Health Insurance and Some Thoughts on Medicaid

Protester at Union Square, November 17, 2011. Photo: Edward Arrocha.

One thing that's been on my mind over the past few weeks is the question often repeated on the news and in the media: what is OWS asking for? Granted, there is a detailed OWS declaration outlining "a feeling of mass injustice" thanks to a "corrupted system" that includes inequality and discrimination; environmental destruction and oil dependence; corporate control of the media, the courts, the government, and the economy; bank bailouts, executive bonuses at taxpayer expense, and improper seizure of homes during the mortgage crisis; lack of regulation of campaign finance; the right to education, privacy, and health care; and more. I've seen OWS summed up as "Corporate Greed is killing the American Dream" and many more nice, short messages that fit neatly on a signboard.

But at the heart of it, there is a focus on individual people and their own stories. I've heard it said again and again, "We all have a story." OWS includes the unemployed, underemployed, uninsured, and financially overextended, but it also includes many who are simply deeply concerned that our democratic system is broken and no longer provides equally for all of its citizens. I think, for the most part, people want jobs for fair wages; they want food (dare I say healthy food!), clothing, and shelter; they want health care for themselves and their families.

Frightening new statistics from the the U.S. Census Bureau place "100 million people — one in three Americans — either in poverty or in the fretful zone just above it." There are many who like to portray those on public assistance as lazy and undeserving of help and bemoan throwing their tax money into a "welfare state." The article goes on to point out, however, that "of the 51 million who appear near poor under the fuller measure, nearly 20 percent were lifted up from poverty by benefits the official count overlooks. But more than half were pushed down from higher income levels [emphasis mine]: more than eight million by taxes, six million by medical expenses, and four million by work expenses like transportation and child care." In other words, more than half of the 51 million Americans in this borderline-poverty category got there by doing the right thing: paying their taxes responsibly and taking care of themselves and their families by paying for health care, going to and from work, and paying for child care.

Protester at Union Square, November 17, 2011. Photo: Edward Arrocha.

As for Medicare and Social Security,
there have been no cost-of-living increases to Social Security since 2009. 55 million Americans depend on this income to pay for their homes, food, and other necessities. Medicare allows them to pay for medication and the health care they need to live. The idea of cutting these programs is absurd -- Social Security benefits represent about 41% of the income of the elderly. And before Medicare was enacted in 1965, just 56 percent of seniors had hospital insurance. We--all taxpayers and all workers--pay into these programs. Cutting them will result in more homelessness, hunger, poverty, and needless suffering in the streets and public emergency rooms--resulting in more taxes and even higher insurance premiums.

As one example of what people are looking for in their lives, I turn to health care and how badly people want--need--health insurance.

Disaster Relief Medicaid was available to New York City residents from September 2001 through January 2002. Participants received four months of coverage through traditional Medicaid providers.

I once read an article about how people had used Disaster Relief Medicaid (DRM) in NYC after 9/11. Officials at the time seemed to be surprised by two things. The first was how many people signing up for DRM were gainfully employed but didn't have any health insurance, including business owners, construction workers, retail employees, even teachers. The second was how the enrollees used DRM--they had their eyes checked and got glasses, they went to the dentist, they saw the ob/gyn and got physicals and labwork done.

Squad Company 18 Firehouse shortly after September 11, 2001. Photo: Chris Clarke

The article illustrated one crucial point to me -- officials making policy are pathetically out of touch with their consituents and what they need. It was no surprise to me that people who work--often 60 to 70 hours a week--have no health insurance, as this was true of most of my friends. It also was not news to me that people want to get glasses, go to the dentist, and have regular medical check-ups.

