Stepping up to help improve the health of Americans so we can all thrive has long been a hallmark of our nation.
Medicaid has been an essential tool in helping many people, including isolated rural Americans, young adults leaving foster care, lower-income families, people with disabilities and their family caregivers, and people battling addiction. Especially important now during the coronavirus pandemic, given its role as the nation’s single-largest health care first responder, Medicaid has acted as the assurance that Americans could “be spared the darkness of sickness without hope,” as affirmed when Medicaid was signed into law in 1965.
Fast forward to the present day, when 72 percent of Americans view Medicaid favorably, according to a 2019 Morning Consult poll. Yet the recent “Healthy Adult Opportunity” plan from the Centers for Medicare and Medicaid Services — encouraging states to apply for waivers to “block grant” Medicaid funding at the state level — strikes at the heart of this majority view.
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The CMS plan would mean millions of people throughout America who now are covered could see their coverage and access to needed services sharply reduced — or eliminated outright. The nearly 13 million people who have gained coverage via Medicaid expansion, combined with another 10 million people who receive Medicaid through states’ existing optional coverage, could be in danger of losing their health coverage.
The CMS plan’s potential catastrophic results are of pronounced concern to a growing number of people, including bipartisan voices from the National Governors Association, who argue the CMS-proposed Medicaid restructuring “could lead to unintended consequences that would negatively impact Medicaid beneficiaries across the country.”
In response to similar pushback from a growing number of organizations, CMS Administrator Seema Verma emphasized the groups that would not be adversely affected by the CMS plan at this point — namely seniors, pregnant women, and people who are eligible for Medicaid because they receive federal disability assistance (which may not include nearly 5 million people with disabilities).
But what about the many people who likely would be affected if states choose the new CMS plan — including the 13 million adults now covered by Medicaid expansion? Are they somehow less “deserving” of coverage and access to health services, of the greater financial security that coverage produces, or of health itself?
Here are just a few examples of how the lives of people, families and communities nationwide could irreparably change should states adopt the CMS plan.
A JAMA Network Open June 2019 study ties Medicaid expansion to increased parental financial stability, greater access to mental health care and reduced child neglect rates. It follows that low-income people covered by Medicaid expansion — many of which are currently employed — could face declining health and greater poverty should they lose that health coverage.
Poverty affects us all, not just lower-income families. Childhood poverty, for instance, has been found by researchers at Washington University in St. Louis to cost our nation over $1 trillion. The promising news, however, is Medicaid is among the most effective programs at actually combating child poverty; an October 2017 Health Affairs study found “Medicaid had a larger effect on child poverty than all non-health means-tested benefits combined.”
So what would happen to families in Medicaid expansion states if parents who have gained access to care lose their eligibility? What about people who need to care for a loved one at home with a disability? How about the thousands of fewer cases of child neglect that have been reported in Medicaid expansion states?
The CMS plan would also make an already unstable health care situation in rural America untenable. Rural populations are more apt to be uninsured or use Medicaid, and 1.7 million of the people who gained health coverage through Medicaid expansion live in rural areas. When you consider that the CMS plan’s block grants or per capita caps are expected to translate into greater costs for reduced care, it’s easy to see how health and economic consequences would hit much of rural America.
In order to make up the difference between their current federal Medicaid contribution amount and the lower capped amount they would receive under the new CMS plan, states would either need to use their own funds (siphoned from other state programs) or make sweeping cuts to health services that people need. The CMS plan would mean more struggles for already cash-strapped rural economies — including sicker residents and increasing physician shortages when provider compensation rates are cut.
Rural American communities could also expect to see even more hospital closures; The (Pittsburg) Morning Sun in Kansas reported in July 2019 that a staggering 72 percent of all rural hospital closures since 2010 were in states that did not expand Medicaid. This is not coincidental.
A February 2020 Health Affairs blog post notes that fatalities caused by alcohol, drugs or suicide increased a staggering 51 percent from 2005-16. The post details how vital Medicaid expansion has been to addiction treatment and mental health services. This is key, when you consider nearly 47 percent of U.S. adults will experience a mental illness in their lifetime, while nearly half of us have a family member or close friend who has been addicted to drugs, according to the Pew Research Center.
Medicaid, and specifically Medicaid expansion, has meant improved access to care and medication for people with depression. Furthermore, people with Medicaid are more likely to receive treatment for opioid addiction than those with private coverage, and treatment rates for opioid abuse have been much higher in Medicaid expansion states, Modern Healthcare reported.
Encouragingly, Medicaid expansion also is linked to lowered death rates tied to fentanyl, heroin and opioids (10 percent, 11 percent and 6 percent, respectively). It’s a small wonder that Kaiser Family Foundation researchers found that rather than reducing Medicaid coverage, some states are looking to Medicaid to expand coverage to address the opioid crisis and get people the care they need.
At the end of the day, Medicaid expansion has meant progress: reducing poverty and neglect, increasing access to care, promoting family stability and saving thousands of people’s lives. The improvements it has delivered ultimately benefit millions of people nationwide, their families, our communities and our economy. If states adopt the new CMS plan, it will mean more people will generally be in poorer health and less able to weather a significant health crisis — like coronavirus — in the future. In equal measure, it would defy principle, logic and hope itself to not just halt this vital progress but actually reverse such important headway through the CMS plan.
Charlotte Haberaecker is president and CEO of Lutheran Services in America, a Washington, D.C.-based not-for-profit organization whose network of 300 health and human services organizations serves 1 in 50 Americans, providing services to seniors; children, youth and families; people with disabilities; and people affected by disasters.
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