Medicaid cuts could hurt Wisconsin’s kids

I have no idea what’s in the new health care bill. Neither do most senators. “It’s not a good process,” Sen. Ron Johnson, the Wisconsin Republican, told USA TODAY. It’s a terrible process. But lawmakers crafting the new bill like it that way. As one Senate aide told Axios this week, “We aren’t stupid,” meaning that if voters knew how those billions of dollars are going to be divvied up, a lot of them would complain.

I worry about the smallest voices in this debate. A big piece of the effort to “repeal and replace Obamacare” concerns what to do about Medicaid — and that means what to do about the only health insurance millions of impoverished American kids have.

These are some of the same kids who show up every day for care at Children’s Hospital of Wisconsin, where 54% of its patients are covered by Medicaid, a federalstate program that dates to 1965.

“If they cut the dollars to the degree that they say they are going to cut them … kids will suffer,” said Peggy Troy, president and chief executive officer at Children’s. “The tragic thing that could happen is we wouldn’t be able to do all the things we do now.”

Republicans plan big changes to Medicaid. The House bill, on which the Senate version is based, would convert Medicaid from an entitlement — that’s where the government pays all health care costs for anyone who qualifies — to a grant program. States would get a specified amount of money per Medicaid recipient.

The Congressional Budget Office estimated the House bill would cut $834 billion from Medicaid. A study paid for by the Children’s Hospital Association found that the House bill would mean $43 billion less for impoverished kids by 2026 — and nearly $350 million less for Wisconsin kids.

Conservatives argue that a block grant approach to Medicaid, which is a major budget line item in every state’s budget, would force administrators and providers to figure out how to deliver cheaper, more efficient health care. It’s an alluring argument, and there is some truth to it. Medicaid is a big, complicated, bureaucratic program. Within reason, more flexibility for states could help identify ways to economize.

But both of these bills have been rushed. There have been no hearings, no chance for the public to have its say. Given the scope of the cuts, it seems likely that fewer kids will be covered as eligibility narrows, services are reduced or providers decide to get out of the “Medicaid business” because their rates get squeezed. Under the current law, states must provide what is known as “Early and Periodic, Screening, Diagnostic, and Treatment” benefits to kids up to age 21. The House bill changed that language, which would allow states to reduce services.

The architects of the Senate bill will argue that their efforts will save taxpayers money and still provide adequate care. They’ll argue that giving states the flexibility to better manage Medicaid will make the program more efficient. Maybe so. But will the CBO even get a chance to test those claims before senators vote? Maybe not. Senate Majority Leader Mitch McConnell is pushing for a vote before the July 4 recess.

Given the scope of the cuts in the House bill, it’s likely that some kids won’t get the care they need when they need it. As their conditions worsen, their care will end up costing taxpayers more, or their parents will seek the most expensive care of all — in a hospital emergency room. In that case, all the framers of this bill will have done is shift the cost to somebody else.

The best outcome would be to exempt kids altogether from block grant caps. They are not the ones driving up costs.

Does the public even want this overhaul? It doesn’t seem like it. A Kaiser Health tracking poll from February found that 65% of Americans wanted Medicaid left as it is. Above all, the public deserves to know what’s in this bill.

But the public’s concerns may be swept aside as Senate leadership barrels ahead — in secret — hoping to declare the nation free of Obamacare by Independence Day.