Wall of posters searching for people missing after September 11, 2001. Photo: Chris Clarke

According to New York State's report on the DRM, the program was implemented by mandate from
Governor Pataki about two weeks after 9/11 with a "streamlined" application process. "Infrastructure-supported communication with Medicaid computer systems suffered severe damage. Public transportation was disrupted. Information necessary to establish eligibility was not readily available. Faced with the likelihood of increased health care needs, and the inability to conduct business as usual...a new, time-limited program called Disaster Relief Medicaid/Family Health Plus [was created]. ... The DRM program was unprecedented, and so was enrollment. Thousands of New Yorkers signed up between September 2001 and January 2002. Thus DRM became an unintentional laboratory for examining the consequences of a radically simplified approach to government-funded health care." [P. 5] Mr. O'Kitten was among the 342,362 New Yorkers who enrolled. [P. 21]

Ray's Pizza in the West Village papered with posters searching
for people missing after September 11, 2001.
Photo: Chris Clarke.

Unlike the traditional Medicaid application, DRM allowed you to have higher income ($716/month for individuals, $968/couples) and the only requirements (besides income) were that you be a NYC resident with a Social Security number. The application itself was reduced from 8 pages (plus supporting documents, like bank statements and pay stubs) to a single page. Approval was reduced to 1-5 days from 1-3 months. [P. 13]

Interestingly and importantly, "Providers reported discovering a number of early cancers, early-onset heart disease, and previously undetected diseases such as diabetes, asthma, and HIV among DRM recipients." And how much of a savings in actual dollars (not to mention prevented suffering) does such early detection represent? [p.7]

Lower Manhattan shortly after September 11, 2001. Photo: Chris Clarke.

Here's the report's documentation for the DRM enrollees' use of eye care and dental services: "Generally, utilization of Medicaid services by DRM enrollees was consistent with the regular Medicaid population. Exceptions were Dental ($125 million), Laboratory ($4 million), and Eye Care Services ($5.8 million), which were utilized at higher rates; and Inpatient Services ($194 million), which were utilized at a lower rate."
[p.7] "More than 9,000 individuals [2.7%] utilized an inpatient service." [P. 15] Notably, "Nearly 23 percent of hospital admissions were for drug and alcohol treatment." [P. 15] Also of note, "More than 19,000 women sought treatment for gynecology services." [P. 15]

So what happened to DRM? "DRM was originally intended to provide four months of health care coverage. As the program evolved, it was decided to give DRM enrollees the opportunity to obtain regular Medicaid without a gap in coverage. This opportunity became the Transition Program. Following the four-month DRM authorizations, most enrollees (about 90 percent) were granted extensions, during which they could file a full application for regular Medicaid/Family Health Plus." [P. 21] "As of February 2003, there were 150,676 DRM enrollees, or 44.3 percent, who were ultimately transitioned to regular Medicaid or Family Health Plus from DRM." [P. 22]

The report notes a few interesting things in its conclusions. For instance, "The interviews and focus groups confirmed that, for some people, the life circumstances that create the need for Medicaid often prevent people from obtaining the documentation required to prove eligibility." [P. 48] Any illness that affects physical mobility would certainly fall into just such a life circumstance, as would mental illness. It would also be difficult for someone juggling many hours of low-wage work and child care to spend a day filing for Medicaid. You have file in person (which means taking the day off of work and finding a babysitter) and you may be required to return if you don't have all the proper documentation with you, which is almost a given since they always seem to come up with something you didn't bring with you.

Marylanders seeking help flood the Baltimore County office
of the State Department of Social Services. Photo: Frank Klein

For a glimpse at how daunting the application itself is, you can look at it here. As for the required documentation, the DRM report points out, "Some individuals, primarily those who work “off the books,” have problems in documenting employment. Others who have difficulty include seasonal workers whose previous year’s returns may not reflect their current situation, workers with a variety of temporary jobs, and self-employed individuals with irregular income for multiple services. It also appears that the types of employment that do not offer health insurance are often the most difficult to document."
[P. 48-49]

