Calling Medicaid a “lifeline” for millions of the nation’s most vulnerable populations who cannot afford health care, the ABA urged Senate leaders to maintain support for the program as they consider legislation to repeal the Affordable Care Act (ACA).
On July 25, the Senate narrowly voted 51-50, with Vice President Mike Pence breaking a tie vote, to proceed to consideration of legislation to repeal and replace the ACA. The Senate began immediately considering various proposals, including a bill passed in June by the House, H.R. 1628, and a proposal drafted by Senate Republicans. Both House and Senate bills include major changes in the Medicaid program, which was expanded under the ACA to allow states to provide for health care coverage for millions of low-income Americans.
“ACA repeal could have a devastating effect on our senior population and struggling families, as well as adults and children with disabilities,” ABA Governmental Affairs Director Thomas M. Susman wrote July 24 to Senate Majority Leader Mitch McConnell (R-Ky.). He explained that the Senate proposal to repeal the ACA is expected to increase the number of uninsured Americans by 22 million over the next 10 years and increase health care costs – especially for older adults with low incomes and pre-existing conditions and children, who comprise 43 percent of all Medicaid enrollees.
Susman expressed the ABA’s opposition to structural or financial changes in the Medicaid program that would weaken the entitlement nature of the program or the shared legal obligation that the federal and state governments have to provide comprehensive benefits to all individuals who meet eligibility requirements.
Significant cuts in the program also could impact a large swath of vulnerable Americans across the country who have already spent down their resources to pay for long-term care and now rely on Medicaid for critical home- and community-based services, nursing home care, or other services for a family member with disabilities. Two out of every three nursing home residents are covered by Medicaid, Susman wrote.
Susman emphasized the ABA’s opposition to placing per capita caps on federal contributions to Medicaid or to converting federal funding for Medicaid into block grants to the states.
“While a per capita cap structure would make it easy for the federal government to dial down Medicaid growth rates to achieve savings, this in turn will shift added burdens onto the states,” he said. “The burden shift would likely lead states to ration care by reducing services and provider payments,” he added.
The ABA also is concerned about the impact of ACA repeal and Medicaid cuts on home- and community-based services (HCBS), which are cost effective and enable older Americans and people with disabilities to stay in their homes. The association believes that Congress should expand the availability of HCBS by making it mandatory under Medicaid and available to anyone who would otherwise qualify for institutional long-term care.
Susman also pointed out that cutting Medicaid could “devastatingly” diminish health care coverage for children and survivors of violence. He said that one out of four women in the United States has experienced severe physical violence by an intimate partner during her lifetime, and many survivors struggle with mental and behavioral health consequences stemming from their abuse.
“In summary, if implemented, proposals to repeal the Medicaid expansion will harm the most vulnerable portions of our population, including parents and children, the elderly, victims of violence, and people with disabilities,” Susman concluded, “The expansion of Medicaid under the ACA provides health security to 11 million previously uninsured Americans in 31 states, including 1.6 million older adults aged 50-64 who struggle to find affordable coverage.”