A millennial’s take on Medicaid reform

By Pooja Jairam

Like many millennials, I was not interested in politics before this election season. After hearing the current administration's proposals on health care reform, I began to realize that this administration's policies could leave millions without health care, which led me to get involved.

As a future physician, one of my main goals is to advocate for patients. On March 6, 2017, House Republicans released a bill to replace the Affordable Care Act. The bill mandates that after 2020, those states currently covering their residents under Medicaid expansion programs would no longer receive funding to cover these low-income Americans. Analysis of the bill by the Congressional Budget Office indicates that it will gut Medicaid funding by $880 billion over the 2017-2026 period. Experts predict that this would result in millions of people across the country losing access to health insurance, causing devastating consequences for these citizens - the people I hope to one day care for. I believe the proposed bill should not be passed and instead, we should keep our current Medicaid funding system.

Currently, approximately 418,000 Utahns are enrolled in Medicaid, leaving about 70,000 Utahns in the coverage gap without access to health care. Although Utah did not take the opportunity to fully expand Medicaid, Utah's existing Medicaid plan will still be impacted by current policy proposals, and that is why it is important for all Utahns to understand the facts about Medicaid in our state.

If federal policymakers capped Medicaid funding, about 100,000 existing Medicaid enrollees in Utah would lose their coverage. In other words, many individuals who had been covered by Medicaid would no longer have access to health care because they would be unable to afford other coverage. The proposed policies would take away health care from our neighbors.

Two potential capping policies have been proposed: block grants and per capita caps. The current policy for Medicaid funding includes states receiving federal funds based on their expenditures on Medicaid. Under a block grant, there would be a finite cap on the amount of federal funding paid to the state, which means that much of the costs of Medicaid would shift to the states. The other proposed policy, per capita caps, would cap federal funding per beneficiary. This means that for each eligibility group (such as children, individuals with disabilities and senior citizens), there would be a set amount of money allocated to each state per beneficiary. The problem is that states spend different amounts per beneficiary. Although Utah spends less than most states on Medicaid per beneficiary, over the long run, it puts Utah at a disadvantage because we could receive less funding per beneficiary than other states.

Neither block grants nor per capita caps are viable alternatives to current policies for funding Medicaid. Not only would these policies decrease benefits and reduce how many people Medicaid could cover, but if a public health crisis or an economic downturn were to occur, the state of Utah would have to cover the extra costs needed to support more of its residents on Medicaid. In the long run, these proposed policies will continually and progressively worsen for the states and their residents.

Utah Gov. Gary Herbert recently stated support for capping Medicaid funding because it may give states more flexibility in using the limited funding. Given the detrimental effects of both capping policies on enrollment and coverage in Utah, any perceived increase in flexibility will not outweigh the tremendous negative impacts on Utahns.

If you agree that we should not take health care away from Utahns, you can contact your local representatives so that they do not mistake our silence as acquiescence. We need to tell our representatives that the current policy for Medicaid funding should be kept so that our fellow residents can keep their health care.

As President Donald Trump mentioned recently, health care is complicated. But what is not complicated is ensuring that citizens of one of the most powerful countries in the world are not left to die without meaningful access to quality affordable health care.

Pooja Jairam is a health policy intern for Utah Health Policy Project.

Credit: By Pooja Jairam For the Deseret News