A closer look at the Medicaid 'lifestyle'

In an era when politicians compete to repeat the same sound bites endlessly, I have to give Michigan House of Representatives Speaker Jase Bolger credit for adding a completely new concept to the long shopworn debate over how to implement the Affordable Care Act: The Medicaid "lifestyle."

Bolger made reference to that as part of a GOP-backed proposal introduced in the Michigan House that would limit the state's adult, non-disabled residents to receiving Medicaid benefits for no more than 48 months in their lifetimes.

"It goes entirely to our belief that government assistance is not an entitlement, nor is it a lifestyle, if you're an able-bodied adult," he told the Detroit News. Michigan is one of 16 states still figuring out whether to expand Medicaid.

Kate Segal, a fellow lawmaker who's a Democrat, gave what I thought was the most rational response: "Unless you cap diseases at 48 months, that's an unrealistic demand on people," she said.

Much worse was the reply from the Michigan Health & Hospital Association, whose members would stand to lose hundred of millions of dollars a year treating uninsured patients if Medicaid isn't expanded. "I think we've got to give them credit for a good start. It sure feels good that they at least have a bill," said Laura Appel, the association's vice president of federal policy.

Appel noted that the Centers for Medicare & Medicaid Services is unlikely to approve the waiver required to enact such a cap, making it much more a bill of goods than an actual bill. I don't know if Michigan's hospital lobby is working harder behind the scenes to twist the appropriate arms, but such "attaboy" rhetoric might actually be less helpful than saying nothing at all.

Nevertheless, that's the grand bargain on the table to expand Medicaid to about 400,000 low-income Michiganders who can't afford private insurance but make too much to qualify for Medicaid. Rick Snyder, Michigan's Republican governor, is in favor of expansion, but like his like-minded colleague in Florida, Gov. Rick Scott, he cannot persuade enough lawmakers to approve it.

By the way, it was just reported by the Tampa Bay Times that members of the Florida House continue to receive health insurance so heavily subsidized that they're paying just a fraction of what they proposed the state's poor would pay had they decided to expand Medicaid. But since they rejected expansion, I suppose that point is now moot.

But I digress. I really want to discuss this "lifestyle" notion. It's a term that has been used by conservatives for a couple of decades now to describe behavior they disapprove of. It was originally used to discuss homosexuality, but the tremendous progress on the gay marriage issues as of late has permanentely sidelined that argument. Now it's apparently going to be used to discuss people too poor or shiftless to obtain healthcare coverage using their own gumption.

I wanted to run this by Laura Salwet, someone I befriended in graduate school a few years ago. Laura was the only person I knew ever enrolled in Medicaid. Her lifestyle included constant battles with her doctors about getting the Gleevex she needed to fight her leukemia--as well as dealing with condescension and even outright hostility from her providers because she was on public assistance.  I suggested she threaten to file complaints with the California Medical Board, because even though it's a toothless body, no doctor wants to become entangled in its bureaucracy. It seemed to work, and she kept on getting her medication.

Then Laura's fortunes changed: She got a job on the reality show "The Bachelorette." It paid well, but didn't offer any benefits. She was immediately dropped from Medicaid because she made too much money. I was mostly stumped about offering her advice moving forward, because no insurance company would write a policy on someone with leukemia.

That's changed under the ACA. And I'm sure it would be an enormous help to Laura if she hadn't died about a year after losing her coverage.

For some reason I couldn't bring myself to get in touch with Laura's young daughter and longtime boyfriend to ask their thoughts about the Medicaid lifestyle.

However, I have a pretty good idea of what my late, very smart and even more profane friend would say: Jase Bolger should be quiet in a manner that cannot be printed here. And the Michigan Health & Hospital Association should get much, much louder. - Ron (@FierceHealth)

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