Why Medicare for Libby and Medicaid for Flint?

When we learned that the people of Flint, MI, were being sickened by lead in their drinking water, we were outraged. It's bad enough when adults confront environmental toxins and suffer health consequences, but finding out that the children of Flint were being poisoned was almost unbelievable. Elected and appointed officials at the state and national levels knew about the lead contamination long before a local doctor raised her concerns about how many children she was seeing who were showing the effects of excess lead in their little bodies. I cannot even imagine, still, the anger and heartbreak of having my children permanently scarred by drinking the water in my own home, however humble that home might be.

Surely, I thought, we will immediately grant access to needed medical care benefits under Medicare to every resident of Flint. Surely we will do what is right to give people needed care and take that worry from them even as we cannot take away the sting of knowing just how many people knew or should have known about the poisoning who did nothing in response. After all, when Libby, MT, residents faced asbestos-related disease and death due to a mining company's disregard for human health, President Obama declared a public health emergency and Sen. Max Baucus stepped in and made sure that those asbestos-poisoned Libby, MT, residents would be eligible for Medicare coverage for all of their medical conditions.

The Missoulian newspaper reported in 2010, "A small army of federal bureaucrats has descended on northwest Montana, helping victims of Libby's asbestos contamination to sign up for unprecedented Medicare benefits. 'This is a new thing for Social Security,' said Nancy Berryhill, the administration's regional commissioner. 'No other group like this has ever been selected to receive Medicare.' Under the new national health care law, victims of Libby's asbestos are eligible for Medicare, regardless of age. Generally, Medicare is reserved only for senior citizens, or those with long-term disabilities. The health care law contains a clause that opens Medicare to anyone diagnosed with an asbestos-related disease who stayed in Lincoln County a total of six months over a 10-year period. Even those who have never worked - and so never paid into Social Security - are eligible. And the new Medicare coverage covered Libby residents for all of their health issues, not just those related to the toxic mine or asbestos. The new Social Security benefits are standard Medicare fare - covering all health issues for those who qualify. 'This is a full health-care package,' Berryhill said, covering everything from asbestosis to flu shots to broken arms."

Medicare for life. Medicare for Libby. Max Baucus did well for his Montana constituents. And Max kept on doing well for Libby. In 2014, just before he retired from U.S. Senate, Baucus brought even more good news to Libby about the Medicare pilot program and benefits being expanded to include more counties in more states.

In February 2014, the Flathead Beacon reported, "Previously, the pilot program, which was established under the Affordable Care Act that Baucus engineered, was available only to people in Lincoln and Flathead counties, excluding a quarter of new patients. The program has now been expanded to include five more counties in western Montana -- Glacier, Lake, Sanders, Mineral, and Missoula -- seven in Idaho and six in Washington. An estimated 80 percent of victims of Libby asbestos exposure live in that region, the senator said... Health officials say the long latency period for asbestos-related diseases means victims develop health complications over the course of decades, and many are dispersed throughout the region...Because of the provision, victims of asbestos-related disease in Libby are now eligible for a range of federal health care benefits, including services not normally covered by Medicare. The provision provides funding for screenings as well as Medicare coverage for those suffering from asbestos-related disease."

Libby's Medicare pilot project was done under Section 10323 of the ACA crafted by Sen. Baucus that amended the Social Security Act, Section 1881, to include Sec. 1881A, Medicare Coverage for Individuals Exposed to Environmental Health Hazards.

Medicare for life. Medicare for Libby. The residents of Libby, MT, are 95.1 % white as of the last census. Median household income is just below $30,000/year.

Fast forward to Flint in 2016. Oh, the elected officials rushed to show they were taking action to help the people of Flint. Just as he had done for Libby in 2009, President Obama declared a state of public health emergency in Flint, that brought Federal resources into play that could be marshalled to help. So I thought it would be among the next steps that Medicare coverage would be provided for all residents of Flint who were made sick by lead poisoning from their water. Instead, Governor Snyder pressed the Feds to expand Medicaid coverage to children and youth under 21 years old and to pregnant women. The Obama administration quickly approved the Medicaid expansion requested by Gov. Snyder - the man who is responsible for poisoning Flint residents, and the man who should resign as Michigan's governor. This Medicaid expansion for Flint was done under Section 1115 of the Patient Protection and Affordable Care Act/Obamacare.

