This blog post is cross-posted from Public Health Awakened and addresses potential changes from repealing the Affordable Care Act- June 2017
Proposed changes to Medicaid will lead to:
More people getting ill or dying prematurely, including children.
Low-income children are less likely to die in childhood or adolescence when states expand Medicaid (Howell & Kenney, 2012; Wherry & Meyer, 2013). Cuts that Republicans suggest would end core services to keep kids healthy that past administrations on both sides of the aisle have supported and expanded, including: well-child visits and check-ups, developmental screenings, immunizations, and treatment for vision and hearing, oral health, lead poisoning, mental illness, addiction, autism, and behavioral health issues (Sharfstein, 2017). For low-income adults, expanding Medicaid is significantly associated with less death and better self-reported health (Sommers, et al., 2012). Cutting Medicaid will reverse these trends in children and adults.
More seniors unable to meet basic needs.
For seniors, including those who may struggle to make ends meet, have high medical costs, live in nursing homes, or live with the effects of a stroke, dementia, losing their vision, etc., Medicaid covers long-term care and basic services for everyday life — like eating, bathing, or doing laundry — that are not covered by Medicare (Kaiser Family Foundation, 2016).
Millions of people having health coverage taken away from them.
Estimates are that 14 million people would have Medicaid coverage taken away — more than half of the 23 million more who would be uninsured by 2026 under changes to health care proposed by many Republicans (Congressional Budget Office, 2017). This would reverse the recent expansion in coverage to millions of people under ACA.
Harder financial times for working people, people with disabilities, seniors and adults who already struggle to make ends meet.
Reduced Medicaid coverage will worsen health disparities for already at-risk populations. People who lose coverage will have to make tough financial choices and will be less likely to get needed health care, for themselves and for their children (Chatterjee & Sommers, 2017).
Currently Medicaid covers (Kaiser Family Foundation, 2017):
- Pregnant women: 49% of all births are covered by Medicaid
- Children: 39% of all children, and 76% of poor children
- People with disabilities: 30% of adults with disabilities (excluding and 60% of children with disabilities
- People in long-term institutional care: 64% of nursing home residents
- People in treatment for HIV/AIDS: 41% of adult AIDS patients and 90% of children with AIDS
Wider disparities across states and geographies in access to care.
States with older and sicker residents, as well as rural states, will be most affected (Lambrew, 2005). Safety-net hospitals, nursing homes, and clinics in low-income and rural areas that rely on Medicaid funds may close, and there will be less care for all residents of these already-underserved areas (Kaiser Family Foundation, 2012). Even people who can afford care will have to travel further to providers, and the proposed changes would eliminate Medicaid transportation services. States will likely control costs by paying providers less, and over time fewer providers will accept Medicaid patients (Sommers & Naylor, 2017). In addition, setting the amount of money that states get from the federal government would “lock in” current disparities in Medicaid funding, eligibility, and benefits packages across states: states that currently have less generous packages would not be able to “catch up” to more generous states (Holahan, et al., 2017).
Cuts in health services or states paying more money in the long run.
Reduced Medicaid coverage would reduce access to health care but not reduce health needs. Instead, health care use would likely shift to more expensive acute care services (e.g., emergency departments). Furthermore, untreated health conditions would lead to more severe health needs, leading to higher costs in the long run. An uninsured child costs the community $2,100 more than a child covered by Medicaid (Children’s Defense Fund, 2017).