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OPINION | JOHN BRUMMETT: Vaccine outreach for poor

by John Brummett | August 12, 2021 at 2:59 a.m.

Sometimes one must beware of one's own instincts.

Mine surprised me when Gov. Asa Hutchinson related at his Tuesday briefing an Arkansas vaccination factor I'm ashamed not to have thought about. The state, by the way, ought to be ashamed for just now bringing it up at the gubernatorial-briefing level.

It's that the state contains 627,000 deeply poor people over age 12 who are on traditional Medicaid, but only 27,000 of whom are vaccinated.

That's according, at least, to provider billings for compensation for the vaccines, which is the state's only means of calculation.

That vaccination number might be misleadingly low if providers are holding significant piles of Medicaid billings, which is unlikely, and if large numbers of Medicaid recipients have gone to free vaccination clinics, which is ... well, we can hope.

Still, those are the only numbers we have and they come to a Medicaid-recipient vaccination rate of 4.3 percent.

That's abysmal, woeful. It's tragic and a disgrace that nearly 96 of 100 of our most vulnerable people would be unvaccinated.

The instinct for which I must beware ... that came when I caught myself in a right-wing moment as the governor provided those numbers. I leapt immediately to what I'd call resentment conservatism, which holds that, if we're going to pay for these folks' health care, then we ought to be able to mandate they get the vaccine.

Please forgive me for my meanness and for my contradiction.

The irony is that I have been loudly aghast that the state would presume to tell Medicaid recipients--until the federal courts stopped it--that they had to work or try to find work in order to remain on Medicaid expansion. My passion soared in defense of poor people and disdain for the sheer meanness of telling a person he couldn't get health care because he didn't have a job.

Yet there I was essentially thinking, if only for a fleeting instinctive reaction, that we might deny him health care if he didn't get a shot or two to protect not only himself but all of us.

Of course you can't do that. Medicaid is for health services for the poor, not punishment of the poor.

You can't easily reach 627,000 poor people, just as we found when the state tried to find a mere quarter-million people on Medicaid expansion to tell them they needed to go online and click that they were working or trying to work.

You can't just announce a poor-people roundup for mass arm-jabbing. People aren't cattle. Vaccines aren't brands. Whatever human liberties exist for all of us also exist for the poor.

And even if you presumed to require vaccinations only for those Medicaid beneficiaries showing up at a doctor's office for care, what's your option if they say no?

There isn't one. You treat them.

Still, the number simply staggers. If all 627,000 were vaccinated, we'd probably have in the range of 1.7 million people in the state vaccinated and we'd be knocking on the door of a 60 percent vaccination rate.

We'd be a darned sight better off amid the Delta-variant surge. The danger for schools would be less. The strain on hospitals would be eased.

Hutchinson described the Medicaid unvaccinated rate not as the full explanation for the difference between a poor state like Arkansas and a rich one perhaps in the Northeast, but as a big part of the difference.

I don't think he was blaming poor people for our medical crisis and I know I'm not, now that I've conquered my instinct.

Economically disadvantaged people tend not to get word of things. They tend not to have transportation. They tend to be tied to inflexible low-wage jobs limiting their ability to spend an afternoon at a vaccination site. They tend to assume a cost they can't afford, even in cases--like these--when the service is free to them.

Thus, the state's only recourse is to be pro-active, if rather late about it, and to engage in outreach.

In that regard, Hutchinson announced that Medicaid providers will be newly encouraged to tout the vaccines to Medicaid patients. To reward these providers for pushing the vaccines, they henceforth will get $100 for every shot instead of $40.

There are other encouragements being contemplated ... to vaccinate, not blame, these vulnerable people, and to embrace a spirit of engagement and outreach, not the baser instincts of resentment and punishment.

John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at Read his @johnbrummett Twitter feed.

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