Proposal could cut Medicaid coverage for millions of Americans

Democratic and Republican legislators have for months been sounding the alarm on how changes to the federal Medicaid funding in the name of tax cuts could cause harm to millions of residents across the U.S. Earlier this week, they caught their first glimpse into how some congressional leaders proposed to cut nearly $880 billion from Medicaid, including eligibility changes and a new work requirement.

Although local lawmakers and advocates are still reading through the "good, bad and ugly" of the proposal, the bill is confirming Democratic legislators' worst fears - "an ax to the Medicaid program" that covers 1.2 million Connecticut, said state Sen. Matt Lesser, D-Middletown, in a press conference Monday.

"This bill has a number of provisions that seem designed to hurt people in Connecticut," said Lesser, who is also the state legislature's Human Services Committee co-chair.

The proposed House legislation, unveiled late Sunday night by the U.S. Energy and Commerce Committee, cuts federal costs through several provisions focused on environmental and health to cover $4.5 trillion in 2017 tax breaks set to expire at the end of the year. Some of the changes include, but aren't limited to:

Implementing a monthly 80-hour work or community service requirement for able-bodied adults without children to stay enrolled.

Creating stricter eligibility rules and more paperwork for enrollees, such as checking eligibility twice a year instead of once and allowing states to check income and residency more often.

Preventing states from charging hospitals higher prices for Medicaid services than Medicare pays.

Implementing a $35 co-payment for medical services for enrollees who are above a set income limit

Funding changes that bar gender-affirming care for trans minors and reduce federal money to Planned Parenthood.

The legislation excludes many of the significant cuts lawmakers and advocates were concerned about at the beginning of the Trump administration. However, the changes are still drastic, leaving state lawmakers worried. A nonpartisan report from the Congressional Budget Office said the bill could reduce health insurance enrollees by as many as 8.6 million people over the next decade.

A spokesperson for the state Department of Social Services said the staff is modeling what federal cuts could mean for Connecticut and its members now that there's a more clear picture. At the same time, the department is working with state officials in an effort to mitigate damage and preserve access to care. Yet, the department warned how the funding changes will impact the health and stability of millions in Connecticut and nationwide.

For example, Lesser said the eligibility enrollment changes would cut 2.3 million Americans from the Medicaid program alone.

Another provision of the proposed bill would reduce funding to states that continue to offer Medicaid coverage to undocumented residents. In Connecticut, Medicaid is currently expanded to children under 15 years old regardless of immigration status, funded by the state. Lesser said the state could see a 10% decrease in funds, violating state and federal commandeering laws.

"This will have to be litigated in the courts, but it seems like a huge overreach for the federal government to tell states what they can do with their own funds," he said. "We're not relying on Medicaid. We're not asking Medicaid for anything. We're just trying to keep families in Connecticut healthy and safe."

The proposed bill faces a long legislative road ahead of hearings and debates through the U.S. House and Senate. For it to pass, NBC News said it would need almost all Republican lawmakers in the House to vote in favor of it.

Connecticut House Republican Leader Vincent Candelora, R-North Branford, said the proposal is less dramatic than the "doomsday scenarios" Connecticut Democrats have painted. He said the party members in Washington are more focused on controlling Medicaid's cost growth, not dismantling it, with the proposed draft offering "reasonable ingredients for a final product.

"Proposals like modest work requirements for able-bodied adults and enhanced verification checks aim to encourage workforce participation and add a layer of taxpayer accountability--a concept the majority party here instinctively resists," Candelora said in an email statement to CT Insider. "All that said, it's prudent to watch how this unfolds before jumping to conclusions or setting off alarm bells."

Yet, to Angela Mattie, a professor of management and medical sciences at Quinnipiac University, the proposed bill is "short-sighted" and will impact the most vulnerable communities.

She said taking away access to Medicaid coverage leads to worse health conditions and more people needing emergency care to treat them. At the same time, she said the hospitals and clinics will most likely bear the brunt of covering health care costs despite already working on the fiscal margins and with historically low Medicaid reimbursement rates.

Although the exact price tag to Connecticut's Medicaid program is to be determined, Mattie said she imagines that some benefits not mandated by federal law may be scaled back, like dental and home care. She also questions how specific changes, like work requirements, could be implemented nationally.

"If we don't stand up, we're going to have a public health infrastructure and a health care infrastructure that is completely eroded," she said.

The Associated Press reported that more than a dozen House Republicans may not support cuts to health care safety net programs, knowing how it'd impact families. As a result, some representatives are hopeful to sway the Republican vote.

"Now, more than ever, Americans need to speak up and make their voices heard. My Democratic colleagues and I are prepared to do everything we can to defeat this unconscionable bill. All it will take is a handful of Republicans joining us," said Congressman John Larson in an email statement.

Staff Writer Ken Dixon contributed to this article.