Medcaid 2

Following on from yesterday’s post, I am struggling to understand how individuals have been denied the right to sue the state that they pay taxes to. It seems a gross obstruction to personal freedom.However, the Justice Department has backed the State of California agreeing that the individual cannot sue, while also admitting that Federal law clearly states that Medicaid rates be “sufficient to enlist enough providers.” In other words, there should be no discrimination of resources or access to treatment between the beneficiaries of Medicaid and everyone else in their state. Only what happens when that is precisely what is happening?

“California has been accepting more than $20 billion in federal Medicaid funds per year in exchange for its promise, among other things, to ensure that needy patients had access to health care,” Democratic chiefs wrote in their brief, “California has failed to adhere to its obligations.”

What they are fighting for is the right of the patient or the medical providers to challenge in court any violation of federal law. The response of the Justice Department is that federal health officials have “exclusive responsibility” to enforce the standards set and can punish a state by withholding Medicaid resources from any state found wanting.

The question is whether they would. One former federal health official told the Supreme Court that the DHHS was not able to enforce this stating it was “logistically, practically, legally and politically unfeasible.” The reason being that the DHHS does not have either the staff, money or political clout to do this.

The supporters of the right to sue have all been endorsed and supported by the AARP, the American Hospital Association, the American Medical Association, civil rights groups and the U.S. Chamber of Commerce.

“Judicial enforcement is the only viable means to remedy states’ noncompliance with the Medicaid Act,” the A.M.A. said.

True protection can only come in the courts

In the true story behind my novel, The Accidental Activist, the British Government was ultimately found guilty of not protecting the citizen from a multinational corporation. In the US, the struggle is similar, except we are seeking protection from our own elected government and its agencies. The President, I feel, should understand this better than most.

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Alon Shalev is the author of The Accidental Activist (now available on Kindle) and A Gardener’s Tale. He is the Executive Director of the San Francisco Hillel Foundation, a non-profit that provides spiritual and social justice opportunities to Jewish students in the Bay Area. More on Alon Shalev at http://www.alonshalev.com/and on Twitter (#alonshalevsf).

Misguided Medicaid Law 1

My daily commute involves picking up people from the Casual Car Pool and driving from the East Bay to San Francisco, enabling them to get a free ride (though many offer me $1 towards the toll) and for me to use the car pool lane and pay a lower toll.

Most times we sit in silence and listen to NPR, but occasionally I strike gold. When the gentleman in the passenger seat tutted at a report about President Obama and Medicaid, I discovered that he is a lawyer and actually preparing a case to go before the Supreme Court. He sent me a New York Times article on the topic.

Medicaid - helping those who need it most

I find it hard to believe that President Obama could possibly be an obstacle to low-income people receiving health care. But when it is the Democratic leaders of Congress told the Supreme Court on Monday that President Obama was pursuing a misguided interpretation of federal Medicaid law, it raises an eyebrow.

The case  focuses around the right of Medicaid beneficiaries to file suit and challenge cuts being made to Medicaid around the country on a state level when such cuts hurt their right to care.The Obama administration does not accept this right to sue claiming it “would undermine the effectiveness of Medicaid.” There is also a myriad of court precedents that allow people to sue to block state actions that are inconsistent with federal law.

The politicians behind the brief include many of our top West Coast Democrats, including Representative Henry A. Waxman of California, an architect of Medicaid; Representative Nancy Pelosi of California, the House minority leader; Senator Harry Reid of Nevada, the Senate majority leader; and Senator Max Baucus of Montana, the chairman of the Finance Committee.

“The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958. The court plans to hear oral arguments in October, with a decision expected by the spring. The original plaintiffs in the case, Medicaid beneficiaries and providers, say they were harmed by California’s decision to cut payment rates that were already among the lowest in the country.

Children are one of the largest recipients of Medicaid.

The federal Medicaid law does not explicitly allow such suits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the Constitution’s supremacy clause, which makes federal law “the supreme law of the land.”

More than 55 million people use Medicaid, which is often the fastest-growing item in many state budgets. It provides health  coverage to the most vulnerable groups in our society including children, people with disabilities and nursing home residents.

The problem is exacerbated because many states, desperate to make cuts, have reduced the payment rates to doctors who take in Medicaid patients. This has led to the doctors, dentists, hospitals, pharmacies, nursing homes and other providers often refusing to take these patients and Medicaid patients are finding it increasingly difficult to find the medical services that they need. The government is involved because they reimburse the state for between 50%-75% of the costs.

The question is: what accountability is there for the citizen (other than the ballot box, I suppose) if we are denied legal recourse? In fact, is there a place in a democracy for the government to tell its citizens who they can and cannot sue? And what does this say about our President?

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Alon Shalev is the author of The Accidental Activist (now available on Kindle) and A Gardener’s Tale. He is the Executive Director of the San Francisco Hillel Foundation, a non-profit that provides spiritual and social justice opportunities to Jewish students in the Bay Area. More on Alon Shalev at http://www.alonshalev.com/and on Twitter (#alonshalevsf).