For months, Republicans in Washington have locked themselves behind closed doors, crafting a healthcare bill that their own party’s President called “mean.” The current bill rips insurance from 22 million Americans, raises premiums, slaps an age tax on Americans over 50, and destroys protections for people with pre-existing conditions.
One of the darkest and worst kept secrets about this bill is that it hits rural Americans the hardest.
The bill’s proposed $772 billion in cuts to Medicaid will disproportionately hurt low-income Americans, the elderly, the disabled, and those struggling with addiction, and is a betrayal of the American heartland and rural communities across the country.
Bottom line: in order to finance tax cuts for the wealthy, Republicans are taking away care from the Americans who need it the most. All members of the Republican delegation from California voted for the Republican healthcare plan. As a result:
- Low-income children, families and seniors will lose access to care.
- Rural hospitals will close their doors.
- Jobs will disappear.
- Many Americans already struggling with opioid addiction will have nowhere to turn.
This 4th of July recess, we expect Republicans to play the same old games, dodging their constituents or flat-out lying about the local impact of their bill.
Here’s what Republicans don’t want their constituents to know:
THE REPUBLICAN ASSAULT ON MEDICAID FUNDING
- The Senate Republican health care plan would cut $114 billion from Medicaid in California and reduce Medicaid enrollment from 2.5 million in California over the next ten years
- In California’s Central Valley, where hundreds of thousands currently rely on Medicaid for care, the cuts will be particularly devastating
- In CA-10, currently represented by Republican Jeff Denham, where 1 in 3 people are currently covered by Medicaid, and 49% of all children, 48,500 would lose healthcare over the next 10 years
- In CA-21, currently represented by Republican David Valadao, 1 in 2 residents are currently covered by Medicaid – and 64% of children. 62,300 would lose healthcare over the next 10 years
- Montana, where 1 in 4 Montanans are on Medicaid, would see $5.3 billion in cuts. 81,000 Montanans would lose their coverage.
- In Alaska, 1 in 4 is covered by Medicaid. 64,500 Alaskans would lose their coverage.
One of the most devastating features of the Republican healthcare plan is its assault on Medicaid, which today covers over sixty million Americans including children, the disabled, and elderly. While many vulnerable Republicans pledged that Medicaid would remain untouched, the latest Republican health care proposals show just how hollow those promises are. Once again, it is likely that Americans in rural communities will suffer the most.
The Senate bill would cut $772 billion from Medicaid over the next decade, and freeze Medicaid expansion after 2021. These drastic cuts mean up to 15 million people could lose coverage between now and 2026 – overwhelmingly affecting children, the disabled, and the elderly. The sheer size of the Medicaid cuts would make it nearly impossible for states to absorb the costs, leading to millions of people losing access to Medicaid. Not to mention the fact that block-granting Medicaid would put states and governors in the position of having to reduce spending on patients, or cut services.
These cuts, in addition to people losing private insurances plans, cause a snowball effect that will devastate the most vulnerable populations. Block granting Medicaid may force states to cut back on pediatric benefits, especially for children with complex medical conditions. Another underreported impact of sweeping Medicaid cuts would be the devastating losses to special education: for years, schools have relied on Medicaid to help cover costs for special education services, equipment, and preventative services for Medicaid-eligible children. Republican cuts would impact the ability of schools to provide education services for the most vulnerable children in their care. Fig leaf efforts, like the bill introduced by Jeff Denham and David Valadao to increase Medicaid reimbursements for rural doctors, have been slammed as ‘preposterous’ and ‘illogical’ by healthcare providers.
In conclusion: experts have been clear on multiple fronts that Medicaid cuts would be devastating for the most vulnerable populations: children, those struggling with addiction, the disabled, and the elderly.
SHUTTING THE DOORS ON RURAL HOSPITALS
- 285 clinics in California were classified as rural.
- In Alaska, 29 Federally Qualified Health Centers provide services at 177 sites within the state
- There are 55 rural health clinics in Montana
Residents in rural areas already have more difficulties accessing healthcare, and worse health outcomes, than non-rural residents. One of the challenges facing rural residents is the lack of access to physicians. Another is the financial pressure faced by rural hospitals, which has led to high levels of closures. The Republican healthcare bill, instead of helping vulnerable rural populations, makes it even more difficult for rural hospitals to serve their communities.
