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Debate exposed divide between health plans

Judith A. Stein and Joe Baker

WASHINGTON, D.C. — Last week’s presidential debate included an extensive discussion about Medicare’s future, mostly about the Romney-Ryan plan to privatize and likely end Medicare as we know it.

Unfortunately, the facts and real-life experiences of the 49 million people and their families who rely on Medicare was largely absent from the discussion.

Even more troubling was the lack of attention paid to how the Romney-Ryan plan will affect those who are the most vulnerable. That includes low-income families and those with high-cost, chronic health care needs — significant issues for ethnic and racial populations in the United States.

Romney-Ryan Plan Ignores Real People

The Romney-Ryan plan would save on the federal budget by increasing costs for people with Medicare. That approach ignores the economic realities facing families that rely on the program as a lifeline.

Under the Romney-Ryan plan, people with Medicare would receive an annual allowance — a voucher or premium support — to purchase a health insurance policy. The value of these vouchers is unlikely to keep pace with health care inflation, meaning people with Medicare would have to pay thousands of dollars more per year under the Romney-Ryan plan.

About half of people with Medicare live on incomes of $22,000 or less — just under 200 percent of the federal poverty level — and women beneficiaries live on even less, about $15,000.

Ethnic elders would be among those hardest hit by the increased costs imposed by the Romney-Ryan plan because these populations are more likely to have low or modest incomes. Ethnic seniors are twice as likely to live in poverty  — 18 percent among African Americans and Hispanic households versus 7 percent among whites.

Those in ethnic communities who rely on Medicare simply cannot afford the Romney-Ryan plan.

Obamacare’s Improvements

Increasing out-of-pocket costs for Medicare families is just one troubling trademark of the Romney-Ryan plan; repealing the Affordable Care Act (ACA) — the “Obamacare” the president touted in the debate — is another.

In addition to paying thousands more out of pocket for their health care needs, older adults and those with disabilities in ethnic communities would be disproportionately affected by reduced access to coverage and basic preventive care.

ACA expands insurance coverage to tens of millions of people without health insurance through the expansion of Medicaid to individuals and families with incomes at 133 percent of the federal poverty level and the creation of public health insurance exchanges.

These exchanges would create a health insurance marketplace at the state level, enabling people to comparison shop for plans that meet pre-determined federal and state requirements.

The Romney-Ryan plan strikes a double blow to those who need Medicaid by doing away with the program’s expansion and slashing its funding by a third in the next 10 years.

Ethnic and racial groups are among those populations more likely to be without insurance coverage, representing one-half of the uninsured population. They are also more likely to suffer from debilitating and life-threatening illnesses.

In a letter to Congress, the Leadership Conference on Civil and Human Rights wrote that “tuberculosis strikes Asian Americans at 16 times higher rates; cancer kills 35 percent more African Americans; and Hispanics are twice as likely to die from diabetes as the general public.”

Under the Romney-Ryan plan, ethnic individuals without coverage would lose access to benefits, and those reliant on Medicaid would suffer as a result of funding cuts.

In addition to loss of coverage, the Romney-Ryan system would cause people in ethnic communities to lose important benefits now afforded by ACA.

ACA extends proven preventive benefits to people with all kinds of insurance, including Medicare, Medicaid and private plans. These improvements aim to help reduce rates of diabetes, HIV/AIDS, obesity and other chronic conditions disproportionately experienced in ethnic communities.

ACA also includes programs with great promise to improve care, such as demonstration pilot projects that are test models of care for those with chronic diseases. The projects are testing ideas like “health homes” to coordinate care for lower-income residents now often shuffled from one site to another for treatment.

The health care reform law also includes better data collection that can help close health care disparities, for example, between white and ethnic or racial populations.

A Matter of Life — and Health

We are grateful for the opportunity this year’s election cycle has provided to ponder the future of Medicare and Medicaid. Yet, we are disappointed by the persistent neglect in the national dialogue to the beneficiaries who will be most affected by the changes proposed under the Romney-Ryan plan.

People in ethnic communities, many of whom rely on low incomes and live with chronic, debilitating illnesses, must not be forgotten in Medicare debates. The very health — and ultimately the lives — of these communities are at stake.

Judith A. Stein is executive director of the Center for Medicare Advocacy Inc. Joe Baker is president of the Medicare Rights Center in New York.