Medicaid cuts would hurt more than health
The Senate health bill proposes even deeper cuts to Medicaid than the House bill. At risk is a program that provides relatively low-cost care to nearly 75 million Americans — including children, disabled individuals and elderly people in nursing homes.
As physicians, we are dismayed by the prospect of millions of patients losing access to the medical care they need. But what is often lost in the debate is that Medicaid helps people live healthier, fuller and more productive lives. The unavoidable reality for those trying to dismantle the program is that the health of people is intimately linked to the health of communities, local economies and the nation as a whole.
Medicaid has a number of positive effects for patients and communities that often go unrecognized, including more employment, higher earnings, greater educational attainment and lower incarceration rates.
A 2015 study analyzed how children eligible for Medicaid fare compared with children who are also poor but are ineligible. Children who were eligible had higher earnings, collected less in tax credits and paid more in taxes for decades to come. The longer they were eligible, the greater the effect. Researchers estimated that through greater tax revenue alone, the government would earn back more than half of what it spent by the time these children reached age 60.
The economic impact of Medicaid ripples through communities. Federal funds pay doctors, nurses and hospitals. Facilities pay for rent and equipment; employees and businesses buy housing, food and transportation.
A new Commonwealth Fund study found that if the House bill became law, nearly 1 million jobs would be lost (725,000 in health care) by 2026, gross state products would decrease by $93 billion, and business output would decline by $148 billion. Forty-seven states would suffer job losses.
Medicaid also helps people reach higher levels of education. A 2014 study found that Medicaid eligibility decreases the high school dropout rate by 4%-6% and increases the likelihood of completing a four-year college degree by about 3%.
And Medicaid may be good for the criminal justice system. In Washington state, for example, inmates with mental illness released from prison who received Medicaid were more likely to access services and 16% less likely to be detained in the following year. A program that provided behavioral health treatment to lowincome adults with substance use issues resulted in a 17% to 33% decline in arrest rates, and saved the state $275 million.
The traditional argument for Medicaid rests on a moral obligation: Health care is a right, one that Medicaid helps protect. Yet Medicaid is also a path to higher education, safer communities and greater economic freedom and mobility — what many call the American dream. Cutting Medicaid would hurt people as patients — but also as students, employees and neighbors.