The far-reaching effects of Medicaid cuts Agape CEO explains the changing face of healthcare and its impact on the poor

Editor's Note: This article is part of a series interviewing Agape Health Services CEO Michael McDuffie.

Agape Health Services CEO, Dr. Michael McDuffie, is very concerned about the lasting impacts of the reduction of Medicaid provider rates.

"It is a complete domino effect," said McDuffie. "It impacts how we do business moving forward, which impacts the patients we see, and the consequences are far-reaching, particularly when it comes to the healthcare of poor people. We are already seeing patients who have lost their medicaid benefits and are totally uninsured. And with the Affordable Care Act (ACA) subsidies scheduled to expire at the end of the year, it's going to cause everyone's health insurance to skyrocket. Someone making $15 per hour won't be able to afford health insurance, and they too will join the ranks of the uninsured."

McDuffie also said there is a lot of uncertainty right now when it comes to health insurance providers. "With Blue Cross and Blue Shield laying off staff, one insurance broker told me their rates are going to start going up," said McDuffie. "And with Aetna announcing that it will withdraw from the ACA individual and family health insurance market at the end of 2025, there will be fewer options, higher premiums, and more uninsured moving forward."

As a result, McDuffie said Agape will have to take a hard look at how they do business moving forward. "We are not a free clinic, but we are not going to stop seeing someone regardless of their ability to pay, or whether they are insured or not," said McDuffie. "Our patient loads are already increasing and will continue to do so with limited space and health providers. It may come down to having patients triaged by nurses to determine whether the patient should be seen right away or if they can wait. And keep in mind, we are only a primary healthcare provider. What happens to those who may need the care of a cancer or heart specialist? They will go untreated because they are uninsured or are on Medicaid. Then what?"

McDuffie said as a Federal Qualified Health Provider, Agape will see 3% reduction in Medicaid provider rates. Acute care hospitals, nursing homes, psychiatric residential treatment facilities, and research-based Behavioral Health Therapy/Applied Behavior Analysis services for people with autism will see a 10% reduction, and intermediate care facilities will see an 8% reduction.

As a result, he said, small community health centers may be forced to reduce their services or close their doors altogether. "My sister-in-law has been operating an Intermediate Care Facility for the mentally challenged in Western North Carolina since 1994," said McDuffie. "Their reduction in medicaid reimbursement rates have been reduced by 29 percent. As a result, for the first time since opening 31 years ago, she is having to cut salaries and staff. And they certainly haven't ruled out the possibility of going out of business or selling it. And in the end, more folks will go without being treated. And this isn't an isolated case, so we may start to see these community health centers begin to merge in an attempt to create more stable health centers."

McDuffie added, "What we are seeing is a total trickle-down effect from the passage of the Big Beautiful Bill, said McDuffie. "So for us, we continue to prepare for what lies ahead, and in the meantime, make sure our patients and staff are taken care of to the best of our ability, and see where we go from there."

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