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

Analysis  |  By Christopher Cheney  
   July 17, 2017

Cutting hundreds of billions of dollars from Medicaid, as the GOP's Better Care Reconciliation Act proposes, makes no sense to some healthcare leaders.

In the healthcare industry, the chorus of alarm over congressional proposals to slash Medicaid is thunderous.

In a joint letter to Senate leaders released Friday, the presidents and CEOs of America's Health Care Plans (AHIP) and the BlueCross BlueShield Association called the latest amendment to the GOP bill "unworkable," and said it "would harm consumers who are most in need of coverage."

Ignoring these voices bears the risk of shuttering hundreds of rural hospitals, shredding the financial fabric of thousands of communities, and signing death certificates for people who could live longer lives.

Specifically, here's what some healthcare industry executives have told HealthLeaders Media recently:

Otis Brawley, MD

Chief Medical Officer

American Cancer Society

Atlanta, GA

ACS researchers have already published declines in health disparities in the diagnosis and treatment of several cancers in states that expanded Medicaid, with no change in states that have not expanded.

We see more breast, colon, and cervical cancer screening. There are signals of more accurate diagnostics and improved quality of treatment. We have also seen differences in smoking cessation, with more efforts and more success in states where Medicaid was expanded.

As a health-outcomes epidemiologist, I see provision of adequate care to include preventive services, such as smoking cessation, appropriate screening, diagnostics, and treatment as a human right. The declines in Medicaid are most concerning in that they will decrease preventive measures and early treatment.

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.

In Missouri, one of the most vocal advocates for Medicaid expansion was the Missouri Chamber of Commerce and Industry. They recognized that a system that doesn't address the cost of the uninsured is a system that passes along costs and delivers poorer results.

Peter Wright, FACHE

President and CEO

Valley Regional Healthcare,

Claremont, NH

Over the years, the Centers for Medicare & Medicaid Services and Congress have toyed with 1% and 2% cuts here and there on physician payments or hospital payments for Medicare and Medicaid. These guys are talking about taking nearly $800 billion just out of Medicaid.

If this were to go through the way it is today, you would see loads of hospitals across the country start to go out of business.

We are the third largest employer in the county. We employ about 350 people, and we don't just employ people. Our average wage is higher—we are employing the higher-wage people in our community.

We're already filling a hole in our budget. It was $5 million a few years ago, it was $4 million last year, and it will be $3 million this year. We're starting to dig out, but we are starting to dig out because of the ACA.

They are cutting payments to Medicare and Medicaid. That means the cuts are going to disproportionately affect people in poorer communities and in older communities. This is not going to hit Nashua, New Hampshire, which has a low percentage of Medicaid patients. This is going to hit Plymouth. This is going to hit the North Country. This is going to hit the places in the state where the need for care is the most.

This is going to hit all of the wrong places.

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


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