A little good news on child care

For the last couple years, child care in West Virginia has been in a tough spot, as noted in this post during the 2023 legislative session. Not surprisingly, this situation was made worse by the pandemic. Until very recently, child care providers were reimbursed based on attendance rather than enrollment. And that's a problem. Or was.

To quote from that earlier post,

 

In an era of pandemics, new variations on old illnesses, extreme weather events and the general weirdness of our time, attendance at school or child care varies widely.

Anyone with kids in school or child care knows that classrooms can empty out quickly when a new bug makes the rounds. Basing child care reimbursement on who happens to be there on any given day is no way to run this proverbial railroad. It provides no stability of care for parents who need to work and no stability of income for those who make that possible.

Enrollment-based reimbursement will help keep existing providers open, encourage new ones and help retain employees by providing a measure of stability and predictability of funding.

Child advocates, child care providers and parents tried hard in the last two legislative sessions to make this change in what has been called "the industry that makes other industries possible." Although the idea gained some traction, the legislation didn't make it across the line.

The good news is that it looks like that advocacy wasn't wasted. The WV Department of Health and Human Resources recently made this announcement:

The WV Department of Health & Human Resources (DHHR), Bureau for Family Assistance today announced additional funding to allow child care providers to be reimbursed based on enrollment through August 2024. 

The pay-by-enrollment methodology was instituted during the COVID-19 Public Health Emergency using federally allocated funds to provide financial stability and continued assurance of available child care, and was projected to be exhausted by September 2023.

“By reprioritizing use of available funds, DHHR can help child care providers continue to keep their doors open and help working families get the care they need as the child care operational budgets continue to stabilize post-pandemic,” said Janie Cole, Commissioner of DHHR’s Bureau for Family Assistance. “High quality child care supports both parents and children and is a critical investment in our state’s future.”

That's a huge win for workers, employers, kids and families. 

 

Out of touch

One thing that most people would agree on across the political spectrum is that West Virginia would be better off if more of us were working and earning a living wage. I know I’m down with that.

Unfortunately, some of the ways that have been proposed for working towards that goal are counterproductive and just mean. Possibly cynical, too.

For example, Seema Verma, head of the federal Medicare and Medicaid program under the current regime, recently proposed to solve that problem by clamping down on Medicaid, specifically on those millions of people who gained coverage under the Affordable Care Act. Most of whom work. Go figure.

In a speech to state Medicaid directors, she said things that have at best a tenuous connection with reality. She seemed indignant that some of those who have gained health coverage in recent years are people who “are physically capable of being actively engaged in their communities.”

Let’s start with the basics. They already are. People who gained coverage due to Medicaid expansion had to come from families that had income, although it was under 138 percent of the federal poverty level. That means they weren’t receiving TANF (welfare) or disability payments, in which case they would have qualified for traditional Medicaid.

Generally speaking, that means they work.

Let’s be more specific. These are the people who do the grunt work of society. They wait on us in stores and restaurants. They change our oil. They clean our motel rooms. They wash our dogs. They clean up our messes. And, most importantly, they take care of our children and elders.

It would take a lot to persuade me that Verma didn’t know better when she said that. But if she, and the regime she serves, didn’t, it only shows how out of touch they are with the reality of millions of working people.

According to the Center on Law and Social Policy, around 60 percent of working-age adults on Medicaid have jobs. And around 80 percent are in families with at least one worker. The few that aren’t are usually seeking work, dealing with illness or disability, or caring for other family members.

In her speech, Verma seemed to imply that people like this who get Medicaid coverage enjoy wallowing in poverty and “government dependence.”

(Ever notice that many of the people who complain about this receive some form of health care from the federal government?)

I guess one of the innumerable advantages of being well-off is being spared the knowledge that less than half of all Americans are covered by work-based insurance. According to the Census Bureau, in 2016 only 58.3 percent of West Virginians of prime working age (19-64) get coverage from their jobs.

Here’s the reality in West Virginia. Since 2001, the percentage of low-wage jobs (earning under 150 percent of the poverty level for a family of two) has grown by 14.5 percent, even as jobs in high-wage industries have declined. These jobs typically don’t offer health coverage.

Nearly one in four West Virginians works in such a job. Around 55 percent of West Virginia’s children live in a family with at least one low-wage worker. For many, low-wage jobs are no longer a temporary steppingstone to a better gig but are rather a lifetime path.

Most low-wage workers are white, although blacks make up a disproportionate share. Fifty-six percent are women. Younger workers are more likely to earn low wages, but nearly half of workers above age 35 work in low-wage jobs.

Behold the face of “the enemy.” It may look a lot like our friends, neighbors, relatives and even ourselves.

I think what’s really driving this push at the federal level to cut back on things like health care is the desire of the administration and its allies in Congress to pass a massive “tax reform” package that would give huge breaks to the very wealthy — who don’t need them — at the expense of everyone else. That $1.5 trillion giveaway to the rich has to come from somewhere.

And, under what must be huge pressure from the federal administration, there are officials in West Virginia who seem eager to push for bogus “reforms” that will ultimately reduce the number of people with health care. Cutting Medicaid rolls may seem attractive to some people, even if it means taking away coverage and increasing the costs of uncompensated care for everyone else.

Some options now under consideration include unnecessary and redundant “work requirements” for Medicaid that would wind up taking millions of dollars out of the state’s economy and harming those sectors that are actually providing and increasing jobs.

In the past, Gov. Jim Justice has eloquently defended vulnerable West Virginians. I hope he continues to hold the line.

At this point, no one can say how far these proposed changes will go. But we’d be better off if they didn’t go anywhere.

(This ran as an op-ed in yesterday's Gazette-Mail.)