I used Medicaid this morning, just as I do every morning.
I have quadriplegic cerebral palsy, limited use of my arms and legs, chronic pain, and low stamina. I rely on a Medicaid waiver program (designed by my state’s government and approved at the federal level) to help pay for personal caregiving like bathing, dressing, toileting and meal preparation. This disability program, like similar programs for medically fragile and technology-dependent children or people with severe functional limitations from brain injuries or H.I.V./AIDS, helps cover care, support and equipment that allows me to live with my parents, in the community, rather than in a far more costly institution. Living in my community also allows me to play with my nieces, sing in my church choir and have coffee with friends. In the future, my care may be supported in a group home of my choosing.
My care is time-consuming and energy-consuming. With my remaining stamina, carefully orchestrated pacing and planning, and community support, I have been able to lie on my mat table and remotely attend graduate theology classes at Catholic Theological Union, recently obtaining a master’s degree in intercultural ministry. I am able to contribute short essays and theological presentations on disability. I have contributed to an alumni project with Disability Lead, a network of disabled people working to create a more inclusive society.
I am not alone. I am one of 83 million Americans who depend on this government lifeline to help address basic health care needs. But massive cuts to Medicaid may be imminent unless we make our voices heard. On May 22, by a one-vote margin, the House of Representatives passed a federal budget bill that could cut Medicaid services by almost $800 billion and end health care coverage for an estimated 14 million people. The nonpartisan Congressional Budget Office estimates that the bill, which includes tax cuts as well as spending cuts, would result in a shift in financial resources from the lowest 10th of American households to those in the top 10th. The Senate is expected to vote on the bill in June.
For Catholics, support for a safety net is not merely an economic issue but also a moral imperative. A government budget is a moral document; it shows who we are and what we value.
Every American knows a Medicaid recipient. According to the Kaiser Family Foundation, one out of five Americans, and 63 percent of nursing home residents, obtain their primary health care from Medicaid. In addition, four out of 10 children in the United States are covered by Medicaid; in some states more than six out of 10 receive coverage.
This largest provider of long-term health care in the United States has for decades supported people in varied ways, including in-home and nursing care, meal delivery, physical and mental therapy, behavioral support, acquiring and maintaining employment, and assistance with transportation to dialysis and other medical appointments. Medicaid helps real people with real lives, including the pregnant woman who needs an ultrasound and prenatal vitamins, the 19-year-old coming out of the foster care system who needs health care as they transition to adulthood, the senior on a fixed income who needs financial assistance to pay for a recent hospitalization, the autistic child who needs ongoing occupational therapy, and the adult with a traumatic brain injury who requires speech therapy and nursing care.
Medicaid is part of a social safety net that has supported millions of vulnerable families, senior citizens and children, and that played a major role in reducing the U.S. poverty rate from 26 percent in 1967 to 16 percent in 2012. Supporting our most vulnerable allows more children to attend school and climb out of poverty, and Medicaid’s home-based services allow some 4.5 million people to live in their own homes and communities rather than in institutions (a year in a nursing home costs easily $100,000).
Medicaid is also more efficient than private insurance, with considerably lower administrative costs, and it provides states with the flexibility to design their own programs.
The problem with work requirements
At first glance, the House bill’s work requirements for Medicaid recipients may seem to have merit. But nearly two-thirds of Medicaid recipients already do work, and most of the rest are caregivers, ill or disabled, in school, retired, or unable to find work. Moreover, the Center on Budget and Policy Priorities report that work requirements for Medicaid have been tried in some states with dismal outcomes—increased paperwork and red tape for recipients and staff with no improvement in employment. The C.B.P.P. concludes, “Adding more paperwork and administrative steps would jeopardize coverage among eligible people, so any savings would come largely from keeping eligible people out of the program.”
Let us also consider that although most Medicaid recipients make tangible economic contributions to society, whether through jobs or other means, as Catholics we must not demand such a prerequisite to receiving food, shelter and health care.
Staffing reductions, per-capita spending caps and inflexible block grants to states are other so-called reforms that seem designed to simply reduce funding for Medicaid overall, regardless of how many people qualify for assistance.
Medicaid recipients are your friends, your neighbors, your loved ones and members of God’s community. As Catholics, we listen when Jesus commands Peter to “feed my lambs” and “tend my sheep” (Jn 21:15-18), a profound call for action and accompaniment. We heed Jesus’ words that “whatever you did for one of these least brothers of mine, you did for me” (Mt 25:40). We can assume that Jesus’ use of the word least applies to those with the least access to resources and who are the least connected of society; and with his use of the familial term brothers,Jesus shows love and value toward societally discarded peoples.
Catholic social teaching likewise calls for the preferential protection of the poor and vulnerable, and asserts that every human life is sacred with dignity. Pope Francis embodied this position throughout his ministry and papacy. In his 2020 encyclical “Fratelli Tutti,” he urged Christians to exhibit a “preferential love shown to those greatest in need; it undergirds everything we do on their behalf” (No. 187).
In his address to Congress in 2015, Francis reminded American political leaders that “legislative activity is always best based on care for the people.” And in one of his last papal letters, which affirmed the dignity of migrants, he wrote, “the true common good is promoted when society and government, with creativity and strict respect for the rights of all…welcomes, protects, promotes, and integrates the most fragile, unprotected and vulnerable.” It may not always be visible, but like refugees and migrants, the poor in the United States who require Medicaid are vulnerable. We honor Francis’ legacy when we protect those most in need. And, as Jesus modeled, let’s not place requirements to receive basic care and compassion.
For those of us dependent on this safety net, the thought of losing our chance at a quality life or perhaps any life at all is terrifying. Would my care needs be met? Would I develop bedsores? What chance would I have to thrive and contribute?
It is a turbulent and difficult time, and many of us fear that our lives may unravel. Check in to support your loved ones who depend on Medicaid. Listen to our stories, our needs and our fears, and help us address them.
The Jesuit theologian James F. Keenan, S.J. defines mercy as a “willingness to enter the chaos of another.” Pope Francis willingly entered this chaos. May we also enter into the fear and chaos of our poor and live out our faith by telling our political leaders and representatives that we support the preservation of Medicaid benefits.
