Poverty

This past Sunday, I found the following in the coupon section of the paper: “Buy a $50 Visa Gift Card and receive $10 off your order of $50 or more!” Well, hey, I can put together a list of things I need, or can use in future, that adds up to $50, and I can use that gift card to buy gas or other necessities; in the process I’ll save $10 on things I’d buy anyway! Good deal!

Then it hit me. I am fortunate enough to have sufficient disposable income to take advantage of the offer. If, however, I was eking by from paycheck to paycheck, thus was unable to pay $100 all at once to garner the great savings (10% of the total), I couldn’t take advantage of it, and I’d have to pass on saving an extra and sorely needed $10.

In other words, too often you must have money to save it, or make more of it…too often, those who most need the savings or increased income literally can’t afford to take advantage of the typical means for getting it.

We in the middle class can relate to this on a different level: we can’t take advantage of the same investment vehicles available to the wealthy because they require a million dollar buy-in, for example. We must pay an ever increasing chunk of our paycheck to insurance premiums with ever increasing out-of-pocket costs, increasing our cost of living with no concomitant increase in salary – another example.

But even more systems are set up in this same “no-win” way for the “working poor” – folks who work hard at the kind of low-wage jobs that keep us going (maids, clerks, lawn care, home health aides, social service workers, maintenance workers) yet still live in poverty.

Here just a few of the myriad things that work to keep the poor, poor:

can’t get a car loan, so, presto, no car to get to work, daycare, grocery store, etc.
no health insurance so must pay out of pocket for everything – costs that are far higher than those charged to insurance companies; add to that living in substandard housing which exacerbates asthma, allergies, some still with lead paint, causing more illness
neighborhoods with “D” or “F” rated public schools…so much for a decent education
lots of coupons are found in the daily paper…unless you can’t afford the subscription, then that option is out as well
vehicles for saving for the future (IRA’s, investments, even savings accounts) require a minimum deposit and balance to qualify

We hear, often, of folks beating poverty and making it big. Unfortunately, that is a very small minority, and the ticket up and out is usually through professional sports or the film/music industry.

As an executive with large social service agencies, I know what those who care for your profoundly disabled son’s/parent’s care are paid, and it’s not a living wage. We all know what the hotel maids and all service workers on whom we depend are paid, and we know it’s insufficient. Even teachers and bank tellers are paid ridiculously low wages given the skill and education required.

So, please keep this in mind the next time you see headlines about workers at MacDonald’s and Walmart fighting for a decent wage. They have lots of company in folks with jobs that are far more crucial.

Then keep in mind that the only way out of poverty – or the lower-middle class for that matter – is through wages paid.

Now that the Affordable Care Act has been cleared constitutionally by the Supreme Court, it’s up to States individually to decide if they wish to use the monies set aside for expansion of their existing Medicaid programs, or some variation thereof (like subsidizing purchase of regular insurance), to cover low-income individuals who otherwise could not afford health coverage. Currently, many State programs cover only children & folks on disability.

A number of States have accepted the money; a few States, my own included (Florida), have refused it. To learn why, I wrote my legislators asking their reasons for turning away those dollars, in our case $51B over 10 years to cover the approximately 1.2M uninsured here; what follows are the reasons, similar to those heard around the nation by others who have refused to participate:

By refusing the money, it will go back into the general US treasury and help reduce the deficit (folks for the expansion claim the monies, taken from FL taxpayer dollars, will just be used by other States);
We don’t trust the Feds to live up to this stated commitment, so we’re afraid we’ll be on the hook for the expansion when they renege down the line;
Our current Medicaid system is terribly dysfunctional, so we don’t want to be forced to expand it.

Hmmmmm…..

Something just didn’t seem right to me, so I fact checked their reasoning; here’s what I discovered:

The way the law is written, the monies for it are in a separate fund (not the general treasury), coming from a combination of new taxes on wealthier Americans, fines from companies/individuals who don’t adhere to it, and projected savings from folks no longer using uncompensated emergency room care, instead using the regular system (less costly) thus improving their health outcomes (also reducing costs); monies refused by States go back into this fund to be used for future health care, not into the general treasury to reduce the deficit nor to other States currently willing to accept these dollars;
Although the feds are notorious for their “unfunded mandates” (eg passing a law without dollars behind it for enforcement), the federal government has never stopped paying on its medical obligations (Medicare/Medicaid), nor anything for which funding has been allocated;
Many State Medicaid systems are in fact quite poorly run (and so underfunded that no decent doctors will participate) which is why alternatives like subsidizing the purchase of regular insurance is an option that can be permitted (the option forwarded by a FL legislator who believes in using the federal dollars – he’s Republican btw); no State is being compelled to simply expand their current faulty Medicaid system.

Knowing the facts is particularly germane to we Boomers, because many of us are without health insurance, not on disability, and quickly falling into (or already in) the category of adults who qualify for this expansion of State health benefits. About 8.6 million of us in fact, who were found to be without health insurance according to a special 2009 report by Commonwealth Fund. As a result of the Great Recession coupled with ever increasing health care costs, Boomers caught between drastically shrinking retirement accounts and high Boomer unemployment (with the lowest rate of re-employment) are the biggest casualties.

So, Boomers – a generation known for its high rates of diabetes, heart disease, and obesity – living in States refusing expansion of more affordable care to a larger number of their citizens, are the group to be hardest hit by such decisions. Next are our many adult children who are unable to find work offering benefits, in a system that relies solely on such employer-based access for the most affordable coverage.

As you determine your position on this issue, may the facts be with you.