Time to End the War on Medicaid

Politicians in Washington seem hell-bent to cast life-changing votes affecting the health care of nearly every American and negatively impacting our national economy. Of particular concern is the unwarranted attack on Medicaid, the source of health coverage for over 70 million hardworking Americans.

It would be easy to see congressional efforts to repeal the Affordable Care Act as yet another partisan fight over numbers. But this is anything but a routine vote. Despite overwhelming opposition from patients, doctors, nurses, hospitals, employers, unions, safety-net health plans and others who have a direct stake in these decisions, Republican congressmen have been pushing forward dangerous pieces of legislation that will result in millions of Americans going without health insurance, and driving up the costs for those who are still covered.

Many have pointed to the enormous human toll any legislation that makes cuts to Medicaid would have. People without insurance have nowhere to go for preventive care and screenings that could detect illnesses before they become a chronic or deadly condition. Sixty percent of adults with Medicaid coverage are already working. Medicaid helps people manage their chronic illnesses — so they can keep working. People without insurance often forego taking medications that can cure or control their illness and allow them to stay healthy and productive. And people without insurance avoid checking in with their specialist when their conditions demand care; they go, instead, to emergency rooms or don’t go at all and get sicker.

We see the evidence of this every day at Amida Care, New York’s largest Special Needs Health Plan for people with chronic conditions such as HIV. Prior to the ACA, qualifying for Medicaid was a complicated process that weighed how sick a person living with HIV was against how much they earned. By allowing states to expand Medicaid, the ACA extended health insurance coverage to thousands of people living with HIV and greatly streamlined the process of qualifying for Medicaid, helping them afford medication and stay in treatment. Nationally, Medicaid coverage for HIV-positive people rose from 36 percent in 2012 to 42 percent in 2014.

Thanks to improved access to preventive and primary care, over 75 percent of Amida Care’s HIV-positive members have viral loads that are undetectable, meaning that they are healthier and require significantly less costly care. This saved New York state more than $110 million between 2008 and 2015. Reducing patients’ viral load also reduces the possibility of new infections, and preventing just one new HIV infection can save upward of $500,000 in lifetime medical costs.

If the ACA is repealed, all of this progress is at risk. With millions of people losing coverage, access to care will be limited. Without regular, comprehensive health care, people with chronic conditions like HIV are hospitalized and visit the emergency room more frequently, require costly nursing homes, rack up high bills and get pushed into poverty. Those burdensome costs are ultimately passed on to the government, insurers and taxpayers.

Any cuts to Medicaid would be devastating. Changing Medicaid from an entitlement into a state-based per capita grant program will cause permanent and growing damage to people’s health and the ability of our nation to respond to natural or economic disaster. Medicaid is the backbone of health coverage in America. One in two Americans will need Medicaid at some point during their lifetimes. Medicaid provides for healthy births and assistance for older people to be able to remain in their homes. Today, Medicaid is also there to help many thousands of people who lose their jobs in the aftermath of unforeseen disasters like recessions or hurricanes. Similarly, when an outbreak of illness occurs, Medicaid is there to provide coverage for needed care.

The current epidemic of opioid-related addiction is a perfect example of why Medicaid needs to be preserved. In 2014, more than 1.2 million Americans were admitted to a hospital or went to an emergency room for opioid-related conditions, or 3,500 visits a day. Without Medicaid, many of these patients would be unable to get the care they need to survive and recover from their addiction.

Many congressional Republicans seem determined to vote to tear down the health care safety net, harming our nation’s physical and economic health. Yet some Republican senators have chosen to listen to their constituents and have opposed legislation that will cut Medicaid. Their courage to do the right thing is commendable. With so much at stake and so many unanswered questions, it’s time to end these attacks. It’s time for Congress to reach across party lines to find ways to improve coverage and care. Too much is at stake.


Doug Wirth is president and CEO of Amida Care, a private nonprofit community health plan that specializes in providing comprehensive health coverage and coordinated care to New York Medicaid members with chronic conditions.

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