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The proposed cuts to Medicaid under the Senate healthcare bill will impact millions of Americans. Those living in these four states will feel it the most.
The healthcare proposal in the U.S. Senate would slash $772 billion from Medicaid in the next decade, according to a Congressional Budget Office (CBO) report released yesterday. Known as the Better Care Reconciliation Act (BCRA), the Senate healthcare bill’s proposals for Medicaid programs would hurt vulnerable Americans most. According to CBO estimates, passage of the bill would jeopardize the ability of children, older Americans, and people with disabilities to access healthcare and services. Moreover, the proposed cuts would disproportionately impact U.S. states hit hardest by the opioid epidemic.
As our nation’s single largest insurer, Medicaid provides significant financial support to hospitals (especially those in rural areas), community health centers, and nursing homes in the United States. By reducing federal funding for Medicaid, the BCRA would effectively eliminate over half of the program’s spending budget at the state level, according to Business Insider, “leaving states — which also fund the program — with fewer resources.”
Which states would be hit hardest by the proposed BCRA Medicaid cuts? Let’s take a closer look at how the Senate healthcare bill, if passed, will affect residents of West Virginia, Kentucky, New Mexico, and Arkansas—the states which rely most on federal funding for Medicaid.
West Virginia has a lot to lose if Congress caps funding for its Medicaid program. The federal government currently covers nearly 72 percent of West Virginia’s Medicaid costs. Cutting Medicaid would force West Virginia legislators either to make deep cuts to other state priorities like education and public safety, or to cover fewer healthcare services and fewer people by tightening the threshold at which West Virginians become eligible for Medicaid. Considering that West Virginia’s Medicaid program enables low-income seniors, children, and people with disabilities to access medical care, the sheer magnitude of the spending cuts would put the state in a difficult situation to say the least, with no way to ensure healthcare access for these vulnerable populations.
While the proposed Senate bill allocates $2 billion for treatment and recovery services through 2018 to offset cuts to Medicaid funding at the state level, public health officials and congressmen from both parties believe that more money is needed to adequately address the opioid crisis. Speaking to The New York Times, Allison Adler, a spokeswoman for West Virginia’s state health department, said the bill promises “to create an unsustainable financial obligation” for the state.
Even though New Mexico is among the states that will feel a major economic impact from changes in the federal healthcare law, New Mexico Senators Tom Udall and Martin Heinrich, both Democrats, have criticized the bill as unrepresentative of New Mexican interests. And while New Mexico’s Republican Gov. Susana Martinez stated that she had yet to read the Senate proposal, Martinez told reporters in Albuquerque that “a replacement plan must protect the most vulnerable [people in the state].”
There’s no doubt that a rollback in Medicaid coverage for low-income New Mexicans would be devastating for the state. As of March, 787,110 New Mexico residents rely on Medicaid to cover their healthcare costs. With 187,000 people on Medicaid under New Mexico’s expanded program for adults. As Bruce Krasnow, a journalist for The New Mexican, explains, “The BCRA’s proposed cutbacks would force the state to close the door on new enrollment and eliminate the program” for families and children who depend on these benefits.
Medicaid covers about 1.4 million Kentuckians, 470,000 of them through the state’s Medicaid expansion. According to CBO estimates, Kentucky would experience the biggest enrollment cut (percentage-wise) of any state, with 48 percent of the state’s Medicaid enrollees positioned to lose coverage. Considering that half a million people residing in the state gained health insurance through the Affordable Care Act, (and most of them through the state’s expansion of Medicaid to Kentuckians who make up to $15,000 annually) the state has a lot to lose if the bill eventually becomes law.
The bill has also divided Kentucky’s GOP Senators Rand Paul and Mitch McConnell on opposite sides. Many state residents are puzzled by their Senators’ views, as Kentucky has made tremendous gains in public health and is a chief beneficiary of the state’s Medicaid expansion. More than 400,000 low-income adults in the state are now insured. Medicaid also covers more than 60 percent of state-funded substance abuse treatment in Kentucky, according to data compiled by The Associated Press.
In Arkansas, 30 percent of the state’s population — about 912,000 people — were enrolled in some form of Medicaid as of March 2017, according to CMS data. With nearly two-thirds of children in Arkansas receiving medical coverage through Medicaid— the highest percentage of any state in the nation—the BCRA would surely deal a blow to children who live in the state.
Repealing the Affordable Care Act will also hurt rural hospitals in Arkansas, whose uncompensated costs for emergency room services were cut in half through the the ACA. That helped to keep some rural hospitals open, but the state will likely see more hospital closures if the BCRA becomes law.