The U.S. Department of Health and Human Services explained the Medicaid deal for Flint as follows: Michigan will expand Medicaid coverage to children up to age 21 and pregnant women who were served by the Flint water system from April 2014 up to a date specified by the Governor, and who have incomes up to 400 percent of the federal poverty level (FPL). Michigan will also set up a state program allowing pregnant women and children up to age 21 who were served by the Flint water system and individuals with incomes above 400 percent of FPL to purchase unsubsidized coverage. This comprehensive health and developmental coverage includes lead-blood level monitoring and behavioral health services, among other services. The Kaiser Family Foundation reports, "An estimated 15,000 people will be newly eligible for coverage under the waiver and an additional 30,000 beneficiaries in the impacted area already are enrolled in Medicaid."

The Mayo Clinic claims that lead poisoning can be toxic for all adults. I wondered why the Medicaid pilot program in Flint isolated children and pregnant woman for inclusion. Libby's Medicare expansion had no age restrictions, nor does coverage end when Libby's asbestos-poisoned residents grow older - at least those who survive the poisoning.

Medicaid for a while for Flint. The residents of Flint are nearly 60% African American as of the last census. Median household income is approx. $26,000/year.

Why Medicare for asbestos-poisoned Libby and Medicaid for lead-poisoned Flint? Is it really just the same or is Medicare enough different from Medicaid that we need to ask more questions and demand equal treatment for our sisters and brothers and their wee ones in Flint?

Was the difference that Libby, MT, residents lived in close proximity to one of the nation's most toxic Superfund sites where the EPA still lists the Human Exposure Status as not under control due to asbestos contamination? Well, Genesee County, MI, has its own nasty Superfund site just 13 miles away from Flint in Otisville, MI, where the EPA reports the Forest Waste Products site shows contaminated ground water status as not under control with all manner of contaminants. So in terms of the severity of risk to human beings of all ages, Flint can lay unfortunate claim to at least as much danger as Libby.

Are there enough physicians who accept Medicaid in the Flint area to treat those new lead-poisoned Medicaid enrollees? Many who have Medicare already have trouble finding doctors who accept new patients, so I looked at what the statistics say about providers and acceptance of Medicaid. In an October 2015 report, The Kaiser Family Foundation said that 93% of providers accept Medicare and of those physicians approx. 72% are accepting new Medicare patients. The same study says that only 67% of physicians accept Medicaid and approx. 45% of those doctors are accepting new Medicaid patients. The does not bode well for the people of Flint for whom the clock is ticking on all sorts of illnesses related to lead poisoning.

Many organizations report that throughout Michigan, there is a shortage of primary care doctors and family practice doctors. Finding a doctor to accept Medicaid coverage will be difficult. Michigan's physicians, just like doctors throughout the country, often do not like to have too many Medicaid patients because the reimbursement rates are less than those for Medicare patients.

Lead-poisoned patients in Flint will face many more hurdles to getting care than asbestos- poisoned people in Libby. Why is that acceptable to anyone? It's about the money. It's always about the money, isn't it? Or is it because of something else more difficult to face? Do we value the people of Flint less than the people of Libby?

Now we must demand that all poisoned people are equal - and that the Medicare pilot program Max Baucus secured for Libby must be explored as a better solution for Flint and ultimately for all of us. If we look at the overall situation, it appears that we are setting precedents for our route to true universal, single-payer healthcare after all. Progressive Democrats of America has been fighting for Medicare for all for years, and it is one of the main reasons we support Bernie Sanders in his bid for the presidency. Environmental disaster by environmental disaster, those charged with finding a way to mitigate human suffering turn to our public programs - Medicaid and Medicare - to give people access to needed healthcare. They do not turn to the profit-driven, private health insurance market to provide healthcare coverage to asbestos or lead poisoned people. Medicare for all for life.