As a pediatrician, I prioritize the importance of Medicaid in child health. But as an American I am proud of how Medicaid also cares for 27 million adults with struggling incomes, 6 million older adults, 10 million Americans with disabilities, in addition to 33 million children. With nearly 1 in 3 Americans covered by Medicaid and Medicare, we all know and love people who rely on these programs for their health care. But, the Republican Medicaid reform proposals, which thankfully appear to be dead for now, would be devastating to the program.
Health care providers are hardly thrilled about lower reimbursement from Medicaid, but American taxpayers should recognize that Medicaid is doing a better job than the private insurance industry at providing cost-effective health care. Prior to states opting for Medicaid expansion under the Affordable Care Act, Medicaid spending growth per enrollee was 3.1 percent, compared to the private insurance industry’s 4.6 percent. In 2013, as states began expanding their Medicaid programs, the Congressional Budget Office revised estimates of projected federal Medicaid spending, and determined the federal government would be spending $385 billion less on Medicaid between 2011 and 2020. Talk about getting bang for your taxpayer buck.
Despite this track record of high performance and low costs, Congressional Republicans would like nothing more than to destroy and overhaul Medicaid through proposals like block grants and per capita caps. The majority of the American people did not vote for Trump, and they gave zero mandate to his regime or members of Congress to wreck health care.
However, Trump’s Secretary of Health and Human Services (HHS) Tom Price, Speaker of the House Paul Ryan, and their allies in Congress have plotted against patients before on caps and block grants for Medicaid, which starts by slashing over $1 trillion dollars over 10 years from the program, reducing it by a third of its current size. Then, the federal government would set arbitrary, fixed limits on how much it will contribute to each state’s Medicaid program. There will be no flexibility for any state in the event of economic downfall, epidemics, natural disasters, or other unforeseen challenges. The dominos fall from there, hurting the health care of millions of patients and families.
Because per capita caps and block grants drastically reduce a state’s financial resources for Medicaid patients, Americans can expect to see 14 million patients kicked out of the program with nowhere else to go for coverage. For those patients who manage to qualify for capped or block-granted Medicaid, the severe budget restrictions will limit already limited benefits. That means my patients with disabilities will have fewer visits with physical therapists. The rising cost of long-term care services will be passed to older Americans because capped or block-granted Medicaid cannot cover as much.
Currently, patients and families covered by Medicaid are not facing exorbitant out-of-pocket costs for health care and prescriptions. That peace of mind will end with caps and block grants, as more states demand “more skin in the game” from patients who are already struggling with poor economic and health conditions. In the game of caps and block grants, average Americans are the losers.
Your local hospitals and clinics depend on Medicaid funds in order to serve your community, and that funding needs to be flexible when new health challenges come up from natural disasters, opioid addiction, or diseases like Zika. The per capita caps and block grants envisioned by Ryan and Price are so restrictive that state governments will not receive additional federal Medicaid funds when those unexpected public health challenges arise. Natural disasters and the opioid epidemic are already burdensome for local economies. Capped or block-granted Medicaid will worsen the impact for everyone.
Doctors, patients, and families need to send a clear message to the Trump regime, our Congress, Secretary Tom Price, and Speaker Paul Ryan: We are standing up for our fellow Americans on Medicaid. We absolutely reject block grants and per capita caps. Medicaid is proving its fiscal responsibility by providing health care on a lean budget to over 70 million Americans. People we love are on Medicaid and they are happy with their care. Where we can make upgrades that improve the health of our fellow Americans, we should. However, the majority of Americans did not vote for their health care to be wrecked by per capita caps or block grants for Medicaid. This cannot happen on our watch.
