Elaine M. could be my mother or grandmother — or yours. At 80, Elaine lived by herself until a tragic fall in her apartment left her a quadriplegic. Elaine now requires round-the-clock care and frequent medical interventions, the kind of care that family members cannot possibly provide themselves. Elaine is stable, thanks to Medicaid and the medical and nursing staff at Menorah Park, a Jewish-affiliated nursing home in my hometown of Cleveland, Ohio, which has the resources to meet Elaine’s significant personal care and health needs — for now.
Or maybe you know Dan W., a former factory worker, whose rheumatoid arthritis has degenerated over time. Dan’s arthritis eventually kept him at home with health aides, but he can no longer care for himself. Covered by Medicaid, Dan lives in a long-term care facility, the Abramson Center for Jewish Life, outside of Philadelphia. Maybe Dan is your brother, nephew or neighbor.
Sarah lives independently on a low, fixed income in Miami Beach, but she is oxygen dependent. Sarah is also on Medicaid, which covers the equipment she needs for her COPD and sleep apnea. JCS’ home-delivered meals allow Sarah to continue living in her apartment and not in an institution.
Elaine, Dan and Sarah are fortunate to have their care expenses covered by Medicaid, America’s long-standing health insurance program for poor children, pregnant women, older adults and people with disabilities. If not for Medicaid, where would Elaine, Dan and Sarah go? But the bill unveiled by Senate Republican leadership last week, misnamed “The Better Care Reconciliation Act,” puts them — and the nearly 80 million others like them — in jeopardy.
How much so? A lot.
Medicaid pays for two out of three people in nursing homes, like Elaine and Dan. Medicaid also pays for people like Sarah, older adults and people with disabilities with less severe conditions. Thirty-seven million children nationwide are covered by Medicaid, more than half of Medicaid recipients. Medicaid covers poor pregnant women in most states and pays for almost half of all births in our nation. Medicaid also pays for a good deal of the mental health and substance use treatment provided in our country, a need that cannot be highlighted more than by the raging opioid crisis.
The Senate Republican leadership’s answer to the American Health Care Act passed by the House of Representatives seeks to repeal and replace the Affordable Care Act by cutting health insurance coverage and by phasing down the state Medicaid expansion. Perhaps more importantly, the Senate bill also significantly goes after Medicaid.
Like the House-passed bill and dressed up as “reform,” the Senate bill caps the federal share of Medicaid, cutting hundreds of billions of dollars over time and permanently ending the original, 50-year plus federal guarantee of health care for the poorest, most vulnerable Americans. In fact, based on a “score” by the nonpartisan Congressional Budget Office, the Senate bill would not lead to better care, but would cause 22 million people — including 15 million Medicaid beneficiaries — to lose coverage and a $772 billion cut to the federal share of Medicaid over the next decade.
If cuts of this magnitude are implemented, states will not be able to afford to fill the gap themselves or find efficiencies that generate savings this large. Nor can philanthropies, such as Jewish Federations, make up the difference. The result will be fewer people protected by Medicaid and major cuts to critical services that are helping children to stay in good health and attend school, older adults to age with dignity, and people with disabilities to live and work in their communities.
Through Jewish Federations, the Jewish community supports a large network of nonprofit hospitals, nursing homes, mental health and substance use treatment clinics, and group homes throughout the country. These agencies care for people on Medicaid who live in our communities both Jewish and non-Jewish alike, but will be devastated by provider rate cuts of the magnitude that will ensue under the Senate and House proposals. We are hearing from our agencies that they will be forced to pare back their services, turn away Medicaid patients, eliminate jobs, and maybe even to close their doors.
Capping Medicaid does not improve care or access, nor does it lower costs. It simply passes the buck to states — and ultimately to our nation’s most vulnerable and the providers who serve them.
Slashing the federal government’s financial commitment to Medicaid on the backs of the poor is not reform. Millions of vulnerable Americans are depending on Congress to get this right, but the Senate Republican leadership proposal is not the answer.
William Daroff is senior vice president for public policy and director of the Washington office of The Jewish Federations of North America.
The views expressed by contributors are their own and are not the views of The Hill.