Post-Katrina Health Care Highlights Gaps in the System

by Cynthia Gervais and Carolynn Race

Hurricane Katrina ravaged the Gulf Coast; leaving thousands homeless, jobless and without health insurance. Diminished public health conditions, broken infrastructure, and poor access to records have had a significantly negative impact on public health, emergency care, primary care, medications, acute hospital care, long-term care, and mental health care. The Kaiser Commission on Medicaid and the Uninsured noted, "Katrina threatens to lower the health status of Americans in the Gulf Coast region and to increase health care disparities among racial and ethnic groups living there."

The same day the levees in New Orleans broke, the U.S. Census released data showing that the number of uninsured increased to 45.8 million in 2004, an increase of 800,000 people since 2003. (The uninsured rate remained constant at 15.7 percent, with the uninsured rate for children at 11.2 percent.) Without public programs like Medicaid, Medicare, and veteran's health insurance, the rate of the uninsured would have been much higher. Last year alone, the percentage of people covered by employment-based health insurance declined from 60.4 percent to 59.8 percent, while the percentage of people covered by government health insurance programs rose from 26.6 percent to 27.2 percent.

How has Congress responded to the immediate and long-term health care needs for those without access to comprehensive, affordable health care, and how can Presbyterians become engaged to push for health care reform - so that all may have life, and have it abundantly?

Emergency Health Care Legislation

Prior to Katrina, the Gulf region had high uninsured rates. Among non-elderly populations, 22 percent of Louisianans, 19 percent of Mississippians and 15 percent of Alabamans were uninsured. As the Kaiser Commission noted, the states also had high Medicaid enrollment - 23 percent of non-elderly were enrolled in Mississippi and 19 percent were enrolled in Alabama.

After Katrina, many evacuees were left without jobs and relocated to other states and regions. Unless they met the guidelines for Medicaid enrollment in other states, they could be uninsured.

What role could Congress and the Administration play in responding to this emergency need? One response - provide emergency funding for disaster Medicaid. After another disaster, September 11, 2001, Governor Pataki (R-NY) announced immediate disaster relief measures, including Disaster Relief Medicaid. This was a short-term, four-month program that covered nearly 350,000 people following the disaster.

Responding to the health disaster that followed the storm, Senators Grassley (R-IA) and Baucus (D-MT) authored legislation, S 1716, to extend Medicaid coverage for five months to low-income childless adults from Katrina-struck areas, and to authorize the federal government to pay all Medicaid expenses, usually shared with states, for five months to Louisiana, Mississippi, and parts of Alabama. The bill also would create a fund to help survivors pay the premiums to continue their job-based health insurance. The Congressional Budget Office estimated that their bill would cost $8.9 billion between 2006-2010.

The Bush Administration is not supportive of S 1716 and, instead, announced in September that it will issue waivers to reimburse states for their Medicaid and uncompensated care costs through January 31.

Senator Baucus recently shared his concern about the status of the Katrina bill with his colleagues on the Senate Finance Committee. In his remarks the Senator spoke about Emanuel Wilson; a man with intestinal cancer who lost his job and health insurance to the hurricane. When he sought assistance through Medicaid, he was told that he did not qualify. As Senator Baucus said, "he does not fit into the right pigeonhole to get America's health care." The Emergency Healthcare Relief Act is designed to temporarily cover those like Mr. Lewis who urgently need medical care. "Our bill would help him get back on his feet."

The Grassley-Baucus legislation did not pass the Senate, due to resist- ance from the Bush Administration and some Senators - in part due to its cost. A portion of their legislation was included in the Senate-passed budget reconciliation package.

Budget Reconciliation

The Senate Finance Committee, of which Senators Grassley and Baucus serve as Chair and Ranking Member, respectively, was instructed through the fiscal year 2006 budget resolution to find at least $35 billion in spending reductions in mandatory programs under the committee's jurisdiction, including Medicaid.

Both the House and Senate budget reconciliation bills provide some Medicaid funding for hurricane survivors. On November 3rd, the Senate passed its budget reconciliation package that included about $10 billion in net cuts to Medicaid and Medicare over five years and also included a scaled back version of the emergency Medicaid legislation. The version, while falling far short of earlier relief proposals, provides 100 percent federal matching payments for Medicaid and SCHIP services provided to individuals living in select parishes and counties in the Gulf region. The House passed similar language regarding Katrina relief. The House version would cost $2.5 billion while the Senate version would cost 1.8 billion. Both budget reconciliation bills would reduce funding for other areas of Medicaid spending.

On November 18th, the House passed its version of a budget reconciliation spending reduction bill by a vote of 217 to 215. The bill included $50 billion of spending reductions to mandatory programs over five years, including reductions in Medicaid spending. Provisions include allowing states to impose substantial new co-payment and premium fees on millions of low-income Medicaid beneficiaries, and scaling back substantially the health care services that the Medicaid program provides. The Congressional Budget Office estimates that the provisions that will cause many low-income Medicaid beneficiaries to be required to pay more out-of-pocket for health care, and will reduce the health care services for which these beneficiaries are covered, represent cuts of nearly $30 billion over 10 years.

