Kim Krisberg has already ably described how the Senate’s “Better Care Reconciliation Act” would gut Medicaid while giving massive tax breaks to the wealthiest, so I want to emphasize a few key points that are worth bearing in mind.
The Congressional Budget Office score of the Senate bill finds that over the next 10 years, 22 million people would lose coverage (relative to keeping the current law), and 15 million of those people would be losing Medicaid. The worst of the Medicaid cuts would come after 2026, though, as the per-capita cap on the federal share of spending rises much more slowly than healthcare costs.
- The House and Senate bills wouldn’t just undo the Medicaid expansion; they’d make this essential program far weaker than it was pre-ACA. With billions less in federal funding, states will be forced to cover fewer people and/or provide fewer services to those with Medicaid.
- Medicaid covers 49% of all births, 39% of all children, and 64% of all nursing home residents. Do we really think it’s acceptable or useful to cut their care so wealthy people can get tax breaks?
- Hospitals — and especially rural hospitals — will suffer financially under Medicaid cuts. Eleven states, including West Virginia and Kentucky, will see uncompensated care costs double. Bruce Seigel, president of America’s Essential Hospitals, told the Washington Post’s Juliet Eilperin and Amy Goldstein, “Let’s not mince words. This bill will close hospitals. It will hammer rural hospitals, it will close nursing homes. It will lead to disabled children not getting services. . . . People will die.”
- The bills’ per-capita caps would leave Medicaid unable to respond appropriately to epidemics or new treatments, when per-capita costs tend to jump. My George Washington University colleague Sara Rosenbaum gave a good example to the New York Times’s Margot Sanger-Katz: If drug makers produced a Zika vaccine that cost $50,000 a dose, we’d want every woman of childbearing age to be immunized. But few states would be able to make that investment if the federal government were no longer paying the share it does today.
- Cutting Medicaid is a moral issue. Medicaid is how we as a society ensure that people can get care when they’re at their most vulnerable. Deciding to do far less of that, with no credible alternative plan for meeting pressing healthcare needs, in order to cut taxes is immoral. I hope Republicans will revisit the words of President Johnson when he signed into law the Social Security Amendment Act that created Medicare and Medicaid:
No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.… there is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.
What else belongs on this list? What else should Senators be keeping in mind as they decide how to vote?