On Friday, Governor Palin spoke in Pittsburgh about children with cognitive disabilities. This was her long-awaited "serious policy speech" about matters that touch her personally. As a caregiver myself, I wish her and her family the best. I'm sure Governor Palin will be an excellent parent, role model, and advocate for her son and for others.
Her speech included a few good ideas. She favors full funding of the Individuals with Disabilities Education Act (IDEA). Senator Obama has long been on record supporting this, too. Opposition from fiscal conservatives has been the main obstacle here. I guess Senator McCain's promised spending freeze will include at least one exception.
Now that I've dispensed with the niceties, I can say that her speech illustrates the huge gap between the two parties, and why Governor Palin's preferred policies do not serve children (or adults) with chronic illnesses and disabilities very well.
The defects in Governor Palin's worldview are especially glaring when it comes to health care. I performed a global search through her published text. Here are some words that never appear: health insurance, Medicare, Medicaid, SCHIP, disability, SSI, Social Security.
Especially when we consider what will happen to kids with disabilities when they become adults, these omissions are jaw-dropping. Yet I can see why she didn't get into it. She offer nothing in these areas to address families' very serious needs.
For starters, the McCain-Palin health plan permits insurers to continue the current practice of discriminating against consumers with chronic illnesses and disabilities. Governor Palin reports that her son Trig is in good health. He is lucky to have parents who can afford the costly services he might need. Many of his counterparts have complex physical and mental health needs, or require complex rehabilitative, physical, and occupational therapies. They are the classic people with "preexisting conditions" that insurers want to avoid.
The McCain-Palin plan would tax employer-paid health coverage, replacing the current approach with a $5,000 family tax credit. It seeks to move families into cheaper and barer high-deductible insurance plans. Unfortunately, $5000 doesn't come close to covering healthcare costs, even for families that do not include children or adults living with costly conditions. McCain staffers have proposed working with the states to cover high-cost patients. Yet they provide minimal details and do not propose to allocate the money required to accomplish the task.
Moreover, the McCain plan would erode the current employer-paid system of health insurance that, despite shortcomings, significantly protects people with costly health problems. Most children with disabilities are now insured through their parent's employer. Employer-paid plans also cover most adults living with chronic illnesses or disability. The McCain plan seeks to shift millions of Americans from employer-paid coverage into the non-group market, where insurers typically charge higher premiums, restrict coverage, or deny coverage to individuals who confront costly conditions.
There is more. Last year, President Bush vetoed a bipartisan compromise that would have expanded state children's health insurance programs (SCHIP) to 3.3 million kids, including many with disabilities. Senator McCain called this veto "the right call."
Less visibly, Republicans have promoted Medicaid cuts that have special impact on the disability community. President Bush's 2008 budget proposed to cut Medicaid funding of school-based medical and social services and community-based rehabilitation. The Bush administration has moved to tighten Medicaid asset verification requirements, and to limit the home equity families could transfer to a disabled child who received Medicaid.
Consider the contrast with Senator Obama's health plan. It would provide affordable health coverage to every citizen, regardless of ability to pay or preexisting condition. It would bar insurers from rejecting consumers or charging higher premiums on the basis of disability or health condition. It would also allow young adults to retain coverage on family health insurance until age 25. These are critical matters to the disability community.
Republicans -- Senator McCain in particular, rhetorically support the disability community, but fail to back up to this rhetoric on key issues that require public resources. The Community Choice Act (CCA) would require Medicaid to provide individuals with the same personal assistance services in their family home that they would be eligible to receive in an institutional setting, Democrats support CCA. Senator McCain opposes it. One could write the same sentence about increases in early childhood education, enhanced Family and Medical Leave for caregivers, and other matters.
Governor Palin asserts without specifics that Barack Obama would raise taxes on the special needs trusts parents establish to help a child with disabilities once they themselves are gone. As far as I can make sense of this, it's a bogus issue to all but a small minority of affluent caregivers.
Ironically, a major motivation for special needs trusts is to address draconian Medicaid asset tests and other rules Republicans favor. It was, after all, Republican HHS Secretary Michael Leavitt who stated: "Medicaid must not become an inheritance protection plan."
Speaking of Medicaid, the Wall Street Journal recently reported:
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan "budget neutral," as he has promised. The McCain campaign hasn't given a specific figure for the cuts, but didn't dispute the analysts' estimate.
Whom do you think are most affected by these cuts?
By eerie concidence, the McCain tax plan would add $1.3 trillion more than Senator Obama's to the federal debt by 2018. Most of this arises from further tax cuts to families whose annual incomes exceed $250,000.
Especially in these hard times, restraining tax giveaways to the wealthy embodies an ethic of mutual responsibility America sorely needs. Governor Palin speaks eloquently about children with disabilities. Yet her crude attacks on Barack Obama as "socialist" show that she misses the larger point. We must do more to help families caring for child with disabilities. We must to do more to help others who face other challenges: joblessness, mortgage foreclosure, or the loss of health insurance coverage.
Governor Palin's narrow governing vision does not promote the inclusive society every American deserves. So I wish her and her family well, but I cast my vote for Barack Obama and Joseph Biden.