Proposed Medicaid Cuts Will Force States to Ration Care or Raise Taxes

Ill woman with medicines suffering from flu headache in bedroom

Because the Senate is writing their health bill in secret, we don’t know a lot about what is in it. But there is a good chance the bill will look very similar to the one passed by the House of Representatives on May 4 – one Senator told the media the bill will be ‘about 80 percent’ the same. So we can anticipate that whatever the Senate comes out with, it will include most of the shocking cuts to Medicaid that were proposed by the House.

The House bill is widely understood as an ACA repeal bill, which it is. But it isn’t just an ACA repeal bill.  The members of the House who voted for the bill, and many of their colleagues in the Senate, are not just talking about undoing the progress made over the last seven years of the ACA. What they really want to do is go back to over 50 years ago, before we had a program that let poor people get medical care.

Currently, if you qualify for Medicaid, the program pays for the medical care you need. The Republican plan, to “put Medicaid on a budget” as they call it, is to cap the amount that gets spent on each person. So if you need treatment that costs more than what the federal government decided you deserve, your state has to figure out how to cover it. That’s the flexibility Republicans keep mentioning – states will not get enough money from the federal government to cover people’s real heath care needs, and they’ll be on their own to figure out how to manage. The Center for American Progress tried to envision what this would look like – the last time states experienced a budget crisis like the one this bill would create, they cut education, both higher education and K-12. States also raised taxes, with disproportionate impacts on lower- and middle-income people.

The other option states would have is to start refusing people medically necessary care in order to save money. Most of the people who would have their care rationed in this way are our most vulnerable. The majority of Medicaid funding is used to pay for things that elderly people or people with disabilities need. Most of the individuals who get covered by Medicaid are children, who typically have inexpensive health needs – but who do sometimes experience serious health issues. What would it really look like to put a seriously ill child or adult, or a person in a nursing home on a health care “budget”? It’s terrible to imagine, but that is what the Republican bill is forcing us to consider.

sad childMedicaid is the single largest insurer for children in the United States. The program covers more than 35.5 million children nation-wide and more than 2 million children in New York State alone. On May 4, the House of Representatives voted to repeal and replace the Affordable Care Act (ACA) and cut more than $830 billion from the Medicaid program. In addition to these dramatic cuts, Congress has also proposed to lower the federal minimum Medicaid eligibility threshold for children under 19 from 138 percent of the Federal Poverty Level (FPL) (about $28,000 for a family of three) to 100 percent of FPL (about $20,000 for a family of three). A new policy brief from the Institute for Child, Youth, and Family Policy at Brandeis University shows what these cuts to Medicaid and change in eligibility will mean for school-aged children.

According to the policy brief, there are currently 15.2 million children eligible for Medicaid coverage in the U.S. The proposed change in the federal minimum eligibility for the Medicaid program would reduce the number of eligible children by 4.7 million. The brief also explains that eligible children are disproportionately Black and Hispanic or Latino. This is also true in New York State. According to the brief, New York ranks fourth in the nation for the number of Hispanic or Latino children who would lose Medicaid eligibility under this change (90,600) and fifth for the number of Black children who would lose Medicaid eligibility (48,400).

New York State has always been a leader in children’s health coverage. New York currently has an insurance rate for children of more than 97 percent, and all children under the age of 19 are eligible for health insurance regardless of immigration status. New York State also has a Medicaid eligibility level for school-aged children of 149 percent of FPL (about $30,000 for a family of three) through 2019, which is greater than the federal minimum eligibility under the ACA. However, even with these many steps in the right direction, Black and Hispanic or Latino children remain more likely to be uninsured than other New York children. Cuts to Medicaid and reduction of the federal Medicaid eligibility level would be a huge step backward and only serve to exacerbate existing health inequities for New York’s children.

xrayThe first budget proposed by President Trump adds over $600 billion in cuts to Medicaid to the $880 billion included in the American Health Care Act. This would cut the program in half. The budget also cuts the Children’s Health Insurance Program (CHIP), insurance for kids who do not qualify for Medicaid but cannot afford health care, by 21 percent.

