Before the Epstein story caught the attention of the people and the national media, the focus had been on the “BBB” budget bill. Supporters of the bill claim that we are broke, that we need to get a handle on spending and eliminate the fraud in our social safety net that they claim is rampant.
I have a bit of a problem believing either of those claims. The BBB is going to add $3.2 trillion to the deficit ($4 trillion if you count the interest that will be added to the debt).
As for the claim of rampant fraud, supporters give numbers that actually refer to improper payment amounts which includes fraud, but also other errors, most of which are rectified. The improper payment amount in 2024 for Medicaid as an example, was 5.09%. That is still a large amount of money, but this was the third year of decline since new oversight was put in place. It was 8.58% in 2023.
There is a long list of reasons our Medicaid spending is high going back to the 1970s, but that is a subject for another column. I want to talk about how these cuts to Medicaid will affect one of our most vulnerable populations, people with disabilities, and their families.
Until fairly recently, most people born with disabilities were put in institutions. Over the last several decades, families have fought to keep their children home, to have them be educated and to live as normal a family life as possible. Funding from Medicaid, along with money from charitable organizations, has made this possible for many working-class families who do not have the economic resources to pay the costs out of pocket.
There are also those who because of injury or illness, or in the final stages of life, fall into the category of people with disabilities. In- home care is expensive. Having a family member become the full-time care giver means giving up their job. Colorado is one of the states that has a system to pay a family member to be the full-time caregiver, in part because there are not enough professional caregivers. This program is not a high paying gig, and anyone who has taken the role of caregiver can tell you that it isn’t an easy system to navigate.
Under the BBB, states will have to make drastic cuts to, or eliminate, their Home and Community-Based Services. Besides health care, these programs also include training, transportation, and job support systems to allow people with disabilities to be as independent as possible, work and avoid being placed in institutions or nursing homes. These programs are more cost effective than an institutional setting or nursing home. There is also the very human cost of separating children, siblings, spouses or parents from their families who desperately want to stay together.
This bill has passed, the states do not have the resources to make up the difference, so it remains to be seen how we as a society will deal with this. This country seems to be stuck in a place where money matters more than humanity. I write this column for my son Cole, born with Down syndrome and a 16-year survivor of a major stroke at the age of 11. He is part of the Durango community, as are all the other people here who live, love, and thrive in spite of the hand they have been dealt.
Instead of just listening to the politicians and talking heads of either party and taking their word for things, do some research. And look deep for the human costs of the policies that they represent.
Scott Perez is a former working cowboy, guide and occasional actor. He earned a master’s degree in natural resource management from Cornell University and lives in the Animas River Valley.
