Medicaid Cuts and Vision Loss

The draconian changes made to Medicaid in a recent legislative bill will have significant implications for the blind and low vision community. Let’s take a quick look. The changes include a work requirement of 80 hours a month if you are between the ages of 19 and 64 in order to receive Medicaid. This may seem like a reasonable request until you realize that according to World Services for the Blind and other resources, the unemployment rate for people who are blind and visually impaired is higher than 70%.  Not only is this far above the national average, it is also far above many other disability groups. There are 3 main causes for this: employer bias of negative attitudes toward blindness; lack of accessibility in many work settings and technology, despite laws that make this illegal; and lack of transportation options. These are very serious barriers that continue to prevent the most ambitious potential workers with a vision loss from finding work.

Many of those, enable to secure work opt for disability and the added benefit of Medicaid. Social Security Disability is difficult to qualify for. Only 30% of first-time claims are accepted. Most have to go through a lengthy appeals process. As a result, once qualified, many recipients are reluctant to risk getting kicked off disability or Medicaid by starting a new job, or accidentally working too many hours or making over the income limits. Ironically, if the process for getting on Medicaid was made simpler and faster, more people with disabilities would be willing to risk working more or take a job that might disqualify them for their needed health benefits.

What about the millions who lose their Medicaid coverage? How will this impact health costs. Three of the leading causes of vision loss are macular degeneration, diabetic eye disease, and glaucoma. While it is possible there can be a sudden and dramatic loss of vision from any one of these, it is usually a gradual process that may go unnoticed without a visit to the eye doctor  and a dilated eye exam. For African Americans, this is recommended annually starting at age 40. It is recommended annually for those with diabetes. For those on a limited income, without health coverage, these are the types of exams likely to be considered “optional.” Instead of catching these conditions in time to prevent significant vision loss, they may instead, put off these exams, become visually impaired, lose their job, and some independent activities. As a result of them not having access to Medicaid for preventative care, the ultimate cost to the healthcare system will be dramatically higher.  By losing a job and becoming part of the 70% who are unemployed, their quality of life is at risk of declining and they will require disability to financially survive, rather than working and paying income tax.

Again, making Medicaid more available for this group of people, those at risk of developing eye conditions resulting in permanent vision loss, will have a significantly negative impact on preventing or minimizing a more permanent vision loss, and ultimately cost the healthcare system far more.

If you too are concerned about the negative impact the changes to Medicaid will have on those with a vision loss, call your state representatives at 202-224-3121 and let them know cuts to Medicaid are not the solution to long-term healthcare cost savings. In fact, it might be better to focus our attention on the negative bias toward blindness, lack of accessibility in the workplace, and poor public transportation options for many of us. That would be a far more sensible path to healthcare cost savings!