Last week, Michele Woodward, a prominent Republican and former White House staffer in the Reagan Administration, posted a powerful critique of the Republican health care reform bill known as the American Health Care Act. Ms. Woodward noted of the legislation that:
You see, the health care bill passed in the House today has nothing to do with making sure all Americans have access to healthcare. The GOP leadership didn’t go in saying, “How can we raise the standard of living for all Americans by insuring their health?” No, they did not. Instead, they said, “How much money can we take out of this program?” Why? Because taking money from Obamacare allows the tax cuts the GOP really wants. Tax cuts that mostly benefit the wealthy and large corporations. Tax cuts that will continue to ensure that we don’t spend enough on critical infrastructure. They are single-minded in their pursuit of starving the government of funds and, thereby, fundamentally changing the American way of life for the worse.
The American Nurses Association takes similar issue with this piece of legislation. First and foremost, the American Health Care Act would deny millions of Americans access to critical health care services. Although the Republicans in the House decided to blindly vote on this bill without knowing its financial or human impact, it is not substantially different from the previous version of the bill which would have resulted in a loss of health care coverage for 24 million Americans and an $880 billion reduction in Medicaid funding. This version, in fact, would also put at risk the ability of the roughly 15 million Americans with pre-existing conditions to purchase and access critical health care services. The process by which the legislation moved through the House was also striking for its lack of transparency and the absence of meaningful debate, stakeholder input, or bipartisan collaboration. The House, in short, was reckless in its determination to pass this flawed legislation.
Further, this legislation marginalizes vulnerable populations by eroding their ability to access health care services for the benefit of the wealthiest Americans, who would receive a large tax cut. Such a shift goes against ANA’s core principles of health care reform and, as Ms. Woodward pointed out, would fundamentally change the American way of life for the worse. The American Nurses Association stands in opposition to this bill and urges the Senate to take a far more judicious and bipartisan approach to health care reform which ensures that all Americans – rich and poor, young and old, sick and healthy alike – have access to comprehensive health care services.
A newly published Commonwealth Fund study sheds light on the health care experiences of Medicaid enrollees when compared with privately insured and uninsured individuals. Accessibility and quality outcomes for Medicaid enrollees have long been subjects of heated debate. Proponents of Medicaid expansion note that access to and use of health care services – particularly preventive care – through Medicaid reduces emergency department utilization and the cost to hospitals of uncompensated care. The Trump Administration recently reversed an Obama Administration policy of withholding federal funds to states to fill in financial holes for hospitals’ uncompensated care costs, which was meant to encourage states to expand Medicaid. This policy reversal comes in spite of evidence that Medicaid expansion has significantly reduced uncompensated care costs and improved hospitals’ financial stability. These arguments also ignore the fact that Medicaid provides access to comprehensive health care services for vulnerable populations including children, the elderly, and the disabled. Medicaid also provides critical services such as maternal care, mental health and substance use disorder services, and long-term services and supports like nursing home care.
The results of the Commonwealth study demonstrate the value of the Medicaid program from an access standpoint. This study surveyed adults with Medicaid for the full year, adults with private insurance for the full year, and adults with no coverage either at the time of the survey or at some point in the past year. The study found that Medicaid enrollees generally have access to care at rates comparable to those experienced by the privately insured population. Medicaid enrollees reported better care experiences than those without insurance and similar experiences to those with private insurance. Medicaid enrollees also received preventive care at a rate similar to that of individuals with private insurance and at a much higher rate than those without insurance. Medicaid enrollees also had fewer issues paying medical bills and had fewer instances of cost-related access issues than both the privately insured and uninsured populations.
The results of this study demonstrate that Medicaid provides access to crucial health care coverage for low-income and vulnerable populations. This is yet another piece of evidence that Medicaid expansion has moved the U.S. health care system toward achieving the American Nurses’ Association’s principles for health care reform: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.
Medicaid is one of the most crucial pieces of the U.S. health care system and provides critical health care coverage to low-income, disabled, and elderly Americans as well as to low-income children. It pays for nearly half of all births in the nation, and is the largest payer of long-term services and supports such as nursing home care and home and community-based services. Medicaid is also the largest single payer for behavioral health services, including mental health and substance use disorder treatment. Medicaid plays a major role in the treatment and prevention of chronic diseases like diabetes and cardiovascular disease; Medicaid recipients and uninsured individuals have a higher prevalence of chronic disease than the population at large.
These impacts have grown with Medicaid expansion. Since the Affordable Care Act expanded eligibility to childless adults with monthly income up to 138 percent of the Federal Poverty Level, 11 million more Americans now have access to comprehensive health care coverage. These individuals now have a means by which to treat and manage chronic conditions and comorbidities, to receive care that enables them to stay in their homes and communities, to seek treatment for debilitating mental health and substance use disorders amidst the raging opioid crisis, and to bring healthy babies into the world. Medicaid expansion has driven down hospitals’ uncompensated care costs, allowing them more resources to treat patients. (See ANA’s recent Health Policy piece on this subject). Medicaid expansion has also figured prominently in policy debates at both the national and state levels. Republican and Democratic lawmakers alike cited Medicaid expansion as reasons for their opposition to the ultimately failed American Health Care Act.
Medicaid expansion has moved the U.S. health care system toward achieving the American Nurses’ Association’s (ANA) core principles of health care reform: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.
Despite a major legislative setback, discussions around health care reform and the future of the Medicaid program continue. ANA is committed to preserving the coverage gains made in recent years. ANA will continue to provide our members with all new developments on health care reform and the Medicaid program.