One of the statistics I recall, I think from Jack Markell's healthcare plan but it could have been elsewhere, is that roughly 27,000 Delaware citizens are not signed up for the Medicaid benefits to which they are entitled.
I don't know about you, but when I heard that it brought up visions of poor people suffering and not going to the doctor because they didn't know they actually qualified for state-sponsored health insurance. And I believe (but it's Saturday night and I'm way too tired to go check) that both the Markell and Carney health plans involve, as one element, making it easier to find these people and sign them up.
But I no longer think that's necessarily the case.
Keeping in mind that I understand it is usually dangerous to reason from the specific to the general, I want to tell you a story.
My eldest daughter is 26, unmarried, with a five-year-old son and one of those "full-time/part-time" jobs at a local assisted-care facility (which means they carefully keep her hours at just a tad under that which would require them to offer her benefits).
She's too old to cover on my health plan, so she and my grandson have Medicait (specifically, Delaware Physicians Care).
Every three months DE Medicaid sends out to my daughter (among a voluminous number of other pieces of useless correspondence) a notice that her status is to be reviewed. There is a page of questions to be answered about your job, your address, etc. The page is sent essentially without explanation, and--trust me--it is very difficult for a person with limited reading skills to decipher. Only in the fine print does it tell you that if you don't return this form within two weeks you lose your insurance.
If you don't return this form (or, if you return it and they lose it), you get one--count 'em--one notice that your insurance has been canceled, and an explanation of an appeals process that is more complicated to follow than Einstein's Theory of Special Relativity.
Periodically--let's say twice every three years--my daughter is summoned to appear before a case worker [whom she has never actually seen, given that Medicaid is the only State service she accepts] with her son carried along physically, because she must prove he still exists. The day and time for this is set by the bureaucrats without consultation with the clients--you either show up or they cancel your insurance on the spot. If you have to miss a day of work to verify your insurance, tough shit. This one is also delivered in an unmarked envelope and phrased in language that would have confounded Paul Dirac.
Ok, so we got used to all that. Then last week the bureaucrats running the State's Medicaid system showed us a new trick.
My daughter went in to pick up a refill of her depression medication, only to be told that her health insurance had been canceled, and that would be $248 for the Wellbutrin, please.
She called the current case worked [it required two calls just to find out who her current case worker was]. The case worker told her to call Delaware Physicians Care. DPC was sort of astounded by this, as they told her that the order canceling her insurance had not only come from the case worker's office, but had been signed off by the case worker in question.
Back to the case worker. Now, she says, "Oh, because you make too much money, and your status hadn't been reviewed in two years, your coverage has been dropped. There's an appeals process, but I don't think it'll do any good."
She said my daughter could come in and discuss it, but that she only worked until 3:15 pm every day. My daughter, I told her over the phone, works until 3:00 pm, and it would take her at least half an hour to get there.
"Well, then she'll have to take off work if she wants her insurance back."
So she did. Fortunately, I haven't raised any cowards. My daughter went down there to discover that the records were so out of date (despite her returning her required forms every three months) that they showed her simultaneously working all three different jobs she's held over the past four years, and thus making three times the amount of money she's really bringing home. (Exactly how they thought she was working three forty-hour weeks each week is beyond me.) She showed them her pay stubs, corrected their records, and they told her that her insurance would be restarted some time in the next 2-3 days.
During this conversation, she asked them if she had missed some notice about this review. No, they told her, for this kind of review they didn't send out notices [so you only found out your insurance had been dropped when the card bounced at the doctor's or the pharmacist's officer].
They also told her that these reviews were part of a regular, systematic attempt to purge people from the system in order to keep costs down, but they told her not to tell anybody that, "because that's not supposed to be public knowledge."
As a footnote, they told her that her insurance would be restarted, as promised, in 2-3 days, but it would take a week or more to get her new card. Without your card, you can't pick up prescriptions or be seen in a doctor's office, so I'm not real sure how you can say the insurance has been reinstated if you can't actually use it.
The point of all this: I no longer think there are 27,000 people sitting around Delaware unaware that they qualify for Medicaid benefits.
I think that possibly a large number of people were on the rolls at one time and have been discontinued by a system that seems intent on finding as many ways as possible to force people off. And I think most people in that category, who don't have advocates [and, by the way, the DE Medicaid workers go to great lengths to try to keep advocates from getting access to any information], just go away....
I think of people who don't read or write that well.
I think of people who actually believe what the bureaucrats (who go home at 3:15pm) tell them is the truth.
I think of these people now going to the emergency rooms at Christiana Care, or St. Francis, or Bay Health, and costing us extra thousands and millions of dollars each year, because they can no longer access the insurance to which they are entitled by law.
I am not going to do a Libertarian rant on government bureaucracies here (though I reserve the right to do so in the future).
What I'm doing here is a father's rant, and an attempt to explain to people that the problem with health care in this State, and in this country, is far more complex than any single, sweeping solution will fix.
Food for thought.