As the co-authors of the recently-released survey "Losing Health Care in Missouri: Impact of the 2005 Medicaid Cuts," we object to the characterization of our report in the Standard-Democrat's March 19 editorial.
The editorial questions the survey's validity. We acknowledge that this is not a random sample of low-income Missourians affected by the Medicaid cuts. We were not able to obtain a random sample because the Missouri Budget Project and the Missouri Association for Social Welfare do not have access to the database of Medicaid enrollees. Only the state has this confidential information. That's why we are calling on the state to track what is happening to low-income Missourians who were cut from Medicaid. Several other states have conducted research studies to evaluate the consequences of such health policy decisions.
Our report is based on responses from 2,435 Missourians who completed a survey distributed by nearly 30 nonprofit organizations across the state. Timothy D. McBride, a Professor from the St. Louis University School of Public Health, provided the data analysis and concluded that the sample "looks a lot like the population that was in the Medicaid program in 2005, with a good representation of characteristics such as gender, race, household size and income."
Therefore, according to Dr. McBride, the survey provides valid information about the impact of Medicaid cuts on low-income parents and other adults, children and people with disabilities.
We take great exception the editorial's characterization of the survey as "bogus." However, we do agree with the author when he says it makes him "sick," as well it should considering that 34 percent of those who responded said they will cut back on food and 36 percent will cut back on utilities as a way of coping with Medicaid cuts. It should make all of us "sick" that those most in need have to sacrifice other necessities of life to try to pay for health care.
We also are dismayed that the Department of Social Services calls the survey an "opinion poll." In fact, the survey did not ask respondents their "opinions" about any issue or topic, but asked them factual questions about what Medicaid services they lost, and how they are coping with the cuts. We do not consider it an "opinion" when 59 percent of respondents say they cannot afford or have lost coverage of prescription medications. It is not an "opinion" when 40 percent report they have lost dental services or that 22 percent report they cannot get batteries or accessories for their wheelchairs. To label these responses as merely "opinions" is a telling response from the state which apparently is not interested in either the opinions or the hardship of these former Medicaid enrollees.
The editorial also questions people who "cheat" the Medicaid system. The vast majority of so-called "waste" in Medicaid is the result of provider-related fraud and billing errors. That's why we are calling on legislators to adopt a state version of the Federal False Claims Act. This will make it much easier for Missouri to recover millions of dollars lost to provider fraud.
The Medicaid program does not operate in a vacuum, but reflects the overall problems in our health care delivery system's cost, inadequate access and lack of fairness - which will not be remedied by adding to the increasing number of uninsured Missourians. If the inefficiencies and double-digit inflation in health care costs are not addressed soon, all of us will be at risk of losing access to affordable health care as well.
We commend the editorial for acknowledging that some of the Medicaid cuts were wrong. Concerned citizens must ask their elected officials to restore health coverage to 100,000 low-income Missourians - especially since the state is expected to have an estimated $250-$300 million more in revenue than originally anticipated at year-end on June 30.
Sharon Feltman, LPN, MPA, Director, Health Access Project Missouri Association for Social Welfare
Jennifer Hill, Director of Health Policy Missouri Budget Project