Like millions of Americans, Rachel Phalen is grateful for the Medicaid expansion that accompanied the passage of the Affordable Care Act (ACA).
Phelan, a substitute teacher from Kentucky, has an 11-year-old son, Vance, who suffered a stroke in utero that caused him to have seizures for the first year of his life.
As a result, he has autism, tic disorder, and attention deficit hyperactivity disorder (ADHD).
Most of Vance’s needs, Phelan said, are insured only because of a Medicaid-covered waiver in her state.
“Considering all the obstacles he faces, Vance has significantly improved in all areas of his life,” she told Healthline. “He requires constant speech and behavior therapy. He is growing into a functional person.”
But if Medicaid funding is cut, Vance would likely lose many of his much-needed services.
“It will set him back so far,” Phelan said.
Medicaid cuts on horizon
If House Republican leaders and President Trump have their way, nearly $880 billion in Medicaid funds will be cut over the next 10 years.
Over the same period of time, wealthy Americans would receive a tax cut of just about the same amount.
Under the House GOP’s plan, Medicaid expansion will be killed, and payments to the states will be capped and paid out by block grants.
Instead of the feds paying a set percentage of the states’ Medicaid needs, they would only pay a fixed amount per beneficiary.
This cap does not account for the almost inevitable increases in healthcare costs.
Under the GOP plan, recipients will be cut off if they lose eligibility for two or more months.
Critics say it is just a way to take more Americans in need off the program.
The majority of the recipients of the Medicaid expansion are typically on the program temporarily, or come in and out of it.
Therefore, the proposed changes have struck fear into the hearts of millions of Americans, including families with low incomes, seniors, those with intellectual and developmental disabilities, pregnant women, people dealing substance abuse, and children.
Obamacare to become Trumpcare?
When Obamacare was passed, Medicaid was expanded to include all Americans under age 65 who earn up to 138 percent of the federal poverty level.
Since then, Kentucky and 30 other states and the District of Columbia have chosen to participate in the expansion, with 19 states abstaining.
More than 11 million adults have enrolled since the expansion through March 2016, according to a review by the Kaiser Family Foundation of data from the Centers for Medicare & Medicaid Services (CMS).
Beyond those 11 million, Medicaid, which has been available since the 1960s, covers an additional 57 million Americans, almost six times as many as those enrolled in the Obamacare marketplaces.
President Trump promised on the campaign trail that he would not cut Medicaid.
However, the House bill will lead to 14 million fewer individuals being covered by Medicaid by 2026, according to the nonpartisan Congressional Budget Office (CBO).
Debate in Ohio
In Ohio alone, some 3 million residents with low incomes or disabilities are now receiving coverage because of the Medicaid expansion.
Officials at the Center for Community Solutions, a nonpartisan group based in Cleveland, said the plan could cost Ohio more than $25 billion by 2025.
The center concluded that the resulting payments wouldn't be enough in Ohio to keep covering the state’s recipients.
The Columbus Dispatch reported that Ohio's proposed Medicaid budget for next year is projected at $28 billion, including federal funding.
Ohio Gov. John Kasich, who enacted the Medicaid expansion in his state under Obamacare in 2013, opposes his fellow Republicans’ plan to cut Medicaid.
He said Republicans need to reconsider their plan and come to a compromise with Democrats.
“If all you focus on in life is what's in it for me, you're a loser. You are a big time loser,” Kasich said on “Meet the Press” this month. “And this country better be careful we're not losing the soul of our country because we play politics and we forget people who are in need.”
Kasich also took issue with an interview Vice President Mike Pence did on an Ohio television station in which Pence said the new legislation would give Ohio the “resources and flexibility that they need to be able to meet those needs going forward.”
Said Kasich, “No, he's not right. Look, the bill needs [to be] fixed. The current system doesn't work. That's why it's possible to get Democrats involved … Don't kill Medicaid expansion, and you've got to fix the exchange, but you have to have the ability to subsidize people at lower income levels.”