The House and Senate must now reconcile the differences between their bills. A vote on a conference report may happen the week of December 12th.

From the 1960 statement that challenged the church to examine its contribution to ill-health in society, through the 1994 statement that urged "Congress to assure a basic benefits package that includes the needs of the historically underserved," General Assembly policy has affirmed that the church has had a long- standing interest in the health of persons. The values of caring, doing justice, and building a stronger community give the church a unique voice in the public policy debates regarding health care. In Matthew 25, Jesus makes clear that a society is judged by the health and wholeness of its most vulnerable members. As Congress considers cuts to Medicaid, Presbyterians should lift their voices to advocate for abundant life for all.

Two Opportunities to Participate in the Public Policy Debate

#1 - Included in the Medicare prescription drug law passed in 2003, Congress called for the establishment of a Citizens' Health Care Working Group. Congress noted, "In order to improve the health care system, the American public must engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how they are willing to pay for coverage." The Working Group is charged with holding public hearings, community forums, and preparing a health report to the American people. It has as its mission to "provide for a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage."

Shape national policy by telling the President and Congress how to make health care work for all Americans. To get involved, visit the Web site.

In its brochure Health Care That Works for All Americans, the Citizens' Health Care Working Group highlights three basic issues in the health care discussion: cost, quality and access.

Cost - Costs are rising at an alarming rate. In 2004, America's health care bill was $1.8 trillion; in 1960 about a nickel out of every dollar earned was spent on health care, today it is about 15 cents. Higher costs do not necessarily mean increased coverage. As insurers raise premiums, employers may be less likely to offer affordable coverage, and employees may forgo the expense.

Quality - Quality of care varies greatly from one region to another. Despite spending more per person for health care than other developed countries, U.S. results are not consistently better and are sometimes worse. There is consistent evidence of a difference in the availability and quality of care related to race, ethnicity, and income.

Access - The uninsured, about 46 million people, are nearly eight times more likely to skip health care than the insured, due to costs. As costs escalate, some employers no longer offer health insurance coverage and others shift more of the expense to employees.

#2 - Our Healthcare Future, a new innovative initiative sponsoring dialogues on health care, was developed by representatives from the St. Joseph Health System, NETWORK: A National Catholic Social Justice Lobby, and faculty from Georgetown University. Their initiative offers an opportunity for individuals from a variety of backgrounds to participate in a grassroots effort to transform health care. Through small group discussion, this initiative will help determine what citizens value in a health care system. Recognizing that there will be conflict, the dialogue eases the move toward the consensus necessary to make big changes in health care public policy. "Dialogue helps create conditions for change. It builds community, uncovers common ground, and offers hope for the future." Field-tested materials are available to engage in small group discussions in your congregations that will lead to potentially transformative and values-driven dialogues about what a health care system should be in our society.

General Assembly

A major policy statement was approved by the 200th General Assembly (1988) entitled "Life Abundant: Values, Choices and Health Care." In recognizing a growing crisis in health care, this report affirms:

"Equal Access to Appropriate and Necessary Care. Every person must have affordable, quality health services. Access should not be limited by income, ethnicity, or geography. It is the proper function of all groups of society including government in their concern for justice to ensure equal access to health services."

For a Biblical and theological context, the report cites the many Gospel passages related to the healing power of Jesus Christ. "For Jesus, healing was a sign of the in-breaking of God's rule in human history." The Gospel tells us that Jesus not only restored the physical body, but also provided spiritual and mental healing. This blessing of health and wholeness had a profound affect not only on the restored individual but also on the community. "Relationships were renewed and community restored."

Believing that the "people of God are intended to be both illustration and instrument of God's creative, healing, and redemptive activity," we are called as a church to work toward wholeness in our community. We are God's agents. Jesus' healing ritual sometimes included "a washing or baptism, symbolizing not only the presence of God's spirit * but also restoration or admission to the community of God's 'whole' people." This is our paradigm. As God's agents, we are called to spread the Good News of "the abundant life made possible through the grace and mercy of the Creator." As we are commanded to go and baptize all nations, we are also commissioned to aid the restoration to wholeness in body, mind and spirit of those in our community. In John 10:10b, Jesus announced "* I have come that you might have life and that you might have it abundantly." This promise is central to our faith and, mindful that the Creator intends health for the created, we are called to actively participate in God's activity. (Minutes, 1988, Part I, pp. 517-524)

The Resolution on Advocacy on Behalf of the Uninsured, published in 2002 by The Advisory Committee on Social Witness Policy, states that "the health of a society is measured in an important way by the quality of its concern and care for the health of its people." Basically, how a society cares for the newborn, the elderly, the sick and the disabled - the most vulnerable - is a clear indication of the "moral character" of that society. The Resolution further affirms the 1998 Policy Statement by saying, "at the minimum, credible commitment to health includes convenient access to quality, affordable, preventive and curative health services." Among the concluding recommendations of the resolution is to "[D]irect the Presbyterian Washington Office to advocate the following: Urge the expansion of Medicaid to insure more low-income and fixed-income persons, including the recently unemployed." (Minutes, 2002, Part I, pp. 633-635)