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Health Care Debate Ignores Massive Changes to Medicaid

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March 16, 2017

Lost in the debate about individual mandates, the validity of the Congressional Budget Office (CBO) analysis and the political threat to allow the Affordable Care Act (ACA) “fail”, are the extensive changes to Medicaid proposed in the Republican American Health Care Act (ACHA).

By any measure, the ACHA will lower the number of insured.  The CBO – the non-partisan budget and policy analysis office for the U.S. Congress – projects 14 million less insured by next year and 24 million over the next ten years.  More than half of those uninsured will result from Medicaid reductions.

It is standard political practice for a proposal’s supporters to criticize and devalue the CBO’s finding when they run contrary to their proposal.  The opposite is true when the CBO supports their bills.  But the CBO has been a reliable, non-partisan estimator of Congressional proposals for almost 50 years.  It projected the impact of the ACA better than any other institution.

Posturing and spinning aside, Catholic social teaching stresses that any policy debate should focus on people and the effect of a proposal on their life and dignity.

Just as they did for the debate on the ACA, the U.S. Conference of Catholic Bishops suggested five guiding principles for health care reform: respect for life and dignity; honoring conscience rights; access for all; truly affordable; and comprehensive and high quality.  In transmitting these principles to Congress, the USCCB stressed:

Any modification of the Medicaid system as part of health care reform should prioritize improvement and access to quality care over cost savings. The Bishops have serious concerns about structural changes to Medicaid that would leave large numbers of people at risk of losing access to health care or that lack adequate safeguards and accountability at the state level.

According to the CBO, however, the ACHA will decrease Medicaid spending by $880 billion over the next ten years.  About 14 million fewer people would be covered by Medicaid by 2026 – with most of those losing coverage as funding is shifted to the states in 2020.

(Medicaid, established in the mid-1960s provides health care insurance to very low income individuals and families who would not otherwise afford coverage.  Medicare, funded by payroll taxes, covers people over 65.)

Many states expanded Medicaid coverage under the Affordable Care Act, contributing to the surge in insured people in the United States.  Other states declined to participate.

The new Republican proposal will actually give more leeway to states to determine their own eligibility requirements and coverage.  States will also be given a fixed dollar amount from which they must decide who and what is covered.  Along with that flexibility, however, comes a greater share of the cost.  In a recession or circumstance creating increased enrollment, states will be responsible for footing the bill or cutting services.

Between the competing health care approaches, people face real needs and real concerns.  High premiums confront consumers in some states, not enough choices are available in others.  People at or below the poverty line will no longer be able to receive Medicaid coverage.  Projections that health care costs will seriously increase for seniors as healthy, younger people choose not to obtain coverage, create serious concerns.

As the debate on repealing and replacing the ACA continues, it is worth considering the emphasis Pope Francis raised in an address to Italian charity leaders this past February:

If there is a sector in which the throwaway culture is manifest, with its painful consequences, it is that of health care. When a sick person is not placed in the center or their dignity is not considered, this gives rise to attitudes that can lead even to speculation on the misfortune of others...The application of a business approach to the health care sector, if indiscriminate, instead of optimizing resources may risk discarding human beings. Optimizing resources means using them in an ethical and fraternal way and not penalizing the most fragile.

Selecting priorities in the policy debate on health care will mean making choices but as the Bishops say in their letter to Congress, “Health care is not just another issue for the Church or for a healthy society. It is a fundamental issue of human life and dignity.”