The latest health reform bill voted down by the Senate proposed unprecedented funding cuts to Medicaid that would leave 22 million Americans uninsured by the end of the decade, according to the Congressional Budget Office. In the webinar “Medicaid Undone? Covering the Safety Net’s New Future,” hosted by the Center for Health Journalism on July 26, expert panelists discussed the potential health impacts of Medicaid’s restructuring under the Senate health bill and how reporters can best draw public attention to this issue.

While plans to roll back Medicaid and reduce eligibility have struggled to win Senate approval, the panelists cautioned that policymakers will continue to push for similar reforms likely to garner White House support under the Trump administration. These reforms would hurt more than 70 million Americans who currently depend on Medicaid by repealing major elements of the Affordable Care Act and radically changing how Medicaid is funded.

 

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The Congressional Budget Office reports that the latest version of the Senate health bill planned to cut Medicaid by $756 billion, or 26 percent, over the next decade. According to Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, these spending cuts would weaken state health systems and spur an increasing number of uninsured Americans.

Park explained that the bill proposed changing Medicaid funding in two ways. One is limiting the amount of federal spending per Medicaid beneficiary, also known as a per capita cap. The second is through a block grant, which gives states a pre-set amount of funding for Medicaid. Currently, federal funding for Medicaid is decided based on states’ actual spending needs. Under a per capita cap or block grant, states would have a much smaller, fixed amount of money that does not account for unanticipated costs such as epidemics, increased enrollment during a recession or the growing health costs of aging Baby Boomers.

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These reforms would also cut Medicaid expansion entirely. Under the expansion implemented by the ACA, federal support for state Medicaid programs rose from covering 57 percent to 90 percent of costs, according to the Center on Budget and Policy Priorities. This means that the federal government pays 90 cents of every dollar in state spending in states that chose to adopt Medicaid expansion. With less federal funding, Park predicted that states would be forced to reduce Medicaid benefits or make cuts elsewhere in areas like education.

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The loss of this safety net would have direct impacts on public health, according to Kathleen Nolan, managing principle at Health Management Associates and former director of state policy and programs at the National Association of Medicaid Directors. Health issues that states address through Medicaid expansion, including opioid abuse and hepatitis C, will re-emerge as Americans lose access to treatment. Funding cuts would also deal a major blow to programs for mental health, family planning, and adult vaccination that are supported by Medicaid expansion, said Nolan. Overall, these cuts would limit the ability of health systems to deal with an influx of uninsured Americans.

Regardless of Medicaid expansion status, states would be in for a slow and painful adaption process, according to Nolan, and Americans with disabilities and chronic conditions would be particularly burdened.

Lauren Sausser, a health care editor and reporter at The Post and Courier, advised reporters to call attention to the benefits of Medicaid for all, regardless of age or income. According to Sausser, many Americans don’t realize that most Medicaid enrollees are children and nursing home residents and that diseases and disabilities can happen to anyone. Bringing their stories to light can help shape the national health care debate and combat negative stereotypes about Medicaid enrollees. Sausser recommended connecting with patients by reaching out to local doctors, hospital executives and advocates.

While the future of Medicaid remains undecided, these experts agree that one thing is certain: Cutting Medicaid funding will shift costs and risks to states while leaving them with limited means to protect their citizens.

We encourage all Americans to engage in efforts to defend public health and health care for the most vulnerable in our nation. Here’s how you can stand up for public health with APHA.