I consider the outcome distressing for at least two reasons.

First because it was decided by so few registered voters.  How is it that less than 10% of the electorate thought it worth a half-hour of their time to decide who goes to Jackson to represent them and provide them access to the policy-making process?  Could it be that the quip I heard at the voting place where I poll watched yesterday is on target – “In race-saturated Mississippi, all bright white women look alike, so why bother to choose?”

The second cause of concern is more important: Ms. Rehner, a social worker possessed of the world-improving passion that all social workers should display, is appalled at the political direction Mississippi is taking, sacrificing investment in the future of the many in favor of tax cuts and sweet deals for the few, and would have fought vigorously to correct the sad slide of the state under its current super-majority Republican leadership.  That won’t happen now – at least not in HD 102, at least not for another couple of years.  Voters – we blew it.

Dr. Michael Forster

Two “good news” health stories with dark undersides

Today’s papers carry two health related stories that are definitely good news for ordinary Mississippians.  The first is that our state Department of Health has received national accreditation.  As a result, the Department will be eligible to draw down funds from the federal Centers for Disease Control (and a few other places) it couldn’t get previously, and so should be able to expand efforts to protest and improve the health of Mississippi residents.  The second story is that the latest Republican effort to “repeal and replace” the Affordable Care Act (aka Obamacare), the Graham-Cassidy bill, appears dead in the water, unable to garner the 51 votes it needs to pass before a September 30 deadline.  As a result, millions of low-income Americans will get to keep, for the moment at least, the health care insurance coverage they gained under Obamacare.

But here are the nasty undersides of the “good news.”  Just as the Mississippi Department of Health gains access to new external funds, our state leadership remains busy looking for new ways to cut the budgets of already badly underfunded state agencies – including health, mental health, and education – still further.  A grant here and there will not and cannot ever make up with for a major shortfall in public investment, which is what we now face.  On the federal side, progressives should not delude themselves into thinking that efforts to undercut the Affordable Care Act – to help it “implode” – are over.  The president and leading Republican members of Congress are committed to the end of Obamacare, and remain unconcerned about the consequences of whatever version of “Trumpcare” is put in its place.

As social workers, our common problem is that the wrong people are in positions of power, making decisions affecting the health and well-being of all of us.  We need people in power who care about people without power – who think the way social workers think – regardless of party affiliation.