By Lori Lee
NDG Contributing Writer
With all but two Republicans in the game and all Democrats folding, the House Budget Resolution passed by only two votes on April 10. The resulting budget framework paves the way for massive cuts to retirement and health benefits, hurting millions of Americans.
Despite the Republican commitment to shaving government spending down to 1.5 trillion, the U.S. budget deficit is nevertheless projected to grow by trillions of dollars. This, due mainly to a $4.5 trillion tax cut, half of which will only benefit the top 5%, according to the Center on Budget and Policy Priorities.
The move will result in drastic cuts to health and nutrition programs, including the greatest cuts to Medicaid and Supplemental Nutrition Assistance in history, explained Stan Dorn, Director of Health Policy Project for Unidos U.S., at a March American Community Media briefing.
One might question why so many Republican lawmakers would be willing to make the drastic cuts, which will surely affect their constituencies.
It is fast-track procedures that allow such bills to pass quickly and without resistance, explained Dorn. Most bills pass with a 60-Senate vote, requiring both Democrats and Republicans to be on board. But the budgeting process requires only a simple majority, meaning Republicans can pass their budget without a single Democratic vote.
As a practical matter, the budgetary process is the only way Congress will be able to make the cuts they want, explained Dorn.
The budgetary process is composed of two steps, he said. Budget resolution sets overall numerical targets. Once the House and the Senate agree on these dollar targets, they move on to budget reconciliation, where relevant committees make specific, detailed changes to laws affected by the monetary targets set during budget resolution.
Massive cuts to health and retirement are being justified as targeting waste, fraud, and abuse, added Dorn. Truth is, the 2017 Trump tax cuts are set to expire after this year, and keeping them alive will require the administration to come up with about 5 trillion dollars, according to the Congressional Budget Office.
The good news is Congress is nervous that taking Medicaid away from millions of people could damage them politically. We know that huge numbers in every congressional district rely on Medicaid for health insurance, he said.
It’s a bizarre circumstance that the House Budget Resolution passed considering many Republicans won by narrow margins, and most say they’d rather not cut Medicaid or SNAP. They’ve been told there won’t be any real cuts at the end of the line, he said.
Truth is, Republicans will call the cuts anything but cuts, be it waste, fraud, or abuse. What the cuts will mean in reality, is that fewer people will have health insurance.
Ending Medicaid for people who can’t meet new work requirements may be appealing in theory, said Dorn. In practice, it will mean fewer people with sufficient health care to maintain an ability to work. It will mean more people unable to resolve debilitating health conditions.
People of all races and ethnicities will suffer, but communities of color are especially vulnerable, said Dorn since over 13 million African Americans have Medicaid as their health insurer, covering 60% of Black children and more than a third of all Black adults age 65 and older.
The current program supports their at-home and nursing home health care, meaning when these programs are cut, many will be on the street. In some states, about a quarter of the people have already lost their coverage, said Dorn.
Cuts to Medicaid include rigid federal caps on how much a state can get per person, he said. This will shift federal costs to states, forcing them to face tough spending decisions.
States are already having budgetary troubles, said Dorn. The federal cuts may mean states may be forced to cut K-12 education, police, roads, or fire fighters.
A big portion will lose benefits because they didn’t hear about the policy, didn’t fill out all the paperwork, or couldn’t get through on overcrowded phone lines, he added.
Since most patients under the system already work, said Georgetown University’s McCourt School of Public Policy Research Professor, Joan Alker, the added level of bureaucracy will result in people losing coverage that they’re still eligible for.
In the two-pronged Medicaid system where both states and the federal government contribute, states will not be able to make up for the federal cuts, resulting in ripple effects throughout the entire healthcare system, Alker explained.
The Children’s Health Insurance Program (CHIP) runs off Medicaid, covering nearly half of all American children and 41% of all births. The cuts will be devastating to young families, as well low-income seniors, who use Medicaid to help cover their costs under Medicare, said Alker.
Community health centers will also feel the pain in a reduced number of provider reimbursements. With more coverage after the Affordable Healthcare Act, explained Alker, health centers became more financially stable.
“Financial stability enables growth and expansion, she said, and this enables community health centers to open new sites, provide new services, start new programs and [add] new initiatives to support their patient’s health.”
We know when patients are uninsured that they’re more likely to minimize or delay care. They have fears related to costs, and this just leads to worse health outcomes in the long run,” she said.
Many will end up in emergency rooms, which is far more expensive and isn’t good for anyone. These health care cuts will impact all of us and the sufficiency of the overall healthcare system to meet the needs of every American, she said.
“Last November, people voted with their wallets, seeking greater affordability, including for healthcare,” added Anthony Wright, Executive Director of Families USA. “Cuts in the recent budget resolution would only shred our safety net, the opposite of what voters called for.”
Polling tells us that nearly 75% of Americans agree Medicaid is very important to their local community, and that includes over 60% of Trump voters.
They’re trying to play hide the ball, added Wright. They may call their cuts work requirements or leave out the word Medicaid in their budget resolution, but the fact remains, there are 880 billion dollars of cuts under the House Energy and Commerce Committee, which oversees Medicaid.
If you cap the formulas or cut funding streams to states, it only shifts the costs to already strapped states, which are then forced to make a Sophie’s choice of either cutting coverage, benefits or services.
Wright, who grew up in the Bronx–one of the poorest congressional districts in the nation where Medicaid enrollment is 70%, asked:
“What happens if that source of coverage, Medicaid, is cut by hundreds of billions of dollars? What happens to the hospitals in that area? What happens to the clinics in that area?”
What can be done to stop the cuts, he asked. People can share their opinions with members of Congress.
This is not a done deal yet, he said, and Republicans only have a slim majority.
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