Disdain for the poor
The plans that Republicans and Trump have for Medicaid are actually not conservative enough for the Freedom Caucus, an ultraconservative group.
In addition, a growing number of moderate GOP governors and Congress members say the plan reflects an uncaring side of the GOP toward people with low or no incomes.
An example of this uncaring contingent is Kansas Republican Congressman Roger Marshall.
“Just like Jesus said, ‘The poor will always be with us.’ There is a group of people that just don’t want healthcare and aren’t going to take care of themselves. I think just morally, spiritually, socially, [some people] just don’t want healthcare,” he told New York magazine.
Seema Verma, the woman Trump tapped as the new administrator of the Centers for Medicare and Medicaid Services (CMS), appears to share the same opinion.
Just hours after she was sworn in last week, Verma reportedly sent a letter to the nation’s governors, urging states to alter Medicaid by imposing insurance premiums, charging recipients for part of emergency room bills, and prodding them to get jobs, according to multiple news reports.
The letter also called the Medicaid expansion a “clear departure from the core, historical mission of the program.”
Critics of Verma, who was approved virtually down party lines in the Senate, say that the Medicaid expansion is actually right in line with what Medicaid has always been about: assisting America’s less fortunate.
Verma had already riled critics when she worked for Pence when he was governor of Indiana.
Verma’s Medicaid model in Indiana threw a person out of the program for missing two payments — no matter what their life circumstances at the time.
‘Remarkable level of cruelty’
In December, Dr. Robert Zarr, president of Physicians for a National Health Program, said Verma’s actions in Indiana “signal that she will inflict cruel and unusual punishment on America's most vulnerable citizens.”
Senator Maria Cantwell (D-Wash.) told the The New York Times that Verma made millions of dollars in consulting fees by kicking poor, working people off of Medicaid for failure to pay monthly contributions similar to premiums.
Dr. Michael Carome, director of the health research group at Public Citizen, the nonprofit consumer advocacy organization, told Healthline, “The House Republicans’ plan to cut nearly a trillion dollars from the Medicaid budget over the next 10 years, while simultaneously giving a huge tax break to wealthy individuals and corporations, demonstrates a remarkable level of cruelty and callousness.”
Carome, whose organization spearheaded the Clean Budget Coalition, an alliance of hundreds of public interest groups that together are calling on Congress and the White House to pass a clean budget with no ideological riders, said that the Republican health plan, if enacted, “would deprive millions of our country’s poorest and most vulnerable people of the healthcare they deserve, resulting in preventable suffering and death.”
Seniors affected, too
The group that perhaps stands to lose the most if these controversial plans for Medicaid are approved is seniors, who voted for Trump by a wide margin.
Without Medicaid, millions of seniors and their families may simply not be able to pay for things like long-term care, nursing home services, and other services.
Nancy LeaMond, executive vice president of The American Association of Retired Persons (AARP), the nation’s largest group for seniors with more than 37 million members, said in a statement last week, that the Medicaid cuts would put the health and safety of 17 million Americans, including seniors as well as children and adults with disabilities, “in jeopardy” by eliminating services that allow individuals to live independently in their homes and communities.
“This harmful legislation would make healthcare less secure and less affordable,” LeaMond said.
Trump’s press secretary, Sean Spicer, dismissed the AARP’s concerns about the bill, suggesting that AARP is a special interest group.
Mick Mulvaney, the White House budget director, said on Thursday that deep cuts in Trump’s proposed budget to multiple programs for seniors and the poor is “one of the most compassionate things we can do.”
San Diego seniors fearful
Beverly G., who’s in her 80s and still lives in her own home in San Diego, said Medi-Cal, which is California’s version of Medicaid, “means absolutely everything. End of story. There is no other answer. If I didn’t have it, I’d be really, deeply struggling.”
Beverly is a member of ElderHelp, a community-based nonprofit organization in San Diego that provides personalized services and information that helps seniors remain independent and live with dignity in their own homes.
