Last week was brutal for anyone who cares about the future of health insurance for low- and middle-income Americans. On Tuesday, the federal government’s Medicaid funding portals temporarily shut down, sending doctors, patients and hospitals into a panic. The next day, President Trump’s nominee for health secretary, Robert F. Kennedy Jr., fumbled basic facts about the program during a Senate hearing, despite the fact that it covers more than 70 million Americans. In the House of Representatives, meanwhile, legislators are circulating a so-called menu of spending cuts that would gut access to health care.
It’s that last threat that could prove the most devastating and long-lasting. You see, the Trump administration faces a dilemma: The president has promised to extend the 2017 tax cuts (nearly half of which will go to the wealthiest 5 percent of Americans) at a hefty cost of $4 trillion over the next decade, but many Republicans are reluctant to add to the federal deficit.
How do they square the math? It appears they are prepared to do so at the expense of the poor and middle class, by yanking health care coverage from children, new mothers, people with disabilities and seniors. Republican leaders in Congress have suggested that one option they are considering to bankroll their tax breaks would be to cut hundreds of billions from Medicaid; another proposal would roll back subsidies that have helped middle-class families pay Affordable Care Act premiums. They have made it clear they want to finalize legislation in the first 100 days of Mr. Trump’s presidency.
It’s hard to overstate how catastrophic the proposed cuts would be. Medicaid alone covers more than 40 percent of births in the United States. Far from being a handout, it is one of the most cost-effective insurance programs in the country, meaning there is very little fat to cut without immediately harming people. It’s because of Medicaid that children, seniors and people with disabilities — groups that make up more than 75 percent of the program’s spending — can see doctors and fill prescriptions without going bankrupt.
In their menu of options, House Republicans propose adding work requirements to Medicaid, which would cut benefits to some recipients and, they claim, save billions. Proponents of work requirements argue that such measures incentivize employment, but the evidence overwhelmingly shows that they don’t. This is because nearly every adult in Medicaid who can work already does, or is a student, disabled or a caretaker for someone else. Instead, people lose access to care because of bureaucratic red tape and difficulty proving they qualify. Work requirements bloat the bureaucracy and result in worse care for fewer people.
Republicans are also considering distributing a set amount of money to states, regardless of what care actually costs. But states are already struggling with tight budgets. They don’t have hidden, untapped solutions to magically fund health care. With less money, they must refuse coverage to more people or pay providers even less, which means fewer doctors will see Medicaid patients, which reduces access for everyone. Twelve states have trigger laws on the books that might end Medicaid expansion programs or severely cut them if the federal government reduces funding.
Medicaid isn’t the only potential victim. Congressional Republicans are also eyeing the Affordable Care Act’s premium subsidies — the same subsidies that help working Americans buy private insurance at more affordable rates. Roll back these credits, and families could see their monthly premiums soar by hundreds of dollars.
Before A.C.A. subsidies were expanded, millions of people could not afford health coverage. Lower-income families faced impossible choices between paying the rent or maintaining health insurance.
We should be honest about these trade-offs: Families lose health insurance if we cut Medicaid or slash A.C.A. premium credits. Children go without care. Clinics and hospitals in rural areas close. People suffer.
With Republicans holding only a razor-thin majority in the House, it would take just a handful of them to block this plan — and protect the very people who entrusted them with their votes. After all, the political long game is questionable. Cuts to Medicaid would cripple the rural hospitals and patients represented by the congressional Republicans who would need to pass this plan. Republican politicians increasingly claim to champion working-class families, especially as more of these voters lean to the right. Yet shuttering a local hospital to finance tax cuts for top earners would be the ultimate betrayal of those very constituents. Recall that Republicans’ last effort to rescind health care coverage by repealing Medicaid expansion along with the Affordable Care Act in 2017 likely contributed to their loss of the House majority the following year.
I’ll be the first to admit that the U.S. health care system has serious problems — sky-high costs and poor outcomes. The way to fix those problems isn’t by targeting the most vulnerable.
Let’s shift the conversation away from stripping benefits and toward addressing what really drives up costs, according to years of research: high prices and bloated administration.
Gutting Medicaid, or making it impossible for middle-class Americans to afford A.C.A. exchange plans, is callous. No parent should choose between taking a child to the emergency room and paying the grocery bill.
The post The Republicans’ Choice: Tax Cuts for the Rich or Health Care for Americans appeared first on New York Times.
