Medicaid cuts shift burdens to states

Senate Republicans suffered a dramatic failure early Friday in their bid to advance a scaled-back plan to overhaul the Affordable Care Act. Trang Do reports.

Thanks to massive grassroots mobilization efforts, our state narrowly averted disaster when Congress failed to pass any version of Affordable Care Act (ACA) repeal that would have restructured Medicaid and left thousands of my constituents without health care coverage.

Stopping health care repeal was a huge victory, but the fight is not over yet. Even deeper cuts to Medicaid have been proposed in the 2018 budget resolution, which would slash health care by $1.5 trillion over the next 10 years to pay for billions in tax breaks to the rich and corporations over that same period.


I worry that these cuts would not only have a devastating impact on families in my district but that they would have dangerous long-term consequences for state budgets and our local economy. Medicaid represents the single largest source of federal funding to our state. Loss of that funding because of federal caps, block grants and cuts would shift costs back to Maryland, creating a tremendous burden for our state budget. Moreover, Medicaid cuts would put health care in competition with other key priorities like public education, transportation and housing.

In 2015, Maryland received $5.7 billion in federal Medicaid funding. Per capita caps would gradually shrink that amount, forcing states like ours either to find alternative sources of funding, cut coverage and services for enrollees, or cut other state-funded services to free up resources for health care.

These cuts would impact 975,400 people in Maryland who depend on Medicaid, including 77,000 seniors, 148,800 people with disabilities and 32,000 veterans. Medicaid also provides health care for 478,200 children — that's one out of three of children in our state — and pays for 19,100 Maryland births, or 26 percent of babies born here.

Seniors would be particularly hard hit since Medicaid is the leading payer of long-term care services for the aging and disabled at home, in the community and in nursing homes. Medicare doesn't cover the cost of these services. More than one in seven low-income seniors enrolled in Medicare (6.9 million people) also rely on Medicaid for their health and long-term care, including 119,800 in Maryland.

And the need for Medicaid is only growing. The number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060, and the AARP Public Policy Institute projects a 12 percent increase in per person spending in Medicaid.

Nationally, Medicaid's administrative costs are less than half that of private insurers, making it a good deal for states and the federal government. Far from increasing flexibility for states as GOP leaders in Congress assert, federal cuts or caps in Medicaid would leave state lawmakers with few options for providing critical services to the most vulnerable populations or for managing the growing health care needs of a rapidly aging population.

Taking resources from states does not increase flexibility. Our experience with the ACA is the best example. Thanks to the ACA, our state had the opportunity to expand Medicaid and provide 248,000 Marylanders with health care coverage, helping to reduce our uninsured rate from 10.1 percent to 6.7 percent at virtually no expense to our state and infusing much needed resources that stimulate our local economies. Repeal of the ACA including the elimination of the Medicaid expansion would cut over $14 billion from our state budget between 2020 and 2026 and mean loss of coverage for 294,000 enrollees who currently have coverage and take our state backward.

Given the tenacity of conservatives in opposing the ACA and expansions of Medicaid, we can expect that efforts to dismantle health care will continue to resurface in the federal budget proposal, negotiations around the reauthorization of the Children's Health Insurance Program (CHIP), the coming continuing resolution debate and elsewhere. But the public doesn't support repeal or cuts to Medicaid and does not support cutting health care to give tax breaks to the rich and corporations.

Like many of my fellow lawmakers in Congress, I became an elected official to serve my constituents and make life better for the people of my district. It's time to stop the partisan bickering and political games in Congress and start governing for the people we all represent.

C.A. "Dutch" Ruppersberger (Twitter: @Call_Me_Dutch) is a Democratic member of the United States House of Representatives, representing Maryland Congressional District 2.