Medicaid Survival Has Critical Messages for Access to Justice Strategy

For decades, legal aid advocates were terrified of the potential political appeal and horrendous damage that block granting Medicaid would do. We feared that as a “poor people’s program” it would have few defenders and no voting clout. We were right in our fear, but wrong in the implicit anticipated outcome. That teaches us a critical lesson for an effective ATJ strategy.

Medicaid now appears not only safe but unassailable. I wish I could say that the public has gained sudden sympathy for the poor, but I am skeptical.

Much more likely is that the expansion of medicaid coverage up the income ladder, the realization of how high a percentage of the population relies on the nursing home benefit, either for themselves or a family member, and the impact of the opiod crisis, have changed the perception of the program. They have caused people to understand that for almost every family, in one way or another, this is “their” program. (Sadly, it does not hurt that opiates are now seen as a “white” problem.)

Moreover, the very strong economic interests of providers played a critical role in the alliance that prevented the immediate demolition of Medicare.

The implications are little short of obvious. Access to Justice will only move forward, and survive challenges if it is understood as much more than a poor people’s program, and if providers have strong, not just rhetorical incenties, to protect the prgram.

The further implications are also simple. Services, although no necessarily the same serices, have to provided all the way up to the income level at which people can afford ATJ serices on their own. And, the provider base has to go way beyond a fw thouant salaried lawers and advocates, to hundreds of thousands of lawyers. Moreover, this is not as difficult as it sounds. A small tax on legal fees, would suport many lower-priced lawyers doing a lot of access work.

I beleie that something similar is politically necessary for 100% access.

P. S. I would add that this approach has huge, and much less obvious, implications for branding. I will address these in a future post.


About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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