Guest essay: Bad policies hurt us badly

Dr. Leach: Health care, jobs, money will be lost

Dr. Richard Leach

Please consider supporting The Front Page with a paid subscription: HERE

Dr. Richard Leach

The Trump administration’s plan to defund Medicaid and its plan to deport millions of migrants are usually spoken about in separate conversations. As both a physician who well knows Medicaid‘s impacts on patients and as an advocate for our new American neighbors, I think of the plans as conjoined and, among other things, of having huge impacts on American jobs and our economy.

The impacts will be especially terrible in more rural America, like New York’s Congressional District 21.

You have seen the estimates: up to 17 million people in the U.S. will lose health insurance coverage under Trump’s bill. That is bad enough. But defunding Medicaid will inevitably produce important job losses.

First, understand that a huge private sector industry provides long-term services for elderly and disabled persons. This industry has been growing markedly in the past two decades for these reasons:

* People are living longer.

* Families no longer support their elderly in homes the way they used to; millions of old folks are living in institutional settings.

* Since the Rehabilitation Act of 1973 and the Americans With Disabilities Act of 1990, vastly more disabled people are also in institutional settings.

* Many elderly and disabled folks still living at home receive in-home services to help them stay there.

Second, understand that Medicaid is the single largest payer for long-term care services. It covers nearly half of the total industry costs, including for nursing home employment and in-home care services.

Third, hospitals also receive critically important Medicaid funding. Emergency departments are legally obligated to provide care for anyone needing it, regardless of ability to pay. The costs of emergency care that are not reimbursed are likely to force hospitals to cut services.

Emergency departments or whole hospitals may have to close, depriving residents of access to health services, and in many cases, eliminating the jobs of the area’s main employer.

Trump’s bill is probably have the following effects in New York, per Governor Hochul’s estimates:

* cut an estimated $8 billion to our hospitals

* lead to 34,000 lost hospital jobs

* cause 1.5 million individuals to lose health insurance.

As jobs are lost, poverty increases and health care becomes less accessible. Folks with developing illnesses postpone seeking care and deaths result.

Trump’s bill pours $170 billion into the Department of Homeland Security and its division of Immigration and Customs Enforcement.

ICE is yanking migrant workers out of critical industries where they fill jobs that many American-born folks seem reluctant to take, such as jobs in:

* General warehousing and storage

* Farming and agriculture

* Tourism/hospitality

* Mining

* Construction

* Landscaping services

* Health care

To understand what such job losses will mean, consider the California agriculture industry, which provides a large share of America’s fruit and vegetables and is hugely dependent on migrant labor. Lose the workers and the crops won’t be picked. Food prices will inflate and some foods will become unavailable.

ICE attacks are increasingly occurring in our congressional district, NY 21. Although our regional economies are not yet badly affected, many businesses are feeling painful impacts. The likelihood is we will soon begin to notice as goods and services become less available and more costly, and as we lose some of our friends and neighbors.

Nationwide, Medicaid defunding and mass deportation will combine to produce so many lost jobs that inflation will be aggravated and recession made more likely.

Social Security and Medicare are already under pressure and on track to go into the red in under 10 years. Fewer workers will mean fewer tax dollars going to support those programs. They will flounder earlier.

Since our American population is trending toward aging, more folks will need more support. Where will they get it?

In NY 21, the combination of Medicaid defunding and mass deportation

will hit in these specific ways:

* Regional nursing homes will suffer defunding. Many are already financially marginal. Estimates are that at least one in four will close.

* Hospitals and medical clinics will have fewer housekeepers, fewer nurses and doctors.

* They will have worse-than-ever problems in discharging patients to questionably supported environments.

* Some hospitals will be forced to close* Folks will lose home-care services and their families will have to assume their care. In many of these families, both parents work, so one may have to stop and the family may sink into poverty.

* The Amazon and Target warehouses in our region will struggle to perform their functions.

* Delays in new structure construction, already slow, will worsen.

* Tourism and hospitality businesses will suffer and may have to close.

* Dairy Farms will lose workers and may have to fold. Milk will be more expensive.

* Apples and strawberries will remain unpicked; orchards and truck farms may disappear.

* Favorite restaurants will go out of business.

* The taxes paid by our foreign-born friends will dry up, and our economies will further suffer.

* And we will lose their cultural contributions and their friendship.

Poverty, family stresses, failures of businesses and services, inflation, recession losses of cultural diversity and friends — these are the storms on our near horizon.

Watching them roll in, we must ask questions. Why are we being hit with this double whammy? We will lose so much … who will profit from our losses? How will our children and grandchildren deal with the massive increase in our national debt?

And most importantly: Is this the vision of America we seek?

It is not mine. In my view, the measure of a truly great culture is how it takes care of its less fortunate and how it welcomes the stranger.

(Dr. Richard Leach practiced in Glens Falls for 40 years, is now retired, and is currently active through the Adirondack Regional Immigration Collaborative (ARIC) in protecting our migrant neighbors from deportation and through the Healthcare Coalition for the North Country in informing our regional communities about the ramifications of Medicaid defunding.)