"[DRM] Participants’ health status varied considerably. Many of the participants felt they were in relatively good health and needed only routine preventive examinations. They had often lived with dental problems, allergies, and chronic pain without receiving treatment except in emergencies. About ten percent of the participants had chronic health conditions such as diabetes, lupus, high blood pressure, and cancer that require ongoing care. Many stated they would do “whatever they could” to purchase the medications and treatments as often as possible. Their economic situation did not allow them to have the kind of health care their medical situation warranted [emphasis mine]. Each focus group had one or two elderly participants with at least one, and often multiple, serious, chronic health care problems. They could not afford to purchase the medications and treatments that were not fully covered by Medicare (even if they were enrolled)." [P. A-8]

"The many reasons for applying for DRM reflected participantsʼ diverse health needs. Many participants used DRM for preventive services such as check-ups, mammograms, pap smears, prostate exams, and lab tests. Dental services was mentioned most often. Receiving vision care was also a commonly used service. One participant saw a psychiatrist to help him with his reaction to 9/11. Those with previously diagnosed chronic health problems often enrolled to receive care they could not always afford in the past, including medications. Many said they signed up to receive health care services they knew they needed but could not afford
[emphasis mine]. A number of individuals had relied on emergency room visits for treatment in the past." [P. A-8, 9]

Congress Voting the Declaration of Independence,
Edward Savage and/or Robert Edge Pine.
c. 1776. Oil on canvas.

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed." [The Declaration of Independence, July 4, 1776.]

If we are indeed a First World country, and believe in Life, Liberty, and the pursuit of Happiness, it is indeed shameful that any one of us should endure ill health when modern medicine can relieve us of our suffering.

“Does it make you a king
to have more and more cedar?
Did not your father have food and drink?
He did what was right and just,
so all went well with him.
He defended the cause of the poor and needy,
and so all went well.
Is that not what it means to know me?”
declares the LORD.
“But your eyes and your heart
are set only on dishonest gain,
on shedding innocent blood
and on oppression and extortion.”

Therefore this is what the LORD says about Jehoiakim son of Josiah king of Judah:

“They will not mourn for him:
‘Alas, my brother! Alas, my sister!’
They will not mourn for him:
‘Alas, my master! Alas, his splendor!’
He will have the burial of a donkey—
dragged away and thrown
outside the gates of Jerusalem."

Jeremiah 22:15-19

Protester at Union Square, November 17, 2011. Photo: Edward Arrocha.


OWS: Marching on November 17

Rally in Union Square. Photo: Chris Clarke

Yesterday was November 17, and Mr. O'Kitten and I went downtown to join the Occupy Wall Street march. I didn't really know what to expect, or even where to go exactly, but after Bloomberg's wee hours closure of Zuccotti Park, seizure of the OWS People's Library (containing over 5,000 books), and subsequent harassment of people trying to go in and out of the Zuccotti Park, I was determined to participate in some small way.

I knew that there were actions planned beginning at 7am at the New York Stock Exchange and continuing throughout the day, but I had a noon appointment and Mr. O'Kitten had a class. We met up around 2pm just a few blocks from Zuccotti Park at Foley Square, which was already being barricaded by dozens of police officers. Mr. O'K was coming from City Hall, where there had been hundreds of marchers, police in full riot gear, and tension in the chilly autumn air.

Marchers on Lower Broadway. Photo: Chris Clarke

Mr. O’K reported that he’d been among a sizeable group of marchers heading south, and we met them coming back up Broadway in a drizzly rain. Dozens of police officers in single file walked alongside the enormous group, ordering anyone who stepped off the sidewalk back onto it. The NYPD officers occupied an entire lane of Broadway and we filled the sidewalk in the cold drizzle. I have no idea how many blocks of marchers there were, but when we crossed Canal and proceeded through SoHo, our chants echoed off of the tall cast iron buildings and filled Broadway with a tremendous chorus of voices. People stood in every storefront to see what was going on, taking photos and video along the entire route, many waving and smiling in solidarity. The windows and fire escapes over Broadway were also full of on-lookers, some waving their own posters and signs of support.

