Followup on the Jacks case...

I did some online exploring, and I thought I'd share some of what I found pertaining to what was or should have been available to Banita Jacks. Again, everything posted here is strictly my opinion and doesn't represent anyone or anything other than myself.

First off, it's important to understand a couple of things about public assistance in general, and Medicaid in particular. Bear with me, because while this is dry going, it'll have some relevance.

Medicaid has had a long and torturous history, undergoing revision after revision, change after change, and every state has some of their own variant on it. A major part of the reason for this is that while it is largely a federally-funded program through three of the different Titles under the umbrella of Social Security, the underlying idea is the same; matching federal dollars. States are expected to divvy up a portion of their own money in order to get matching money from our federal government, under a you-spend-this-much, and I'll-give-you-this-much-more-per-dollar-you-spend arrangement. All of that is dependent on meeting certain federal benchmarks and performance measures. When you hear about this in the MSM, this is what they're talking about. Different programs, obviously, have different expectations, but nearly every single form of public assistance available follows this general arrangement in some way. Read through the link to Wikipedia at the start of this paragraph, and count to yourself how many times you encounter the word "Optional".

Oregon has been, for the last approximate decade, a leader in this field. Governor Kitzhaber, a former (and possibly still practicing, I have no idea) physician from Portland, came up with the idea of the Oregon Health Plan, which extended the federally funded classes of disabled, elderly, pregnant, or child groups into the mainstream population under certain income levels tied to the Federal Poverty level. OHP was a revolutionary idea, and initially, it was supposed to be a pairing between private and public-sector healthcare. The private part fell through, naturally, and the public part came very close to bankrupting Oregon about six years ago - the money to pay for about 130,000 adults to have inexpensive healthcare was coming out of the general fund, which is entirely supplied by state income taxes and also covers Transportation, Emergency Services, and Education. In other words, it became as much a part of the infrastructure of this state as the roads, the police, and the school system. The problem is, when the economy takes a nose dive and people are out of work, there goes the state's funds. Oregon doesn't have a sales tax.

OHP had to be scaled back to a mere shadow of its former self in the 2001-2002 biennium, if I remember correctly. The state simply quit paying for all of those extra services that had started to get well and truly intertwined with the social fabric. The homeless population and crime rates in crowded urban areas soared. The mental health sector essentially dried up and the counselors moved on, because the people that really needed it no longer had health insurance. Chemical Dependency classes for diversions on DUIIs went away. Parents who had lost their children to Child Welfare due to Oregon's soaring methamphetamine problem couldn't get medical coverage to get clean and get their kids back. Jail populations rocketed upwards. Police became overburdened default healthcare services in the absence of preventative medicine.

None of that is an exaggeration. I lost count years ago of the number of times I had to tell adults, "Sorry. You didn't pay your $6 premium for one month of your Medicaid, and since you have arrearages now, I have to cut your medical off. Get it back? I'm sorry, you don't understand....the program doesn't exist anymore. You can't get it back." It was heartbreaking.

The District of Columbia is unique in this country, in that by dint of its inclusion in the Constitution, not only is it not a state, but it can't be a state. Guess what that means for the concept of matching dollars, as I outlined above? You got it....the amount of money that DC has to spend on ANY kind of discretionary funding simply isn't there. How often have you seen news reports about the problems keeping the roads paved in DC? If they can't keep roads paved and cops paid for, they won't be paying for extra healthcare for the poor.

I took a look through the Human Services website for DC earlier today and found what I had expected - Medicaid services are the bare-bones minimum of what federal dollars are allowed to pay for. There aren't any additional services. I would also hazard a guess that my own counterparts in DC, on both the family programs and the protective services sides of things, aren't nearly as well paid as I am, and probably have a bigger and more difficult caseload problem than I do. By saying that, mind you, I'm not downplaying my own job - I'm just saying as hard as I've got it, their job is harder by a whole order of magnitude. Consequently, the boom of time that Oregon got where nearly everybody under 100% of the Federal Poverty Level was eligible for affordable healthcare really hasn't ever existed in DC. It's bad there, it never got better during the 90's like most of the rest of this country, and as hard as the rest of us have it, it's worse there.

The CPS worker mentioned in this story was very likely in an impossible position. Expected to maintain contact with an impossible number of families and work 1:1 with all of them on an ongoing basis, she very likely did what any of us would have done - if one encounters an absolute refusal to cooperate on the part of the client, even to answer the door, then at some point one has to quit paying attention to that family and move on to the next, just as or more urgent need. Every day, there are news stories about horrifying things that happen to kids, wives, husbands, elders, or immigrants in this country. Those stories aren't unusual - to the CPS workers out there, those stories are every day reality. In medicine, we call it triage and it's understandable. In social work, the public refers to it as laziness, and yet decries the expense of maintaining more trained and willing staff to handle the workload.

In a nutshell - Banita Jacks did not have adequate mental health care because there wasn't enough money to pay for an undiagnosed disabled adult with children to have such care, unless she fell under about 10% of the Federal Poverty Level and qualified for some variant of TANF. Banita Jacks didn't ask for help because she was disturbed and probably couldn't. Banita Jacks didn't get the help she needed from the social agencies that are tasked with it because the schools, the social workers, the police, and her neighbors did not have the resources to pay attention to the little things - they are in a position where the big problems are as much as they can deal with.

It comes down to money, and that's the worst tragedy of all. You know 1% of each of the 50 states' budget would be enough to make DC one of the most beautiful and sought-after capitol cities in the world? And yet we depend on stingy federal money, Congress that has other things to argue about, and lobbyists from other parts of the country squeezing the federal teat for all they're worth. Banita Jacks' family died because she was sick, and because nobody could help her.