Commentary

Trump’s budget guts Medicaid; would devastate services to children and others in need

When the U.S. House passed the American Health Care Act (AHCA) earlier this month, GOP lawmakers made it painfully clear that they intended to cut and dismantle Medicaid as we know it. Cuts to Medicaid as proposed by the AHCA would shift more than $6 billion dollars onto North Carolina state government as the proposal dismantles Medicaid’s current funding structure and devolves it to a “per capita” cap or block grant. Such massive cuts would put the lives of two million North Carolinians at risk, most of whom are children. Nationally, the AHCA would cut federal funding by 25 percent over 10 years and end coverage to 14 million people across the U.S.

Now, if that isn’t bad enough, Trump’s newly released budget proposes to dramatically expand those damaging cuts. Indeed, Trump’s budget would cut Medicaid by an additional $610 billion. Together, Trump’s budget and the AHCA would cut Medicaid in half (or by $1.4 trillion). Elizabeth G. Taylor of the National Health Law Program put it this way:

“In times of great economic inequalities, the president’s budget is wildly out-of-touch, cynical and cold-hearted. Medicaid, regardless of political rhetoric, is a popular and effective health care program for low-income individuals and families and provides quality care to more than 30 million children. The program is integral to health care providers, professionals and hospitals who provide care to Medicaid beneficiaries. These cuts, if enacted, would harm tens of millions of people, and to what end?  Shrinking the federal government is not a sufficient justification when millions will suffer.”

Needless to say, such massive cuts will have devastating impacts on North Carolina’s Medicaid program. Drops in federal funding for Medicaid will force North Carolina to make difficult/impossible decisions. To maintain coverage for the state’s most vulnerable (children, people with disabilities, and older adults) North Carolina will have to raise taxes or make draconian cuts — to provider payments, benefits,  enrollment or all of the above.

To make matters even worse, Trump’s budget also goes after a program that has long enjoyed bipartisan support, the Children’s Health Insurance Program (CHIP), as it cuts approximately $6 billion from that program. On top of that, it only assumes that CHIP exists at all through 2019. Together, the proposed cuts to Medicaid and CHIP threaten the well-being and healthy development of North Carolina’s children. More than one million children rely on Medicaid and CHIP. These programs help North Carolina’s most vulnerable children – these are children in foster care, living in poverty, and children with disabilities.

Trump’s budget claims to put taxpayers first, but, this is a disastrously shortsighted claim. The truth, of course, is that children with Medicaid coverage have higher education attainment, get better jobs and are much more likely to grow up to be successful tax-paying adults. Tragically, this obvious and simple connection appears to be too much for the President and his allies in Congress to grasp.

Commentary

North Carolina’s Medicaid reform is missing one transformative component

Dr. Mandy Cohen, Secretary of North Carolina’s Department of Health and Human Services, hosted the fourth and last Medicaid Reform Public hearing last night in Raleigh. Secretary Cohen noted that even though there were hearings last year before the previous administration submitted its plan to move North Carolina’s Medicaid program to a hybrid managed care model, she wanted to hear from providers, Medicaid enrollees, advocates and community members. And like last year’s hearings, approximately half of the comments highlighted the fact that Medicaid reform is not going far enough because the state has not closed the coverage gap.

Mothers, stroke survivors, pediatricians, representatives of health insurers, and members of the faith community all called for North Carolina to extend Medicaid coverage to 500,000 North Carolinians in the coverage gap. Thirty-two states – including Washington D.C. – have successfully extended coverage to veterans, low-wage workers, students, and parents.

One health concern that was raised many times in relation to closing the coverage gap is addressing North Carolina’s opioid crisis. If lawmakers lift the Medicaid blockade, 20 percent of uninsured adults with opioid addiction can finally access the care they need. On top of that, research shows that there are at least 144,000 uninsured North Carolinians with substance use disorders or mental illness that would benefit in lawmakers extend Medicaid coverage. Research also shows that Medicaid coverage increases one’s ability to access both inpatient and outpatient treatment. For example, 37 percent of people with Medicaid coverage are able to receive treatment for opioid addiction compared to only 20 percent of the uninsured.

