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BCRA's Proposed Medicaid Cuts Stand at the 'Intersection of Value and Values'

By Christopher Cheney  
   July 17, 2017

Stuart Hill, MBA

Vice President and Treasurer

Unity Health

Searcy, AR

The Arkansas Hospital Association has estimated that one-third of those who obtained coverage will lose it. That will obviously increase our deductions and bad debts, and hinder the future delivery of healthcare services, particularly for the rural safety-net hospitals. [About a quarter-million Arkansas residents gained health coverage through Medicaid expansion.]

Herb Kuhn

President and CEO

Missouri Hospital Association

Jefferson City, MO

States like Missouri will be in a significant bind. Costs to care for the most expensive categories of Medicaid enrollees continue to rise, and the state is unlikely to have—or to generate—the revenue to absorb cuts to the federal share of the Medicaid partnership.

This is especially true in states like Missouri that rely on provider taxes to support their programs.

There is significant inequity built into the Senate's Better Care Reconciliation Act. The 19 states that did not expand Medicaid under the Affordable Care Act will forego $737 billion in net federal Medicaid outlays throughout a decade, compared to states that have opted to expand the program.

These states, including Missouri, have already fallen behind. Federal cuts will only exacerbate the inequity, creating have and have-not states.

Medicaid's largest enrollment category is children. It's most expensive category is the aged, blind, and disabled. The low-cost, high-value of investment in children's health is indisputable. The necessity of caring for the impoverished elderly and the disabled is equally undeniable. The discussion meets at the intersection of value and values.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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