Medicaid provides health insurance for 74 million Americans who do not make enough money to buy private coverage. There is simply no way to cut Medicaid by over a trillion dollars without drastically changing who is eligible for the program and what services they can receive. And those people include our most vulnerable. Over half of the children born in the US come into the world with Medicaid coverage. Over 60 percent of the money spent on Medicaid supports the elderly and people with disabilities – kicking every single non-disabled adult and child off would still not even approach covering cuts of this magnitude.[1]

You can find out how many people in your county get Medicaid or our CHIP program (called Child Health Plus) here. And you can talk to your friends and family about how they get health insurance – almost everyone knows someone who has benefited from Medicaid.[2] More than half of Americans say Medicaid is important for their family – including 43 percent of Republicans and 57 percent of Independents.[3]

Politicians often say Medicaid is a “broken” program – but Medicaid is a program that makes life better for millions of people. Talking to your friends, family, and elected officials about how Medicaid helps you, your family, or your community is vital for changing the conversation and protecting the program. Maybe Medicaid let you get health care and still pay your other bills, or helped you survive a health emergency without hurting your family financially. Maybe Medicaid helped you have a healthy pregnancy, or is keeping your loved one safe in a nursing home. Let people know! You can also share your story with us.

 

 

[1] Mary Beth Musumeci and Katherine Young, State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities, Kaiser Family Foundation, May 1, 2017, http://kff.org/medicaid/issue-brief/state-variation-in-medicaid-per-enrollee-spending-for-seniors-and-people-with-disabilities/.

[2] See Figure 8, Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid, February 24, 2017, http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/?utm_campaign=KFF-2017-March-Polling-Beyond-The-ACA&utm_content=54701829&utm_medium=social&utm_source=twitter

[3] See Figure 9 in the Kaiser Health Tracking Poll.

keep goingLast Thursday, the House of Representatives passed the American Health Care Act (AHCA). If the AHCA were to become law, 2.7 New Yorkers would lose their health insurance, Medicaid would be cut by more than $800 billion, and protections for people with pre-existing conditions would be severely weakened. Seven of New York State’s nine Republican Representatives voted in favor of the bill; two Republicans voted against it; and all 18 Democrats voted against it. The bill is now in the Senate for further consideration and revision.

However, the conversation on the AHCA and what it will mean for New Yorkers is not over! Members of Congress left for recess shortly after the vote and came home to face constituents, many of whom were dismayed by the passage of the devastating legislation.

In the days following the vote, town halls took place in the districts of Representatives King, Faso, Stefanik and Reed, who all voted in favor of the AHCA. Representatives King and Faso did not attend the town halls in their districts, and Representatives Collins, Tenney, and Zeldin, who also voted in favor of the bill, did not host town halls. This video from the town hall in Representative Reed’s district provides some insight into how some constituents are feeling about the AHCA and how they think it would affect their care.

It is not too late to call your Representatives and tell them how you feel about the AHCA and about their votes. You can call your Representatives in their districts using the numbers listed here:

Voted Against the AHCA (Thank you!!)

  • Congressman Dan Donovan
    • Brooklyn Office (718) 630-5277
    • Staten Island Office (718) 351-1062
  • Congressman John Katko
    • Auburn/Lyons Offices (315) 253-4068
    • Oswego/Syracuse Offices (315) 423-5657

Voted for the AHCA (Start defending the health of constituents over tax cuts!)

  • Congressman Pete King
    • Massapequa Office (516) 541-6602
  • Congressman Tom Reed
    • Corning Office  (607) 654-7566
    • Geneva Office (315) 759-5229
    • Ithaca Office (607) 222-2027
    • Jamestown Office (716) 708-6369
    • Olean Office (716) 806-1069
  • Congresswoman Elise Stefanik
    • Glens Falls Office (518) 743-0964
    • Plattsburgh Office (518) 561-2324
    • Watertown Office (315) 782-1291
  • Congresswoman Claudia Tenney
    • Binghamton Office (607) 376-6002
    • New Hartford Office (315) 732-0713
  • Congressman  Lee Zeldin
    • Patchogue Office (631) 289-1097
    • East End Office (631) 209-4235