One of the most sobering comments came from a representative from Coastal Children’s Services. The Wilmington area is one of the the state’s hardest hit for opioid abuse and this has impacted the care at Coastal Children’s Services as between 15 and 20 percent of babies in the NICU are experiencing opioid withdrawal. Stories like this further reinforce comments along the line of one of the more pointed and succinct ones uttered last evening: “Obviously we need to expand Medicaid. Everyone knows that except for ten people in legislature.”

public health, Trump Administration

Trump budget weakens NC’s ability to respond to public health, workforce needs

President Trump and the GOP want to dismantle the Affordable Care Act and restructure Medicaid, and “American First: A Budget Blueprint to Make America Great Again” provides further evidence that they do not want to invest in a healthy and thriving North Carolina. While many North Carolinians may not feel the impact of the provisions outlined in the budget immediately, there are significant threats to public health, our state’s ability to address their health, and capacity to strengthen our healthcare workforce.

In addition to an 18 percent cut to the U.S. Department of Health and Human Services (HHS), the Trump budget outlines a $5.8 billion cut to the National Institutes of Health (NIH), a 31 percent cut to the Environmental Protection Agency (EPA), and the only mention of the Centers for Disease Control and Prevention (CDC) is in reference to a $500 million block grant to states. These cuts are threats to North Carolina’s public health because the NIH funds research that could help identify innovative cancer treatment, the EPA helps to ensure that rural communities have access to safe drinking water (Note: 80 of North Carolina’s 100 counties are rural), and cuts to the CDC could impact vaccine development for the next epidemic. Read more

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.

Commentary

Proposed federal Medicaid cuts, policy changes could be disastrous; General Assembly must act

Republicans in Washington are upping the ante when it comes to destroying health coverage gains that resulted from the Affordable Care Act. In addition to eliminating provisions that protect and ensure affordability to millions of Americans, the GOP has added provisions that would eliminate Medicaid expansion. Thirty-one states and DC were able to make significant coverage gains once they expanded Medicaid. Even though North Carolina’s Senate and House leaders continue to block expansion and thus leave 500,000 North Carolinians in the coverage gap, the leaked plan has provisions that will greatly impact North Carolina’s Medicaid program.

The latest plan would restructure Medicaid into either a block grant or a so-called “per capita cap” program. Conservatives claim that the aforementioned proposals will offer states more “flexibility,” but that’s really just spin designed to camouflage what’s really being proposed — slashing funding for programs that help vulnerable Americans live up to their full potential and contribute to their communities. Currently, the federal government funds 66.7 percent of Medicaid spending. In other words, for every $100 in Medicaid spending, the federal government pays $66.70 while the state funds the remaining cost. Block grants and per capita caps would reduce the federal government’s commitment to funding Medicaid.

As Medicaid is a joint federal and state program, a significant decrease in federal funding really only gives states more flexibility to make hard decisions. If Washington heads down this road, North Carolina lawmakers will have to choose which North Carolinians to cut off, which services and benefits to end and/or which provider reimbursements to “recalculate.”

North Carolina’s Medicaid program likes to boast of the high provider participation it enjoys, but that will change dramatically if the promised cuts are enacted. If states no longer get significant financial support, North Carolina will likely have to cut services. Eighty percent of Medicaid beneficiaries in North Carolina are among our state’s most vulnerable. These are children, seniors, and people with disabilities. Even with a per capita cap, there is not guarantee that that set amount each person receives for Medicaid will meet the costs for their health care needs. Even if North Carolina lawmakers want to keep coverage at current levels, trends show that per capita spending always exceeds actual economic growth.

The bottom line: State lawmakers must be prepared to act and minimize the damage if the federal government heads down this road. They must also consider how proposed changes in Congress will impact the Medicaid reform proposals that the state recently submitted. The Medicaid reform waiver states that North Carolina’s new Medicaid program will lead to: 1) Better experience of care, 2) Better health in our community, 3) Per capita cost containment and funding stability, and 4) Improved provider engagement and support. These kinds of changes won’t happen merely through wishful thinking. To maintain viable and effective Medicaid system in these difficult times, we will need our state leaders to stand up for North Carolina’s providers and the most vulnerable.