The rain stopped as we reached Union Square, having covered a distance of about three miles. We threaded our way alongside the Holiday Market (which was barricaded off), moving slowly through a narrow passage toward 16th Street. The entire northern half of the park was already full. The portion of the OWS protesting oppressive student debt had already begun, and I had no idea how many marchers were still behind us, yet to arrive.

Rally in Union Square. Photo: Edward "Eak" Arrocha

At this point I’d like to address the criticism that OWS "does not have a clear list of demands." As you look at photos or watch coverage of OWS, you will also notice signs with different viewpoints on them. However, one unifying point is the shared feeling that our current political system does not equally serve every citizen, but is biased toward (if not actually owned by) the rich and powerful. Convenient shorthand for this idea is the "1%," indicating "the richest 1% of people [that] are writing the rules of an unfair global economy" that does not work for most of us (perhaps 99% of us). There is the opinion that this is not democracy, accompanied by a strong desire to fix it.

The Declaration of the Occupation of New York City, drafted in late September, does include a list of grievances that includes inequality and discrimination; environmental destruction and oil dependence; corporate control of the media, the courts, the government, and the economy; bank bailouts, executive bonuses at taxpayer expense, and improper seizure of homes during the mortgage crisis; lack of regulation of campaign finance; the right to education, privacy, and health care; and more.

We left Union Square and headed back downtown, to Foley Square. For two blocks, we were allowed to march in the street. This seemed odd to me, even as we triumphantly spread out across Fifth Avenue. Mr. O'K and I were somehow within a couple hundred people of the front of the march. At Fourteenth Street, we were blocked by a police barricade across the entire intersection. Shouts and gestures of "Go back! Go back!" began. Of course, turning a crowd of thousands around would be difficult, even if the massive group could successfully employ something like the People's Microphone.

Then it seemed like we could go forward. Cheers ensued.

But we were mistaken. "Turn around! Turn around!" Confusion. Drums were beating. People were chanting, waving flags. So much energy was contained in the thousands of bodies standing there with their hearts pounding and muscles coiled after walking for miles in the chill rain and then rallying, chanting, applauding and cheering in the park. The need to surge on was strong. The line of officers and police vans was like a small, frail dam trying to hold back a tsunami. A potentially very angry tsunami.

I overheard some people yelling, "Go around! Go around!" and I asked someone, "Can we go around? Because that's what we should do.” I tried to see the police officers over the heads of the crowd but I couldn’t. “I bet they want a confrontation."

Just then, a handful of people began shouting, "Sidewalk! Sidewalk!" We headed for it.

When we got close, a small knot of guys was similarly trying to figure out what to do. One of them was saying, "I think we should push through. We have thousands of people here. We can take them."

"But can we go around?" I asked.

"Well, there's a sidewalk, but it's just a trickle."

"If you try to push through, there'll be a confrontation," I said. "I bet they set up this blockade on purpose. We should just go around."

"It'll take forever to go around," he said. "I have friends in that building right there I can call," he added, indicating the opposite corner, where the second-story windows were papered with big signs saying "Occupy Students and Teachers/Take Back That Which is Yours." People were standing in the windows, waving their fists in the air. He looked at his phone.

Fifth Avenue and Fourteenth Street. Photo: Chris Clarke

His friends started yelling, "Push through! Push through!"

I grabbed Mr. O'K and pulled him toward the corner. "I don't want to get caught here if there's going to be a battle with the police. If we can go around, we should. I bet they set it up like this to channel people onto Fifth Avenue and then stop them at the barricade on purpose. Let's go."

On Fourteenth Street, when we were moving again, about half a block from the barricade, another guy concurred with me. "They thought they could stall us there. The best thing is to keep moving--be flexible. They wanted to stop the march and wait us out."

I don't know if the police were that smart or not, but it occurred to me later that even if they hadn't planned to trap thousands of marchers in a dead end, it couldn't have worked out better for them. I still don't know if there were any altercations at the corner of Fifth Avenue and Fourteenth Street, but I hope not. All I know is that soon enough we were heading across the south end of Union Square and turning south to head back down Broadway, close to the head of a column of thousands of marchers, and evening was falling.

