Families USA’s Executive Director Anthony Wright Responds to Chairman Guthrie’s Medicaid Claims

In a Wall Street Journal Op-Ed published on Mother’s Day, the Republican Chair of the House Energy and Commerce Committee described his budget proposal that would terminate Medicaid coverage for millions of Americans, impose new paperwork and bureaucratic burdens to make it harder to get the care and coverage we need, shift and increase health costs to consumers, states, and the hospitals and health system on which we all rely.

Here’s a guide to the doublespeak where he describes the single biggest health care cuts in American history as somehow a plan to “strengthen Medicaid.”:

✗  “States are struggling to manage rising Medicaid costs.”

✓  The proposed bill actually shifts billions of dollars of costs to states — forcing catastrophic cuts to coverage, benefits, and provider payments.

If this bill passes, states will not just be struggling with Medicaid costs — they will be forced into a full-fledged financial crisis, with no choice but to either raise taxes or make across the board cuts. The nonpartisan Congressional Budget Office (CBO) estimates that this proposal will cut at least $715 billion dollars in federal spending — leaving states to do the dirty work in figuring out how to absorb those funding losses. And those numbers don’t even reflect the tremendous additional administrative costs states would be forced to take on to implement this bill’s onerous paperwork requirements.

✗  “This is particularly true in Democrat-run states such as California that use federal Medicaid funding to subsidize health insurance for illegal aliens through state insurance programs. This policy puts undue budgetary pressure on Medicaid, thereby endangering the healthcare access of the vulnerable Americans the program was designed to help. Just as Mr. Trump is working to end sanctuary cities, congressional Republicans will reduce federal aid to states that give welfare to illegal immigrants.”

✓  Across all states, undocumented immigrants are not eligible for full-scope federally funded Medicaid coverage. Full stop.

In order to ensure healthier communities and better fund their hospitals, clinics and health systems, some states use their own state funds to provide coverage or coverage-like primary and preventive care services to residents who would otherwise be uninsured. Federal Medicaid dollars are not utilized for this purpose. Providing this care in turn helps prevent unnecessary and excessive use of emergency rooms and other expensive health care services.

The proposed policy is blatantly unconstitutional and coercive — punishing states who chose to use their own dollars to provide coverage to state residents by withholding federal dollars for millions of other people who qualify for Medicaid. Ironically, the argument that Medicaid dollars cannot be used to coerce states into making coverage decisions was the basis of the Supreme Court decision that allows 10 states to continue not to expand coverage under the ACA – Republicans cannot have it both ways.

This proposal also puts partisan political attacks into policy, seemingly attacking immigrants and blue states while actually holding hostage and doing harm to the entire health system and the citizens who live in these states. One way or another, this simply is a direct attack on all residents of California, Colorado, Illinois, Minnesota, New York, Oregon, Washington, and other states — including those that specifically use these state dollars only to cover children and pregnant women. People living in Republican districts — including the vast majority of Medicaid enrollees who are U.S. citizens — will feel the full impacts of these dramatic cuts to health funding for their hospitals and clinics.

✗  The Biden administration is responsible for this problem, too, having imposed burdensome regulations on Medicaid that jeopardize the program’s long-term health. The last president stripped away guardrails against fraud by making it more difficult for states to remove ineligible people from Medicaid enrollment and expanded coverage such that capable but unemployed adults could take resources meant for people in need. In total, these Biden rules will cost $172 billion over the next 10 years if they aren’t reversed — as our bill would do.”

✓  The proposal undoes reforms to streamline enrollment for individuals and states, instead putting in place new paperwork and bureaucratic burdens that will make it much harder for people to get on and stay on health care coverage. All while making states spend additional money to process that additional paperwork.

Hard-won experience has provided proven ways to verify eligibility and income status more easily, often electronically, without the complicated and confusing requirements proposed in this bill. Efficient enrollment processes are a win-win-win for families, taxpayers, and states. Given that experience, this proposal can only be interpreted as designed to keep people from getting coverage not because they are ineligible but because the bureaucratic red tape makes it nearly impossible for them to navigate. Among other requirements, this bill would make people re-enroll not just every year, but mid-year as well.

✗  “Undoubtedly, Democrats will use this as an opportunity to engage in fear-mongering and misrepresent our bill as an attack on Medicaid. In reality, it preserves and strengthens Medicaid for children, mothers, people with disabilities and the elderly — for whom the program was designed.”

