Reinventing Medicaid should be about values, not dollars


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Elizabeth Roberts

Near the end of the public commentary period of the Reinventing Medicaid Town Hall Meeting held in Providence, Bonnie Holder observed that, “The measure of a society is based on how we treat our most vulnerable… How did we ever get to the point where we accept it as a society where 1 percent of the population can have enormous wealth and the rest of us here are fighting?”

What the standing room only crowd of nearly 200 people gathered in the foyer of the Providence Community Health Center on Prairie Avenue were fighting for was the funds needed to provide care and sustenance for children, the elderly, the poor and the homeless. Governor Gina Raimondo is seeking to cut $90 million out of Medicaid, an item that takes up about a third of the budget. Because the federal government matches state medicaid spending, the total of lost dollars to medical services in our state could be nearly double that number.

A steady stream of commentators took the microphone to say that our medical system is already straining to meet the needs of our community. Wages are stagnant, demand is only going to grow, and the money needed to get the job done right is already too tight.

Undoubtedly there are savings to be had. Where those savings are to be found is a question of values and priorities. Are we going to force front line caregivers to work longer hours for less pay? Are we going to ask people to give up medical care and prescriptions that will enhance their quality of life? Or are we going to take a serious look at the salaries and compensation packages of some of the best paid CEOs in New England?

Kathy053
SEIU 1199 New England

The Town Hall in Providence was the second of four meetings. The first was held in Woonsocket on Monday night. The next one is scheduled for March 23 at the Peace Dale Library in Kingstown and the last one will be held on April 1 at the Portsmouth Fee Public Library in Portsmouth.

Stay tuned.

Former Congressman Ed Beard was the first speaker. Now a patient in a nursing home, Beard, now 74,  suffers from Parkinson’s and was confined to a wheelchair. At one point a nurse’s assistant came forward to steady his hand so that he could hold the microphone.  “I know cuts will be damaging,” he said, “Just be very cautious when you talk about the seniors. The seniors are a forgotten lot.”

“I am one of hundreds of CNAs in this state who provide personal, bedside care to elders in our nursing homes. My job is physically and emotionally demanding but highly gratifying… I am really concerned that the nursing homes are going to funding cuts again this year…”

“If we don’t have enough to help these people, to pay our nurses, what are we going to do? In our nursing homes, if we have 2 nurses for 6 patients now, what’s going to happen if we have a bunch of cuts?”

“It’s not pleasant to be poor. To wonder whether or not one will eat today, or have enough heat to heat one’s house or even to have a house to live in…”

 “If my wife went to a nursing home, in three years I would be broke. I would have to go on welfare…”

“The corrections department is actually the largest provider of behavioral healthcare in the state…”

“These are people dependent on others for 24 hour care. They cannot safely remain at home, they’re aged and frail, they may have lost their independence, many of those closest to them have died, they rely on us for everything…”

 “As a person living with mental illness and working in the mental health field, I want to stress the idea of peer support. Peer support is important to people living with mental illness… Medicaid should support peer supporters in the mental health system…”

“Permanent supportive housing is an inexpensive way to really effect some true Medicaid savings.”

“A ton of money is saved by being able to point them to either a health center or to a primary care doctor…”

“When we think about cutting some of the costs in Medicaid, home care only accounts for 5 percent of the money that is being spent…”

“Many executives make over six figures, and other executives make millions. Governor Raimondo has set an excellent example with taking a 5 percent pay cut to her salary. Perhaps our hospital and nursing home executives should do the same…”

“We have many patient cases where they cannot afford their medication, they stretch out their medication or split their pills or take their medication every other day. We then see that when these same patients become eligible for Medicaid, their compliance increases, and they become advocates in their own health care.”

