At the time of this writing, many people are expressing outrage at the proposed cuts to Medicaid funding. Before taking constructive action, we need to know a whole lot more than that the Trump White House budget calls for “a large cut to Medicaid and Medicare funding.” This terse statement, which can be found in many news summaries, is utterly insufficient to deciding whether to be incensed or encouraged… or somewhere in between.
The proposed deep cuts to the Medicaid budget are bound to have a profound impact over the next decade... should nothing change to prevent what's proposed for 2020 and beyond. The proposed Trump budget calls for a 25% reduction in federal Medicaid expenditures by 2026, relative to what is currently estimated on the books. The proposal, which is based on the current House version of the AHCA, is not that easy to summarize in a single statement. What the Kaiser Family Foundation "opines" must be based on a lot of assumptions about how those reductions will impact various states and where individual states will choose to cut their Medicaid rolls. Are those in skilled nursing facilities likely to be "discharged" as the means of adjusting to the eventual 25% cut in federal Medicaid funding? There is no state that has made that kind of decision. Questions about how to adjust over the next decade have barely been asked and have definitely not been answered by each of the 50 states. Perhaps I'm missing something?
Because the Republican Congress follows confederate ideology, the solutions to this gradual, federal budget cut must come at the level of individual states. The federal government will provide less; states can decide whether to supplement with state funds or to cut the number/type of people who are eligible. In the current version, any state that has not already expanded eligibility would be forbidden from doing so. For example, some states, under the ACA, extended Medicaid eligibility to cover *anyone* living in poverty. Other (mostly Republican-dominated) states did not. The default is that the individual must meet more than the financial criteria (less than 133% of poverty level).
Across the United States, only 23% of non-elderly recipients of Medicaid are not employed. 63% have at least one family member who is employed full-time. [Henry J. Kaiser Foundation website, "Distribution of Nonelderly with Medicaid by Family Work Status"] Of those 23% who are not currently working and are *able* to work, what percentage of them would find employment that paid so much that they would no longer need Medicaid? I can't find anywhere that provides the data and an answer to this question.
The Congressional Budget Office estimate for this AHCA change in Medicaid coverage is that it represents an $800 billion total reduction in Medicaid costs between now and 2026. As a reference, for fiscal year 2016, total Medicaid spending was $574.2 billion. [Henry J. Kaiser Foundation website, "Total Medicaid Spending"]
Of course, I hope that the proposed changes at the federal level do not happen. We already have great disparity in Medicaid services between states. A gradual 25% cut at the federal level would undoubtedly exacerbate that disparity.
For now, I think we should all be planning ahead, to the extent we can put aside our own resources. With or without the AHCA, something has to change with Medicare and Medicaid. Either the withholdings for those programs have to increase or some other major change in healthcare for older adults and poor people has to happen. Insurance has to pay for itself. We will also need to pressure federal and state officials to develop plans that answer the question of what we do with the people who become ineligible for Medicaid and do not have the means to pay for essential care for themselves and their families. And the answers have to be viable; they cannot fly in the face of facts.
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