✓  This bill proposes by far the biggest cut to Medicaid in history, one that the CBO estimates will mean at least 8.7 million more uninsured people from the Medicaid cuts alone. These cuts to Medicaid will be borne by the states that administer the programs, the hospitals and providers that deliver care, and everyone enrolled in the program — including children, mothers, pregnant women, people with disabilities, veterans, and the elderly.

When this proposal cuts Medicaid funding to states, states will have no choice but to attempt to absorb the impact by being forced to make dramatic cuts across the program and populations, starting with anything that is “optional” under the law — from dental and vision and podiatry, to home and community-based services, to eligibility and enrollment for seniors and other vulnerable populations.

Much of the cuts will end up as reduced payments to providers — and if those hospitals and clinics and providers get less money, they will be forced to scale back services, if not close them altogether — including facilities already under grave financial risk, such as rural hospitals and maternity wards. When providers cut services, hours, or close facilities, everyone who uses those providers suffers as a result — all Americans, including the most vulnerable like seniors, people with disabilities. mothers, and children, and all low-income Americans.

✗  “When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work. That’s why our bill would implement sensible work requirements. Every other capable adult works to afford healthcare. Half of all Americans get insurance through work, seniors on Medicare get coverage because they paid into the trust fund, and veterans earned their care through their service to our country.”

✓  Most adults covered by Medicaid do work, but largely at low-income jobs that don’t provide health coverage to employees or their family members. And those that don’t work usually have good reasons as they are enrolled in school, caregiving for dependents or elderly family members, or have disabilities that put full-time work out of reach. Work reporting requirements, even when they include extensive “exemptions” simply force these people to constantly engage in extensive paperwork to repeatedly demonstrate their status as workers, students, or caregivers to maintain their health care. What’s more, this proposal would put in place a job loss penalty that people who lost their job would lose their health coverage too, undermining their ability to stay healthy and reenter the workforce.

As multiple state attempts in Georgia and Arkansas have shown, work reporting requirements are costly to administer and do nothing to promote work or improve employment rates, but put simply, work reporting requirements don’t work. They have failed to achieve their stated goals in every state that has attempted to implement them — instead resulting in hundreds of thousands of people losing coverage, millions of dollars in extra costs to states, and showing absolutely no evidence of boosting employment rates. They do, however, impose bureaucratic burdens that significantly hinder people from getting the coverage and care they need, and would terminate health coverage for millions of Americans who remain eligible for the program but get lost in the bureaucratic shuffle of trying to constantly prove it.

✗  “The Republican bill also prohibits Medicaid from funding ‘gender reassignment’ surgery for children, instead recommitting the program to essential care for our most vulnerable Americans. The federal government shouldn’t be subsidizing these procedures in any form, and I am proud that we will be protecting all our children from the lasting, harmful effects of these procedures.”

✓  Like all health insurance plans, Medicaid plans cover the services that providers and medical specialists deem to be medically necessary for their patients. Politicians should not weaponize laws to insert their own ideologies into the personal and clinical decisions that should be made between individuals, families and their doctors.

Gender affirming care is health care, determined to be both evidenced-based and medically necessary by every major medical and mental health association in the United States. When it comes to medical decisions, we should trust doctors, not politicians who are in no position to consider the individual needs of patients. Further, setting a precedent that politicians can dictate medical necessity will soon go beyond this specific effort that impacts a very small but vulnerable population and open the door to ideological attacks on any number of medical services.

✗  “Without Republican solutions, Washington risks a complete collapse of Medicaid. Even with these simple steps to eliminate waste and abuse, Medicaid spending will continue to rise every year for the foreseeable future. All who worked on this bill — from my congressional colleagues to the White House — designed it to renew the American dream for families across the country. What could be more common sense than that?”

✓  Nothing in this bill is actually crafted to target “waste and abuse” or to help people get and stay healthy so they can work and contribute to their communities. The bill includes a grab bag of policies designed to generate more than $715 billion in savings by dropping at least 13.7 million people off health coverage, all to fund tax cuts for corporations and billionaires.

If this proposal was about waste, fraud and abuse, we would have a much different set of policies under consideration. If this proposal was a commonsense renewal of the American dream, it would include an extension of premium tax cuts that help working people purchase their own insurance, to prevent a major spike in premiums.

No rhetoric around this bill can disguise it for what it is: an existential crisis for working families, seniors, children, veterans, rural hospitals, clinics, nursing homes, and state budgets. The only common sense evident in this proposal is that for the many Republicans who promised not to cut Medicaid benefits, this bill should be an easy “no” vote.