In March, the quote from President Donald Trump was blasted across social media, and linked to from WhiteHouse.gov: “I’m not going to touch Social Security, Medicare, Medicaid.” Cuts in government spending, Trump vowed, would come from eliminating fraud, and waste. But that’s not how it’s panning out, unfortunately.
Late last Sunday, as House Republicans sought a path to enact a “beautiful” tax bill embodying the president’s domestic agenda, they released a plan that would deprive about 8.6 million low-income Americans of Medicaid health coverage and cost millions of others more in doctor’s fees.
On Friday, the prospect of Medicaid cuts became more fraught: The bill failed to pass out of the U.S. House Budget Committee as a Republican faction demanded even more cuts to Medicaid.
Most observers expect the bill to pass, eventually, though it shouldn’t: It pushes harmful health policy on the nation, and it’s fiscally reckless. The bill’s centerpiece is extended tax cuts for high-income earners, a key campaign promise from Trump — and those giveaways add not millions, not billions, but trillions of dollars to the federal government’s current $36.2 trillion debt.
As a gesture of concern over the mounting federal deficit, the tax bill in its current form eliminates $912 billion in spending over a decade, with $715 billion of that “saved” from tightening qualifications for Medicaid and requiring more fees, and more paperwork.
That’s far from enough to counteract the deficit created by Trump’s tax cuts for the wealthy — but more than enough to cause unnecessary suffering and lack of access to health care for those with little.
“No other previous bill, no other previous law, no other previous event caused so many millions of Americans to lose their health care. Not even the Great Depression,” observed U.S. Rep. Brendan Boyle, the committee’s top Democrat.
Despite the harm these health care cuts would inflict on Americans, the current “compromise” bill pulls short of major Medicaid changes that ultraconservative Republicans demand.
Medicaid’s fate is not yet assured — more negotiations loom — but even the compromise “savings” would upend lives.
The legislation released Sunday sidesteps proposals that would hang states out to dry by eliminating the federal share of Medicaid payments for services, instead focusing on making would-be Medicaid beneficiaries — especially working people who gained Medicaid coverage as part of its expansion under “Obamacare” — undertake a more complex and time-consuming review of their eligibility, and then pay more to use their coverage.
Millions are expected to lose their coverage because of the complicated changes, and states like Hawaii that have expanded Medicaid to low-income adults would be the hardest hit.
In Hawaii, Medicaid is administered as Med-QUEST, providing coverage for more than 400,000 residents, including 1 in 3 children and 1 in 3 women giving birth. Federal funds cover 73% of the $3 billion Hawaii spends annually on Medicaid — and any cutbacks will hurt services proportionately.
Earlier this month, Gov. Josh Green warned that Medicaid cuts — like those currently under consideration — would place more Hawaii residents in debt for health care and keep people from receiving preventative care, which is cost-effective in itself.
Hawaii’s families with working parents who cannot afford health insurance are among those who depend on Medicaid. As Francoise Culley-Trotman, CEO of nonprofit Quest coverage provider AlohaCare told the Star-Advertiser, cuts in this expensive state would be “devastating.”
Further, Hawaii’s hospitals would be hurt by Medicaid cuts, as all care for Medicaid patients, as the governor and Healthcare Association of Hawaii CEO Hilton Raethel have warned. Rural hospitals, many already struggling, would be hit the hardest.
Medicaid is a key source of funding for state and county programs to serve the homeless, many of whom suffer from chronic conditions and/or mental health issues, and may need the equivalent of nursing home care to regain health. Similarly, Medicaid is the last-chance source of support for Hawaii’s impoverished elderly who may need nursing home or hospice care. In high-cost Hawaii, Medicaid insures about 60% of patients in nursing facilities, and is the single largest payer for long-term care in the state.
The governor and Legislature have labored to set aside a portion of the state budget to account for federal shortfalls, and anticipate a special session in the fall to react to federal legislation. But that would only be a stopgap.
On Monday, Green flies to Washington, D.C., where he plans to make a “compelling case for saving Medicaid,” he said, warning that rural health care could be “destroyed” by cuts. Hawaii’s federal representatives are also united in pushing against health care cuts.
But Democrats alone can’t stop this. Americans nationwide must stand together to demand a turnaround on this gutting of U.S. health care while the rich get richer — or suffer the debilitating consequences.
