The War on Poverty is on the Wrong Battlefield!

The history of Medicaid and Peach Care for Kids and how to shore up funding discrepancies has been an annual theme over the last few legislative sessions in Georgia. In 2007, in the wake of a $131 million government funding shortfall, Georgia’s Peach Care for Kids program slammed the door shut on new enrollments. The State House responded by restricting the terms for enrollment in the program while still avoiding the retroactive application of the new terms. Unwilling to see children of working poor denied medical care, Governor Perdue robbed from Peter to pay Paul and dipped into Medicaid funding to cover the difference temporarily.

In the malaise of the 2008 Legislative Session, where the urgency of drought and transportation issues reduced much of the healthcare funding debate to a waterlogged hit-and-run victim, Governor Perdue called for funding that would not hurt taxpayers while the State continued to wish upon the Federal SCHIP star. At the time, the Administration had already handed down a rule requiring 95 percent of SCHIP eligible children – including those with incomes up to 200 percent of the federal poverty limit or a little over $40 grand for a family four – to be enrolled. After all, good medical care is an entitlement.

In the dramatic shake up and exchange of management power in the much beleaguered Grady Hospital debacle, Georgians became acutely aware of funding shortages. Everything from grabbing funding from the Feds to funding through percentages of collections from traffic violators was proposed.

The main issue in providing healthcare for the working poor is whether Georgia taxpayers should be obligated to supplement the medical care of others. Ultimately, this care should be carried out by a myriad of non profit organizations, employer programs, church and other religious institutions and not be a government imposed obligation. The SCHIP program, Peach Care, and yes, even Medicaid, create a permanent dependency through assured availability. Too often there is poor oversight of the funds going out and allocation of those funds can very quickly become a political, rather than a needs-based franchise. It becomes too easy to game the system, witness ever-rising healthcare costs.

The other factor is the obsessive focus on trauma care over preventive care. According to the Georgia Department of Community Health, Georgia ranks 14th in the United States in adult obesity. No wonder we also rank 15th for the highest obesity rates for children ages 10 to 17. Governor Perdue addressed much of the need for change in focus when he signed HB 977 last year, encouraging insurance companies to offer high deductible insurance products to individuals and families.

A fundamental misconception that drives arguments for taxpayer funded healthcare programs for the working poor is the belief that this group occupies a “permanent poor” status. Consequently, the focus shifts from providing incentives to climb to another class level to maintaining status quo healthcare. It is fatalism in both principle and practice. It has existed ever since Lyndon Johnson declared his “War on Poverty” and enlisted the March of the Great Society by tinkering with the mechanics of New Deal programs like “Aid to Families with Dependent Children”.

In reality, statistical snapshots rarely distinguish between people with low current incomes and those with permanently low incomes. Three-fourths of Americans with incomes in the bottom 20 percent in 1975 were also in the top 40 percent at some point in the next 20 years. The vast majority of Americans in any income bracket are transient in those brackets. This economic truth should inspire us to fit policy with economic reality rather than a romanticized perception of the way things are.