Five Years Later, Bush Efforts To Block Medicaid Relief Have A Lasting Impact On The Gulf Coast

This week, on the eve of the five-year anniversary of Hurricane Katrina, a new study was released documenting the shocking psychological toll the storm had on children in the Gulf Coast. Researchers at Columbia’s Mailman School of Public Health found that more than 37 percent of children displaced by Katrina have been diagnosed with depression, anxiety, or behavioral and conduct disorders. These children were also five times more likely to experience emotional disturbances than kids not affected by the hurricane. “From the perspective of the Gulf’s most vulnerable children and families, the recovery from Katrina and the flooding of New Orleans has been a dismal failure,” said study researcher Dr. Irwin Redlener. Earlier studies that examined mental illness in adult survivors found very similar results: just under a third of respondents reported mental problems.

One way that many people could have received mental health care following the storm was through Medicaid. According to the National Alliance on Mental Illness, Medicaid is the dominant source of funding for both children and adults with mental illness, comprising more than 50 percent of public mental health spending. However, the Bush administration — even after being roundly pilloried for the initial logistical response to Katrina — neutered emergency Medicaid relief for Gulf Coast residents in the months following the storm.

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After Katrina, Senators from both parties wanted to enact a “Disaster Relief Medicaid” program, which would have temporarily extended Medicaid benefits to all low-income residents affected by the storm, even if they were above the minimum income requirements for enrollment. The same type of program was enacted after the September 11 terror attacks, but this time around, it met stiff resistance from the Bush administration.

The Journal of the American Medical Association outlined the battle in a 2006 article (subscription only):

[T]he pathway to assistance has proven to be bitterly contentious, reflecting a deep philosophical divide rather than party differences… The legislation met with immediate and fierce resistance on the part of the Bush Administration and its supporters, who sought to halt structural Medicaid improvements, at the very time that Congress, as part of the fiscal year 2006 budget process, was preparing to enact Medicaid spending reductions… Seeking to avert legislative establishment of a Medicaid disaster relief program, the Bush Administration devised an alternative that lacked the central elements of the Grassley-Baucus legislation. Predicated on the Health and Human Services Secretary’s powers under the demonstration provisions of the Social Security Act, the Bush Administration’s plan limited aid to 5 months, retained Medicaid’s exclusion of more than half of all poor adults (relying instead on establishing an uncompensated care fund for use by designated states, who in turn would be under no obligation to pay any specific physician or other health care provider), eliminated national coverage portability, and assumed continued financial contribution from affected states.

As one would expect, researchers looking into this issue have found that “having insurance was associated with continuing in mental health treatment.” The Bush administration’s cruel efforts to limit Medicaid assistance in the wake of the storm is having a lasting toll in the Gulf Coast today.

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But even the optimal Medicaid Relief program, as was used after September 11, would only have been temporary, and a stronger safety net is needed for victims of this and future disasters. “Hurricane Katrina exposed a health care system incapable of withstanding the long-term impact of a major disaster,” the JAMA article says. “Through destruction and permanent displacement, Katrina illuminated the fundamental weaknesses inherent in the national approach to health care financing, as well as the extent to which these weaknesses can threaten recovery.”