Casey
families with a loved one with a disability. It would affect families trying to get a loved one into a nursing home… And it would obviously affect children in rural areas and urban areas that come from low-income families.”
Nearly 2.8 million Pennsylvanians received Medicaid or other public health care benefits excluding Medicare, which benefits seniors, in 2014, according to the Kaiser Family Foundation, a nonprofit organization specializing on health care analysis.
The Congressional Budget Office (CBO) estimates that the Republican proposal currently under consideration would decrease federal health care spending from its present level of approximately 12 percent of the nation’s Gross Domestic Product (GDP) to 6 percent of GDP by 2030, resulting in significant deficit reductions for decades to follow.
The CBO also concluded that the block granting of Medicaid and halting of the program’s expansion under the ACA, while adding flexibility to state’s health care insurance options, would inevitably require states to “decrease payments to Medicaid providers, reduce eligibility for Medicaid and provide less extensive coverage to beneficiaries.”
“It’s a totally ideologically extreme position to take, and Republicans look as if they’re voting for it in Congress year after year, knowing full well it would never become law, but they could go home and look like great budget cutters,” Casey said.
“But now, apparently the Trump administration is talking about embracing the Medicaid proposals that were put forth by Speaker Ryan and (former) Representative (Tom) Price ( R-Ga.), who is now Secretary of Health and Human Services.
“They think the federal government’s too big. They want to cut it dramatically. That’s kind of the opening argument of their position.
“So that’s where we find ourselves, facing a circumstance where if Medicaid were block granted you’re basically talking about a trillion dollars in cuts. And those resources that are taken away mean that less people can receive care, or the care that people do receive is reduced in some way,” argued Casey, citing assertions by Gene Sperling, who headed the National Economic Council under presidents Clinton and Obama, and the findings of the Center on Budget
and Policy Priorities, a progressive think tank which estimated that if the Ryan plan were implemented, there would be a 3 percent decrease in federal funding for Medicaid and the Children’s Health Insurance Program (CHIP), amounting to an estimated $169 billion cut under current levels over 10 years.
Prospective cuts to Medicaid, which along with CHIP
covers 70 million Americans, do not include reductions in coverage affected by the elimination of the ACA’s Medicaid expansion
“It’s really a question of what states do and what happens when there’s less funding there.” Casey explained. “So even if a state wanted to continue the status quo they would receive less resources under the funding mechanisms House Republicans are talking about; a beneficiary cap.”
Casey said that if Medicaid reform was only about allowing states to have more flexibility on how their healthcare dollars were being spent, legislators would probably be having a different conversation. But he doubted whether Republican-led, and Democratically-run states would deal with the issue with any semblance of equanimity.
“Why should the health care of a child who has a disability of some kind be compromised depending on whether they live in a red
state or a blue state?” Casey asked.
“That child should be able to get the same kind of care no matter where they live and that’s why Medicaid is such a good program.
“Even Vice President (Mike) Pence embraced Medicaid expansion. A lot of people in Indiana have health care because a very conservative governor, who’s now vice president, embraced the Medicaid expansion despite its connection to, quote: Obamacare.”
At the state level, Casey doubted if the commonwealth’s Republican-majority
Legislature, already facing a financial squeeze, would back block granting of Medicaid in light of other pressing budgetary concerns, such as corrections.
Analyzing the status of support for Medicaid reform in the Keystone State, Casey wondered if Republicans in the general assembly would “ask families out there with children, many of them lower middle class families who work every day of their lives -sometimes two jobs that get the CHIP program: If your kid’s on CHIP or your kid’s on Medicaid... whether they’d like to see those programs
cut by 40 percent ( the combined estimated decrease in federal spending on Medicaid and CHIP statewide over ten years)?
“That is an abomination. That would be a stain on America if they did that,” Casey said.
“Those families that are adversely impacted know how to drive to Harrisburg just like they know how to drive to Washington. And every Republican legislator who embraces this idea instead of fighting it, I think, is going to have a lot of explaining to do to families in their districts.”