Members of ElderHelp are worried and uncertain about what will happen to their Medicaid benefits, say the leadership at the organization.
“Our response to the GOP plan aligns closely with that of the National Council on Aging (NCOA), AARP, and other national leaders in the aging sector,” Anya Delacruz, associate executive director of ElderHelp, told Healthline.
“In the context of Medicaid, we are particularly concerned that proposed per capita caps will shift the burden of skyrocketing healthcare costs to the states,” she said. “We believe that resultant/imminent cuts will lead to a significant reduction in necessary services.”
Delacruz added that more than one-third of ElderHelp members receive assistance through Medi-Cal. Many, she explained, are already struggling to meet their most basic needs including housing, transportation, food, and rising healthcare costs.
The drug crisis
During a time when America is dealing with a nationwide opioid drug abuse epidemic, the Republican healthcare plan would also eliminate the Obamacare requirement that Medicaid cover mental health and addiction services in states that expanded it.
In his speech last month before Congress, President Trump addressed the drug crisis and vowed, “We will expand treatment for those who have become so badly addicted.”
However, the rollback of Medicaid expansion would deeply affect many states where the opioid addiction crisis is the most severe, including Kentucky, Ohio, and West Virginia.
“If you are drug addicted, if you are mentally ill, you have to consistently see the doctor,” Kasich said in his “Meet the Press” interview. “From what I see in this House bill, the resources are not there.”
Joshua Sharfstein, associate dean at Johns Hopkins Bloomberg School of Public Health, told The Washington Post that the Republicans healthcare plans represent “a major retreat from the effort to save lives in the opiate epidemic.”
Nearly 1.3 million Americans receive treatment for mental health and substance abuse disorders under the Medicaid expansion, healthcare economists Richard G. Frank of the Harvard Medical School, and Sherry Glied of New York University, recently told the Post.
Children affected, too
Medicaid cuts in states like Virginia, where the budget is already tight, could mean far fewer children are covered, according to a Public News Service (PNS) report last week.
Vox reported that Virginia Medicaid covers about half a million children from low-income households.
Margaret Nimmo Holland, executive director at Voices for Virginia's Children, said there’s been bipartisan consensus in Virginia that children's health is worth the investment.
She said 19 out of 20 children in Virginia now have healthcare coverage, and the care delivered through Medicaid was designed by doctors.
She told Vox that shifting costs from the feds to an already strained Virginia budget would mean fewer children covered, less generous benefits, or lower payments to providers.
“It is very concerning that 50 years of progress in children's health could be undone so quickly,” Holland said. “The benefits are actually designed by pediatricians, so it means that lawmakers are not deciding what services kids need, pediatricians are. And so any time that you start cutting the benefits, you're really jeopardizing the health of children.”
Recipients meet with congressman
On Mar. 3, Rachel Phelan and her son’s speech therapist, Leslie McColgin, along with several others with children who receive support from Medicaid, visited the office of Kentucky Rep. James Comer, the Congressman in their district.
Phelan said that while the meeting with Comer’s staff, which Comer himself did not attend, went well, their questions weren’t really answered.
“I do not believe [Comer] will care or listen,” Phelan said. “I hope that somewhere out there these politicians can grow a heart, and realize the way they vote and run our country affects everyone. If you cannot stand up for our vulnerable, then what kind of person are you?”
If the federal government or states stop funding these programs, Phelan wonders what will happen to children with disabilities, like her son, nationwide who are in need.
“Kids with disabilities become adults with disabilities,” she said. “How will we help this vulnerable group? We can’t simply institutionalize them. They are citizens and they have rights.”
Phelan said that applying block grants to Medicaid will create a national “disaster” for Medicaid recipients.
“There’s not enough funding now for our Medicaid system,” she said. “If we ration the funding, we will have to resort to further rationing care. Those who are disabled do not have other options for care. The will suffer greatly.”
Editor’s note: Comer’s press office declined to respond to several requests for comment for this story.