Take Medicaid off the chopping block

As front line nurses, and as New Yorkers committed to healthcare as a human right, we are inextricably connected to the Medicaid program. More than a quarter of New York State’s population — 26% — is covered by Medicaid and Children’s Health Insurance Plus.*

In the nation, overall, Medicaid covers one in five low-income Americans. It is the principal source of long-term care coverage for Americans. Hospitals, community health centers, physicians, nursing homes and jobs in the healthcare sector—all receive substantial support from Medicaid. It is, simply put, part of the bedrock of healthcare funding in the United States.

ACA and Medicaid

Under President Obama’s Affordable Care Act, the importance of Medicaid to the people’s health only grew, as the law allowed states to extend Medicaid to people previously outside its financial ceiling. This meant that Medicaid could be offered on a pro rata basis. So while the enabling statute put a cap of 133% of the federal poverty level, states could raise the cap but require those at 150% of poverty, for example, to pay a small fee for their Medicaid coverage. The ACA initially covered all Medicaid costs incurred by this expansion and this year, 2020, federal support was reduced to 90%. But that does not include the state’s contribution. Prior to the ACA, federal law excluded impoverished adults without children, but here in NYS childless adults below 138% of the federal poverty level are eligible for Medicaid.

To get your arms more fully around this healthcare program in this state, consider this: in New York, two in nine adults ages 19-64 are covered by Medicaid, same for two in five children and four in nine individuals with disabilities. Also, one in four Medicare beneficiaries receives Medicaid, so-called “dual beneficiaries”: the elderly poor. More than half of all Medicaid spending for long-term care in the U.S. is now for services provided in the home or community that enable seniors and people with disabilities to live independently rather than in institutions.

Seeking a cut of $2.5 billion

Most Medicaid enrollees in New York — 61% — are working. Even with gains in minimum wage, there are New Yorkers working full-time who qualify. Last, half of children with special healthcare needs are covered by Medicaid in this state. All told, 75 million Americans received Medicaid in 2017.

Uninsured and working full-time but not able to afford health insurance... Children whose families cannot pay for their health coverage... Elderly who receive Medicare but are so poor that they cannot get by… but for Medicaid.

Now comes the hard part. There is pressure here in NYS to cut Medicaid by as much as $2.5 billion in the coming year.

Governor Cuomo’s Executive Budget for the coming year has a gap of $6.1 billion, of which more than $4 billion is identified as a Medicaid gap, a “structural gap” that exceeds the state’s self-imposed “Medicaid Global Cap” limiting annual increases in state Medicaid spending. The Governor’s budget appoints a new Medicaid Redesign Team (MRT II) to propose reductions in Medicaid cuts of $2.5 billion.

(As of this writing, that target reduction has come down by $1 billion, as a result of Comptroller Tom diNapoli’s efforts in identifying waste, fraud and abuse in the past four years. If verified and accepted by Governor Cuomo, that still leaves $1.5 billion in Medicaid cuts for the next year.)

Unrelenting fiscal pressure

The new budget allows for only a 3% annual increase in the healthcare costs for the poor, a limitation that experts say could “dramatically affect in-home care.” So, likely we will be back at the cutting exercise a year from now because costs are bound to go up more than 3%.

This constant fiscal pressure on Medicaid is a shame. There remain today in New York hundreds of thousands of residents who are ineligible by a small factor and go without care. We should be working towards greater healthcare inclusion, not exclusion. Medicaid funds ought not to be on the chopping block.

“[W]hat’s going on here,” says Assemblyman Richard Gottfried, “… is an old Albany tradition… trying to cut health care for needy New Yorkers.”

A healthy population requires less healthcare services, as we know all too well. But, as a state and a nation, we have to get healthy before we reap the savings.

Besides, even the slightest glance at the skyline, or leafing through an architectural magazine, or watching celebrity news and you cannot help but conclude: this is a time of great wealth in the state and the nation. Cutting Medicaid is a sin.

*CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but not enough to afford private insurance.