“The nurses… throughout the state providing home healthcare, reimbursement rates have been frozen for eight years now…”

“I specifically want to talk about the significance of non emergency medical transportation…”

“Here’s what Medicaid pays for nursing home care: $6.30 an hour…”

“It’s just not what one does that matters, it’s how one does it. And how we choose to reform Medicare will have an impact for generations to come…”

“It’s established that the single greatest that reduces mortality among seniors is isolation…”

“More than 28,000 children in providence receive RICARE benefits…”

“I was distressed to hear about the Medicaid fund reductions. I know the federal government is making cuts…”

“I take care of children who, if there’s no nurse in the home, those parents don’t go to bed. And if there’s no nurse in the home for a couple of days, those parents cannot take care of that child…”

“If you have to increase what you provide in a healthcare setting and your dollars are being cut, there’s only a few places that money is going to come from. Labor and staff, food and medication. So if that’s what we’re looking at cutting, labor, food, staff and medication, shame on everybody in this state…”

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Highway protest bill represses free speech, discourages activism


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highwayshutdownA bill being considered by the state Senate would make interfering with traffic on a street, sidewalk, or highway, a felony. A felony, we should remember, carries minimum prison sentences, and directly or indirectly disenfranchises people for life. The bill, introduced in the wake of the Black Lives Matter protests that swept the nation this winter, is sponsored by state Senators Lou Raptakis, Frank Lombardo, Frank Lombardi, Mike McCaffrey and Paul Jabour, who purport to want to protect public safety. There has been a great deal of outcry about the possibility of blocking ambulances during protests. This sort of objection and these sorts of laws, however, are manifestations of the systematic repressions that protests like Black Lives Matter seek to change.

For one, both the United States and Rhode Island prisons are full to overflowing (I know—I teach community college classes in the RI Adult Correctional Institution). As a nation, we also know that we have a problem with mass incarceration. In fact, it is one of the few bipartisan issues that currently has any traction. Filling more prison beds with nonviolent activists does not help.

Designating people felons disenfranchises them—in some ways formally and directly, and in other ways informally and indirectly. Convicted felons can vote in Rhode Island, but that is not the case everywhere, and there are almost universal employment and housing consequences for those with felony convictions. If every Rhode Islander who participated in blocking highways during the Black Lives Matter protests was convicted of felonies, a substantial portion of the activists in our state would not only be locked away for some time, but permanently relegated to second-class citizenship. To suggest that the bill has another purpose is to engage in delusion.

The threat of felony convictions would, of course, discourage activism, which is a grave mistake. Activists—indeed, civil disobedience—is responsible for some of the greatest social transformations in history, including the suffrage and civil rights movements, to name just two. Activism and civil disobedience have an important place in American democracy.

Third, ambulances are routinely deterred from highways for reasons unrelated to protest. Several months ago President Obama visited Providence, and the highway was shut for several miles during his stay, necessitating a full detour around the city for many of us to get home. There was no outcry about closing highways for such an occasion.

Fourth and finally, because of the bill’s language and the great degree of police discretion it implies, the legislation could scoop up the homeless, further criminalizing poverty. The bill targets anyone that “stands, sits, kneels, or otherwise loiters on any federal or state highway” and that “could reasonably be construed as interfering with the lawful movement of traffic”—meaning, of course, that those who live on the streets would be prosecutable for simply being there.

The First Amendment protects our right to free speech. To turn over the decision of determining when a protest has become “interference” effectively passes off that right to free speech to the discretion of the officers patrolling the event. The bill is on the table in Rhode Island, but it has tremendous implications for freedom of speech elsewhere, and could powerfully affect the climate of activism in the entire country.

Senator Raptakis, for example, thinks that highway blockades are “not the best way to protest.”

Hearing this, I am reminded of Dr. Martin Luther King Jr.’s famous remarks from the Birmingham Jail about the “moderate, who is more devoted to ‘order’ than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: ‘I agree with you in the goal you seek, but I cannot agree with your methods of direct action’; who,” King concludes, “paternalistically believes he can set the timetable for another man’s freedom.”

Let’s let this bill die.