The U.S. split between a wealthy elite and the majority poor is old news. Yet as revelations surface as to who siphons off money for themselves and what happens to the impoverished many, the story continues. It gets into how governments deal with health care. In that regard, health care for children may serve as a marker for when government programs leave off serving the common good. The state of children’s health is like the proverbial “yellow canary” in a mine shaft whose death warned of toxic gas accumulation.
Children are vulnerable, and when problems emerge, they are readily apparent. That’s the case in Florida now. On December 31, 2014 U.S. Circuit Judge Adalberto Jordan announced a decision involving Florida’s Medicaid program and its role in serving child health. Jordan was responding to a 2005 legal action brought by pediatricians, dentists, and nine children on behalf of children enrolled in Florida’s Medicaid program. The lawyer arguing their case insisted that $200 million was needed to fix the program.
As reported by the Miami Herald, Jordan stated that “lawmakers had for years set the state’s Medicaid budget at an artificially low level, causing pediatricians and other specialists for children to opt out of the insurance program for the needy.” Jordan’s ruling declared that to force physicians caring for poor children to accept payments “far below what private insurers would spend — and well below what doctors were paid in the Medicare program for a more powerful group, elders — amounted to rationing of care.”
Judge Jordan cited adverse effects: physicians refusing to care for children served by Medicaid, children going without preventative care, dental care, and screening for lead intoxication. To secure specialty care, children had to travel to other states or to distant cities in Florida. Every year Florida’s Medicaid program removes thousands of recipient children from its roles.
Jordon’s ruling applies to large numbers of children. In 2013, 24 percent of Florida children were classified as poor, presumably making them Medicaid-eligible. More specifically, 40 percent of black children and 15 percent of white children were poor. The year before, 11.4 percent of Florida Children had no health insurance at all.
Child death figures for Florida’s children suggest health services for low-income children and families are fundamentally flawed. For example, mortality for African American children, whose families are much more likely to be poor than those of white children, is high. In 2011, out of 1000 babies born, 11.5 African American babies died in their first year of life; the comparable figure for white babies was 4.8. Similarly, out of 100,000 children from one to 14 years of age, 35 black children and 27 white children died in 2011.
Yet well-to-do Floridians, and their children, are far removed from grim realities like these. It appears that, “Florida ranked third (in the nation) in 2011 in a study measuring the gap between the income of the top 1 percent of Floridians and the bottom 99 percent. In Florida, the top 1 percent earned on average 32.2 times as much as the bottom 99 percent.”
Governor Rick Scott and colleagues drawn from Florida’s wealthy minority have operated Florida’s Medicaid program since 2011. A basic assumption would be that as a program serving the public’s health, Florida Medicaid should prioritize thriving and survival for all children. Judge Jordan’s findings suggest that goals for the program are otherwise, or that its administration is incompetent. Governor Scott is an experienced health care administrator, but what about his priorities?
During Scott’s tenure as CEO of the massive Columbia/HCA health care corporation, the U.S. government convicted 14 of his underlings on charges of fraud. His corporation paid a $1.7 billion fine. The Tampa Bay Times reported that, to avoid incriminating himself, Scott pled the Fifth Amendment 75 times during the course of depositions related to the case. He resigned in 1997, spent a few years as a “venture capitalist,” and then turned to politics.
In a financial disclosure statement released at the end of his successful 2014 gubernatorial campaign – his second – Scott reported a 2013 net worth of $132.7 million. Additionally, “three members of the state cabinet (…) reported a net worth of $10.95 million.” With Scott and his team attending to their personal wealth, the suspicion is that children’s health was never their foremost concern.
Pondering on who is in charge of public health programs for children and how such programs operate has its limitations, however. A larger, more basic, question remains: why are some population groups of children in trouble and others not? A recent United Nations statement epitomizes worldwide epidemiologic analyses over many years. “Children born into poverty,” it said, “are almost twice as likely to die before the age of five as those from wealthier families.”
In this sense, Judge Jordon’s epoch ruling on the Florida Medicaid program evokes an oil and water difference between the interests of two social classes. If that is so, then remediation of problems with Florida Medicaid – the cure – rests ultimately on achieving big changes within U.S. society such that all children survive and live in dignity. The health care part of that agenda would entail a universalized health-care endeavor or a national health service.
Such ambitious thinking rests on unified struggle by the many, which is not presently in the cards. In the meantime, however, what is to keep healthcare activists buoyed up by Judge Jordan’s decision from taking incremental, consciousness –raising steps as they look toward healthcare for us all?
W.T. Whitney Jr. is a retired pediatrician and political journalist living in Maine.