Union Square. Photo: Chris Clarke

It wasn't as cold as it had been in the afternoon, and there hadn't been any more rain. We made much slower progress than we had earlier in the day. The police regrouped almost as quickly as the marchers, and soon enough we were again flanked by a long column of officers. They walked in the western lane of Broadway, and we filled the sidewalk, doing our best to let pedestrians through. I noticed some things I hadn't earlier in the day, like the helmets most of the officers wore, which looked like motorcycle helmets that also covered the neck. Many of them had clusters of zip ties, the kind they use for handcuffs, hanging at their knees, and their batons looked really long and shiny.

There were about five helicopters in the air, one of which was a police helicopter hovering really low overhead. Police cars kept careening down Broadway, sirens yowling, interspersed with several NYPD buses--the kind they transport prisoners in. We passed a number of NYPD Communications Command Unit vans, their rooves full of James Bond-looking spy stuff. I also noticed a number of officers with hand-held video cameras filming us as we marched by.

An NYPD Communications Division Command Post

All through the day, I was continually impressed by the diversity of the crowd. As I mentioned in my previous OWS post, the media’s depiction of OWS protesters as a bunch of disenfranchised "hippie kids" is completely inaccurate. I saw people of many nationalities and skin colors, all ages, and all different backgrounds. Occasionally someone along the route would yell, "Get a job!" and inevitably a number in the crowd would shout back, "I have a job!" So obviously OWS includes both the employed and the unemployed. For awhile we were marching between a group of about eight children (the New York Children’s Brigade) between eight and ten years old who were very concerned about the environment and education and two couples who looked to be in their sixties.

When we finally got to Foley Square, I was astonished that it--like Union Square--was already packed with people. And there were presumably thousands more threading their way toward Foley Park; the column was still making its way down from Canal Street, nearly a mile behind us. It was about 6:30, it was dark, and we were both tired and hungry, so Mr. O’K and I made our way toward the subway.

Right outside the City Hall station, we passed two of the NYPD prison buses we'd seen earlier, both full of people wearing white T-shirts with "99%" emblazoned on them. We stood behind the barricades that lined the street in front of the Manhattan Municipal Building, waving our signs and chanting in solidarity until the buses pulled away, with people cheering and applauding as they passed. It turns out that these buses held the 99 people who had, in a premeditated act of civil disobedience, been arrested in a sit-in earlier on the Brooklyn Bridge. The number intended to draw attention to Occupy Wall Street's message: that OWS represents 99% of Americans.

The most inspiring thing that I've seen happen over the past week--to myself as well as to others--is that our city officials' actions (and those of Mayor Bloomberg in particular, who happens to be America's 12th wealthiest person, worth nearly $20 billion) have caused many people to feel a sense of moral indignation that has long been lying dormant. Subsequently, our political awareness has awakened, pulling us out of our frustration and apathy and spurring us into action.

I thank OWS for setting these events into motion.


O'Kitten Returns; Visits OWS

I know you haven't heard from me in a year, but fortunately rumors of my death were greatly exaggerated. I'm alive, I'm well, and I'm still living in Queens. I haven't felt much like writing, but lately a subject has captured my attention and I'm going to post a bit about it. That topic is Occupy Wall Street (OWS).

When protesters began sleeping down in Zuccotti Park on September 17, I admit I thought it sounded pretty ridiculous. I pictured a few unemployed hipsters from Williamsburg with nothing better to do and figured after a week or so, when no one paid them much attention and their numbers failed to grow, they'd all pack up and go home. I had no idea that the "Occupy" idea would not only grab hold here, but would gain traction around the world, giving me as well as many others hope that maybe, just maybe, things might actually change.

In late October, I saw this:

And I was inspired by Marsha Spencer. I thought, I can knit. I may not be down at Wall Street, but it's getting cold, and I can knit some hats. So I knit steadily for about two weeks.

