“History repeats itself; first as a tragedy, second as a farce.”
– Karl Marx

By Dennis Archambault

Authority Health was established in 2004 as the Detroit Wayne County Health Authority due to a crisis involving Detroit hospitals inundated with uninsured patients, primarily through their emergency facilities. The Detroit Medical Center said that Detroit Receiving Hospital and Hutzel Hospital could not continue to sustain the debt of uncompensated care. The Michigan governor, Wayne County executive, and City of Detroit mayor, acting on the recommendation of a local commission, established this organization to strengthen the health care safety net and minimize the pressure on hospital emergency services. Early on, we operated with the slogan, “It’s about access for all.”

The Affordable Care Act did much to relief the access problem by offering a method of insuring most Americans, and in states like Michigan, enabling low income residents an opportunity to qualify for expanded Medicaid benefits. That was then – well, not quite. Depending on how Congress acts regarding its efforts to repeal and replace the law, the ACA may be with us a few months longer – and perhaps longer, with revisions. But what seems certain is the elimination of the Medicaid program – not only expanded Medicaid, but a significant portion of traditional Medicaid.
The specifics have been widely documented in the popular press. What population health advocates are facing is a massive regression in policy to a time when the poor sought health care in hospital emergency departments as a clinic of last resort. Many individuals and organized groups have protested this. Public approval for the Senate legislation is much lower than any reasonable politician would want to risk. Yet, the Senate soldiers on – or at least its leadership. And the president, trying to make a deal, has suggested that the ACA should be discontinued immediately and let the replacement process follow due course. Or not.

Expanded Medicaid has provided access to health care services for over 600,000 people in Michigan. Traditional Medicaid provides important maternal health, care for the disabled, and for the low income elderly. Ron Lieber, a business columnist in The New York Times, offers a cautionary tale regarding the latter category https://www.nytimes.com/2017/06/30/your-money/plan-on-growing-old-then-the-medicaid-debate-affects-you.html?_r=0. Typical business readers would not consider themselves at risk for becoming an impoverished elder. But as Lieber writes, one in three people who turn 65 will find themselves in a nursing home at some point. Citing the Kaiser Family Foundation, 62 percent cannot pay the bill on their own.

The Hill, a policy-oriented news publication in Washington, D.C., has reported that the proposed Senate health care legislation is likely to have deeper cuts in Medicaid than the House bill, which does not bode well http://thehill.com/policy/healthcare/338411-senate-gop-considers-deeper-medicaid-than-house-bill.

Medicaid is meant to be a safety net program. It’s clear that a lot of people are at risk at losing access to essential health services – taking us right back to where we started in 2004.

Dennis Archambault is vice president of Public Affairs for Authority Health