One way this bill will devastate access to care in rural hospitals is by increasing uncompensated expenses to hospitals when patients can no longer afford treatment. The damage would be two-fold, taking insurance away from low-income, rural populations, and capping federal reimbursement to states, in turn leading to hospitals absorbing more uncompensated expenses. Data clearly shows that Medicaid expansion improved outcomes for rural hospitals – for example, it reduced the burden of uncompensated care across all Medicaid-expansion state hospitals from 3.9% to 2.3% of operating costs in just two years. Cutting Medicaid will disproportionately affect rural hospitals.
Re-shaping subsidies will also have a particularly detrimental effect on rural populations. In Chase County, Nebraska, for example, a 62-year-old earning $18,000 a year might have a $20,000 annual premium – compared to $760 under the Affordable Care Act. Under the Affordable Care Act, a 60-year-old in Alaska might be eligible for up to $25,000 in annual subsidies – but under the Republican House bill, they would received $4,000 – a 76% decrease. Rural states would be hit particularly hard by the drop in subsidies under the Republican plan; patients in 11 high-cost, rural states, could see up to 50% drops in subsidies.
The impact on rural states goes beyond loss of healthcare access: rural hospital closures will lead to catastrophic economic losses for already-vulnerable communities.
A CRIPPLING BLOW TO STATES BATTLING THE OPIOID EPIDEMIC
- Since 2011, more than 100 Alaskans have died annually from an opioid overdose, making it the state’s leading cause of death behind cancer, heart disease and traffic fatalities. In February, Governor Walker issued a disaster declaration in response to the opioid epidemic.
- Montana children have the 3rd highest rate of prescription drug abuse in the country, and 1 in 10 Montana teens are prescription drug abusers.
- The rate of Neonatal Abstinence Syndrome in Montana newborns increased by 1000% between 2000 and 2013.
Rural states like Ohio, Michigan, Maine, Pennsylvania, Kentucky, West Virginia and others have been hit the hardest by the raging opioid epidemic. In Ohio, the state’s number of opioid-related deaths skyrocketed from 296 in 2003 to 2,590 in 2015 — a 775 percent jump over a 13-year period. In West Virginia, the state cannot keep up with the number of opioid-related deaths.
Medicaid has been an invaluable tool in helping states battle the drug epidemic. States that have expanded Medicaid and received federal dollars saw a boost in their ability to provide care for those struggling with addiction. For example, Medicaid pays for 40 to 50 percent of medication-assisted treatment in Ohio, Kentucky and West Virginia. Importantly, Medicaid funds have allowed states to provide comprehensive resources to battle the opioid epidemic- cutting those funds would force states to reduce crucial services like recovery housing and counseling.
House Republicans in rural districts want to take those resources away, which will inevitably lead to an uptick in deaths.
The Senate bill, on top of slashing Medicaid, would allow states to seek waivers to Obamacare substance-abuse treatment mandates. While the bill dedicates $2 billion to opioid-treatment funding, that number amounted to about 1% of what experts said was necessary – preventing those suffering from addiction from obtaining critical medication and treatment. Additionally, cuts would lead to even longer waiting lists for treatment, pushing recovery even further away for many.
A spokeswoman for West Virginia’s health department called the results of proposed Medicaid cuts “an unsustainable financial obligation” for the state. Dr. Shawn Ryan, president of BrightView Health, a network of drug treatment clinics in Cincinnati, went even further: “It would essentially write off a generation. It would be catastrophic.”
JOB LOSSES
The Senate healthcare bill would have a devastating impact on jobs, especially in vulnerable rural communities. Medicaid cuts would have two main impacts on jobs: they would lead to rural hospitals cutting positions, and nursing homes would be forced to cut jobs.
Rural hospitals would once again be hit especially hard. Medicaid cuts, and the ensuing uncompensated care expenses that hospitals would incur, would almost certainly lead to job losses– and what one rural hospital CEO, living in Missouri, described as “devastating” economic consequences for communities. A hospital CEO in rural Tennessee noted that few options would be available: either services would be cut, or the hospitals would be forced to close.
Nursing homes would also be particularly vulnerable to Medicaid cuts. In Iowa, for example, more than half of the nursing home population is covered by Medicaid. Nationally, Medicaid pays for care for most of America’s 1.4 million nursing home residents. Republicans’ cuts to Medicaid would be disastrous for nursing homes; on the one hand, it could lead to patients being forced out of assisted-living facilities, while on the other hand leading to nursing home closures that would force people out of their jobs.
THE BOTTOM LINE
Republicans’ cruel healthcare bill would have devastating effects on rural areas; it would disproportionately hurt the most vulnerable populations; and it would decimate jobs in rural areas. The Republican’s healthcare bill is not the fulfillment of a promise – it is a betrayal of the American heartland and every small town, rural community and sprawling farmland across the country.