Medicaid Need Not Apply

Billionaire energy magnate David H. Koch takes his healthcare very seriously. He’s located his residence on New York City’s Upper East Side, a community with resplendent healthcare resources. The city’s wealthiest hospitals and clinics lie within blocks of his Park Avenue penthouse, medical facilities with conveniences that meet the standards of fine hotels and restaurants.

And he’s adding more to an area already lined with healthcare’s stellar institutions. A new ambulatory care center at New York-Presbyterian Hospital is coming, funded as part of a $2 billion capital campaign underway this year to which Koch donated $100 million.

It’s to be called the David H. Koch Center – “the best personalized care,” according to its promotional literature, in a “single, patient-friendly and technologically sophisticated environment.”

Medicaid under siege

Koch, however, is not as committed to the healthcare of others. He and his brother, Charles, have invested millions to block Medicaid, widely considered a vital program for healthcare for the poor and near poor in the U.S., with tens of millions of Americans covered. Under the Affordable Care Act (ACA), many million additional Americans are covered under Medicaid.

Not if the Kochs have their way. The Koch brothers have launched what is characterized as “a massive campaign” to stop Medicaid. Their target today is Virginia, where Medicaid, if expanded under the ACA, would cover an additional 400,000 people. Operating through an organization, Americans for Prosperity, the anti-Medicaid crusade goes door-to-door canvassing, attends committee hearings, and targets lawmakers with opposing views. 

Americans for Prosperity has carried out these anti-anti-poverty efforts elsewhere, pumping additional millions to derail Medicaid expansion programs in Arkansas, Florida, Ohio, Louisiana, Michigan, and Pennsylvania.

For decades the Kochs have pressed an “anti” campaign – anti-tax, anti-union, anti-regulation – with fierce ideological fervor matched with aggressive financial backing. Their investment in the ideology of unfettered free markets has paid off: the revenues of the Koch enterprises today are a whopping $100 billion a year.

The specifics of their anti-Medicaid mania are a mix of budget distortions and loathing of taxes. They warn that a Medicaid expansion would cost Virginia’s taxpayers billions, assuring hefty tax hikes. They also claim that more Medicaid would upset the “doctor-patient relationship” and increase wait times.

Medicaid’s real value

 In fact, the Medicaid expansion will add very little to what states would have spent on Medicaid without health reform, according to the Congressional Budget Office, while providing health coverage to 17 million more low-income adults and children in the U.S. The expansion will reduce state and local government costs for uncompensated care and other services provided the uninsured. Most important, the expansion is critical to moving in the direction of providing care to all Americans.

Cuts paid in public health

In the upside down world inhabited by Charles and David Koch, where government impedes, regulation ruins, and healthcare harms, they claim to be saving lives in their anti-Medicaid mission. “Medicaid patients are almost twice as likely to die during surgery than individuals with private insurance,” their group says on its website.

Whatever the shortcomings of Medicaid, cutting the rolls and removing funding only adds injury. Medicaid reimbursements are already low, putting a strain on hospitals to meet demand with fewer dollars and inducing many doctors to forego Medicaid patients altogether. Here in New York State, a Medicaid cut was carried out early in the Cuomo administration that is still being felt in under-served areas.

Meanwhile, as Medicaid patients struggle to qualify to receive much-needed care in places like Virginia, the ground is being prepared for construction of the David H. Koch Center. Medicaid patients need not apply.

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