Gutting Medicaid

Proposed cuts to health-care program would be life-threatening for many.

It would appear that Republicans are expanding their assault on the poor to include the middle class. As we learn more about the Senate incarnation of Trumpcare, its meanness becomes increasingly clear. With a few changes to push some of the pain beyond the 2018 midterm elections, it hews closely to the widely unpopular American Health Care Act passed by the House of Representatives. It would cause an estimated 22 million Americans to be uninsured by the end of the decade, according to the Congressional Budget Office. But our concern today is the draconian cuts to Medicaid, which would remove 15 million people from its rolls, and not just low-income people. The cuts would affect a wide swath of Texas’s seniors, disabled citizens, hospitals and mothers and their children.

Seniors: The numbers here are straightforward. Medicaid is the largest payer of long-term care services in the U.S.; fully 20 percent of its overall budget. Nationwide, more than 1.4 million seniors are currently in nursing homes and 40 percent rely on Medicaid. An estimated 70 percent of today’s 65-yearolds will require long-term care at some point in their lives. These are not just poor people. The median annual cost of a private room in a nursing home in Houston is about $80,000; an assistedliving facility: $46,000. The average length of stay in a nursing home is 2.5 years, which adds up to $200,000. Median annual income in Houston is about $60,000; average Social Security benefit is $14,776. Few families can afford the kind of outlay needed for long-term care. As a result, about 60 percent of nursing home residents in Texas wind up on Medicaid after depleting their financial resources.

Disabled: The largest share of Medicaid spending, 42 percent, goes to care for nearly 13 million people with disabilities, according to the Kaiser Family Foundation. These are most often life-long conditions that are beyond the financial capabilities of even middle-class families. Medicaid has allowed disabled Americans to live independent lives. The fear of being forced back into institutions has driven wheelchair-using citizens out to demonstrate against this bill.

Hospitals: When grievously injured or sick patients are delivered to trauma hospitals like Ben Taub and Memorial Hermann, no one asks if they can pay. As hospitals are required by law to do in emergency medical situations, the patients are admitted and treated. Without Medicaid as a backup to pay uncompensated costs, these institutions will have difficult budget problems. Add the loss of insurance coverage for thousands of our neighbors, and the problem grows even worse as these patients revert to using the emergency room for their medical needs. The budgetary shortfalls will have to be covered by state and local taxes, increased premiums for those with insurance or by curtailing services. With any or all of these options, we in Houston will pay a heavy price.

Hospitals in rural communities will be hit even harder, and many are likely to close. These communities often have older, sicker, poorer citizens whose uncompensated care overwhelms hospital budgets.

Mothers and children: Medicaid provides essential care for low-income pregnant women and covers about half of all births in Texas. At 11 percent, Texas has one of the highest rates of uninsured children, and almost half of those with insurance get it through Medicaid. It is difficult to explain how these populations deserve to lose their health care.

The direct impacts on people in need of medical care will in far too many cases be life-threatening. And the costs to our communities will be broad and deep, as hospitals and nursing homes close or cut back, as local taxes and insurance premiums go up. Health care is a sixth of the U.S. economy, and Medicaid is the largest health-care program, covering about 1 in 5 Americans. Transferring what will eventually be more than $770 billion in Medicaid funding from those people to pay for tax cuts for the wealthiest Americans and corporations will have a profound effect on the economy, according to the Commonwealth Fund, especially Houston’s health care-heavy economy.

It is time for our representatives in Washington to show some backbone and stand up for their constituents instead of Donald Trump and right-wing partisans.