On Friday, November 4, I headed into downtown Manhattan just as dusk was falling. I assumed that it'd be easy to find OWS when I got off the subway at Wall Street --every time I've ever encountered or participated in a protest, you can hear the roar of the crowd from many blocks away. But Wall Street was quiet, as it usually is after 6 pm on a weeknight. There were a few people in suits leaving office buildings, some police officers hanging about the subway entrances and in doorways here and there, and a few mounted on horseback. No crowds. It looked almost exactly like this:

I realized I didn't even know where Zuccotti Park was. (It was called Liberty Plaza Park until 2006, which sounds much more familiar.) I walked back and forth on Wall Street--finding no park, and no crowd. Wall Street is actually only eight blocks long (actually, Manhattan is pretty narrow down there anyway) and after I covered about half of Wall Street, it occurred to me that the park might not even be on Wall Street. Fortunately, signage for tourists abounds in the financial district, and I quickly located Zuccotti Park on a map and headed west to Broadway.

Zuccotti Park is that little green bit close to the center of the map,
just above the red A marker.

First I saw a row of food trucks, falafel and halal, tacos and fruit smoothies. I imagine they originally were daytime denizens, feeding analysts, traders, and tourists, but now they can stay around the clock for the occupiers, news media, and additional tourists. Their generators were humming but the park itself was quiet. It was chilly, in the 50s (10-13C), but not windy and the snow that we'd had the previous weekend was long gone.

Photo: Washington Post

Here again, I admit I was expecting the 33,000 square-foot (3,100 m2) park--home to hundreds of people with no plumbing for seven weeks--to be rank, smelly, noisy, off-putting, and disorganized. It was none of these things. I have an extremely sensitive nose, and, to my amazement, there was nothing smelly or dirty about the park. And it was quiet. No crazy drumming circles, no one doing drugs, no one playing hacky sack, no pervasive smell of pot wafting over the grounds. Imagine.

There was a broad path through the park lined by clearly marked areas, mostly with tables and chairs and people with literature and info available: Library, First Aid, Comfort (where I saw a number of coats and winter clothes, and left the hats and wristwarmers I'd knitted), Press Inquiries, Sustainability, Food, Civil Rights, Legal, Media, and many more.

After one pass through the quiet park, I went out and circled back to where I'd come in. The sidewalk around the park was wide and clear, completely clean and impediment-free. On one end of the park a few flyers had been taped, most prominently the Good Neighbor Policy, which I'd also seen on large posters within the park. It included "zero tolerance for drugs or alcohol anywhere in Liberty Plaza; Zero tolerance for violence or verbal abuse towards anyone; [and] Zero tolerance for abuse of personal or public property."

When I'd come in, I'd noticed a group on the stairs at the end of the park. One person would say a few words, and then the group closest to them would repeat the words so the surrounding crowd could hear what was said. I've since learned that this is the "People's Microphone" that circumvents NYC's requirement for an “amplified sound” permit, which would ban microphones, speakers, and even bullhorns from Liberty Plaza. Well, no wonder it's so quiet down there. With drumming "limit[ed] ... on the site to 2 hours per day, between the hours of 11am and 5pm only" by OWS' own Good Neighbor Policy, the group seemed to me far from troublesome, at least in the way it's been depicted in the press.

Photo: Griffin Lotz

Now if you disagree strongly with the ideas behind OWS...well, that's a whole different discussion. But if (as I was inclined to do back in September) you're just complaining that they're a bunch of dirty, disorganized hippies (and, until now, has anyone used that word since the 70s except for Cartman?), you're just plain wrong.

I've been particularly saddened by the news of recent evictions of occupiers in Oakland and, last night, here in NYC. What city officials don't seem to realize is that such actions are only going to serve to make the Occupy movement stronger, because those of us who may have started out on the fence are going to take sides.

As they say, "You cannot evict an idea."

My friend Brian Scott has some wonderful photos of OWS here.