Commentary, Trump Administration

U.S. House vote on ACA repeal and Medicaid matters to me

The first brief in the Medicaid Matters series aims to raise awareness and understanding as to why Medicaid is important not only to nearly 75 million Medicaid beneficiaries across the U.S., but to all North Carolinians. While I am passionate about the work I do as part of the Health Advocacy Project, there is a very personal reason why today’s U.S. House vote on proposals to restructure Medicaid as written in the American Health Care Act and the manager’s amendment worries me.

Like many others in my age range, I have reached the stage of life where I have taken on more responsibility for the health and well-being of my parents. My father was diagnosed with early onset Alzheimer’s disease over ten years ago. The early stages of the disease were challenging, but my family and I developed techniques to calm his fears as he realized that his memory was slipping away from him. My mother retired early to become his full-time caregiver, but recently my father’s Alzheimer’s has progressed to a more advanced stage, and caring for him at home took a toll on her health as well. My father now requires full-time supervision in a locked memory unit at a nursing home. The severity of his condition and health care needs are why restructuring Medicaid into a block grant or “per capita cap affects me.

In the U.S. and North Carolina, three out of every five nursing home residents receive the care they need because they have Medicaid coverage. My father is termed a dual eligible – as a person over 65 years old, he has Medicare, which covers his primary, acute, and post-acute care, but because he needs long-term nursing care, he also has coverage under Medicaid because nursing home services are not covered by Medicare. My father wasn’t always a dual eligible, but after months of paying for expensive nursing home care out-of-pocket, my parents’ savings that was intended for fun retirement activities dwindled to zero as his health care needs increased.

If Congress fails to block the American Health Care Act and Medicaid is restructured into a block grant or per capita cap, my father’s health is at risk. The Congressional Budget Office’s evaluation of the GOP proposal to repeal the ACA and restructure Medicaid shows that funding from the federal government for Medicaid would be cut by $880 billion by 2026. If that dollar amount isn’t shocking enough, the cuts in funding would lead to 14 million people being cut off Medicaid. Advocates and researchers have noted that if funding for state Medicaid programs is cut by either a block grant or per capita cap proposal, states will have three options to reduce Medicaid costs  – 1) cut Medicaid services, 2) cut Medicaid enrollment, or 3) cut payments to providers.

How will states like North Carolina respond to these deep and devastating cuts in federal funding? Will they make reductions to coverage for nursing home care and long-term care services? Will cuts be made to older adult enrollment? Or will states lower payments to providers to the point that they will not be able to cover the costs associated with providing care to the most vulnerable patients? These cuts put my father’s and millions of other American’s health at risk who depend on nursing home and long-term care. My father spent his life serving others — as a veteran, a police officer, and a church volunteer. He enjoyed public service and did not expect to be diagnosed with Alzheimer’s disease right after he retired. As a man who worked all of his life, served his country, his community, and provided for his family, I ask Congress to recognize that he, and millions of other Americans like him, deserve to continue receiving necessary health care services under Medicaid.  That’s why I’m hoping that Congress votes “No,” and protects the care of millions of Medicaid beneficiaries.

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