Hey, county commissioners! You’d better call Senators John Thune and Mike Rounds and tell them not to break your budgets with their health care bill:
The Senate bill would lead to even sharper cuts to traditional Medicaid than the House-passed bill due to an adjustment of the growth rate after FY 2025. Cuts to traditional Medicaid and ACA’s Medicaid expansion (explained below) in the House-passed version were already estimated to total $834 billion, or one-fourth of federal funding over the next decade. Under this scenario, states would be forced to cut benefits and/or shift costs to providers or local governments, including counties.
While the Senate bill would further limit the ability of states to use provider taxes to raise revenue for Medicaid funding, counties receive no such protections in the bill. Provider taxes would be annually decreased by 0.2 percent over a five-year window. Therefore, counties would be even more vulnerable to financing a greater proportion of the Medicaid program, while also having to cover uncompensated care costs and/or services for residents that were previously covered by Medicaid [Brian Bowden, “NACO’s Analysis of Senate Health Proposal: Massive Costs for Counties,” National Association of Counties, 2017.06.23].
NACo says the Senate GOP wealthcare bill also hobbles treatment of opioid addiction, erodes quality of insurance, and cuts funding for public health:
The Senate bill would directly impact approximately 1,900 local public health departments by eliminating the Prevention and Public Health Fund beginning in Fiscal Year 2018 (October 2017). This would result in a reduction of almost $1 billion annually for public health investments, much of which goes directly to states and our counties to help us safeguard our residents from infectious diseases like measles or Ebola and prevent the onset or spread of disease. Such loss of funding would further inhibit counties’ ability to respond to public health emergencies and address the underlying causes of poor health outcomes and health disparities amongst our residents [Bowden/NACo, 2017.06.23].
NACo expresses concern that Senate Republicans will leave lots of elderly Americans, especially rural senior citizens, unable to afford nursing home care. The Minnesota Department of Human Services and AARP share this concern:
“There’s a lack of awareness that Medicaid is really the safety net in Minnesota for so many of our seniors,” said Minnesota Department of Human Services Commissioner Emily Piper, whose agency manages the $11 billion program.
…“It’s not just the seniors who rely on Medicaid, their whole family does,” said Piper. “Their adult children, who are working and saving to send their kids to college, or who are raising young children who can’t take on the additional responsibility of providing day-to-day, 24-hour care of aging grandparents.”
…Last year, nearly 30,000 Minnesotans were served by the Elderly Waiver program. The state spent an average of $1,300 to $1,600 per person a month, compared to the average monthly cost of a nursing home of $6,700.
“The proposed cuts will have an unfortunate impact on the progress we’ve made,” said Erin Parrish of AARP Minnesota, citing a recent AARP study that ranked the state No. 2 in care for seniors and their caregivers. “The number of Minnesotans turning 65 this decade will be greater than the past four decades combined. The cap doesn’t keep pace with changing demographics” [Jackie Crosby, “Medicaid Cuts in GOP Health Care Bill Could Take Toll on Minnesota Seniors,” Minneapolis Star-Tribune, 2017.06.24].
That’s funny: Governor Dennis Daugaard is assuring us that his fellow Republicans’ health care plan probably won’t affect the “most frail populations” currently receiving Medicaid. What population is more frail than old folks in nursing homes?
Vice-President Mike Pence sloganeers that “Before summer’s out,” the Republican push to repeal and replace the Affordable Care Act will lead us to a system “based on personal responsibility, free-market competition & state-based reform.” But in practice, the Republicans seem determined to crush county budgets and price Grandma out of the nursing home.