Trumpcare would cut Medicaid payments for Cape patients

May 15--If some aspects of the American Health Care Act that passed the U.S. House of Representatives earlier this month becomes law, the legislation would reduce and restrict Medicaid services for low-income, elderly or disabled Cape Cod residents, according to local health care advocates.

"The biggest concern for us is the dramatic reduction in Medicaid funding that comes through the bill," said Heidi Romans Nelson, CEO of Duffy Health Center in Hyannis. "It would be bad for the patient as well as Duffy."

The nonprofit health center has 3,200 patients, 60 percent of whom are on Medicaid and 15 percent of whom are on both Medicaid and Medicare, Nelson said.

"We're just waiting to see what happens in the Senate," Nelson said, adding that if the bill passes the Senate, "you can pretty much guarantee there's going to be a loss of services."

The bill passed by the House is unlikely to be the same one voted on by the Senate, which is expected to write its own legislation and could take a vote sometime over the summer. But, whatever bill finally makes it to President Donald Trump's desk could be a problem for the Cape and the state of Massachusetts, home of the model for Obamacare, the target of health care reform being pursued by the Republicans.

Gov. Charlie Baker's office has estimated the loss of federal Medicaid funds in Massachusetts would come to about $1 billion by 2020 and would continue to accumulate in future years.

"It's a huge cut," said Brian Rosman, director of policy and government relations for a non-profit group called Health Care For All, which championed health reform under Gov. Mitt Romney and President Barack Obama.

"For Massachusetts it would be very serious," Rosman said.

According to the Blue Cross Blue Shield Foundation, there are currently about 1.9 million people in Massachusetts who are covered by MassHealth, the state's name for its Medicaid and Children's Health Insurance programs.

The number of people on Medicaid grew under health care reforms during Romney's administration and under Obama's Affordable Care Act.

On average the federal government matches state funding for Medicaid dollar for dollar, and massive cuts could result in cuts in enrollment, caps on benefits or decreased reimbursements to hospitals and doctors, Rosman said.

"It would put a lot of hospitals and community health centers over the edge," Rosman said. "The Cape is particularly vulnerable."

At Outer Cape Health Services, 21 percent of the center's 16,800 patients -- or 3,528 people -- were on MassHealth plans in 2016, according to Outer Cape CEO Patricia Nadle.

As of February that population had increased by 1,492 patients since 2012, when 12.6 percent of Outer Cape patients were on MassHealth.

At the Community Health Center of Cape Cod, 44 percent of the 12,500 patients are on MassHealth. But MassHealth reimbursements come to about 55 percent of the center's revenue, due to government enhancements, according to Karen Gardner, the center's CEO.

In addition, 80 percent of the more than 10,000 patient at Harbor Community Health Center in Hyannis and the Ellen Jones Community Dental Center in Harwich are on MassHealth, Judith Reppucci, marketing liaison for Harbor Health said earlier this year.

"It's kind of scary these days," said Cathy Taylor, assistant director of the Hyannis-based Cape Organization for Rights of the Disabled, which has 300 clients.

Medicaid helps pay for day programs, personal care attendants and transportation to medical appointments for people with disabilities, in addition to providing insurance coverage for medical expenses, Taylor said.

"I don't think people realize this," she said.

At Cape Cod Hospital in Hyannis and Falmouth Hospital, about 80 percent of inpatients are on Medicaid or Medicare, according to officials with Cape Cod Healthcare, the parent company of the two hospitals.

The version of the health care bill passed by the House last week "will likely not be the final legislation the President ultimately signs into law," Cape Cod Healthcare President and CEO Michael Lauf wrote in an email.

"It is still too early for us to comment in depth," Lauf wrote, adding, however, that his organization feels "strongly that those with economic and physical challenges should not be penalized in any new legislation."

Patricia Kelleher, executive director of the Home Care Alliance of Massachusetts, said the health care bill would repeal a Medicaid enhancement meant to encourage care at home instead of in institutions.

"There is a cut to the community choice program of 6 percent," bringing federal reimbursement down from 56 percent under the Affordable Care Act to 50 percent, Kelleher said.

In addition to the Medicaid cuts, there would be reductions in Massachusetts Health Connector subsidies that allow people to pay for insurance products on a sliding scale fee based on income and plan costs, Rosman said.

On the Cape, where residents age 40 to 70 makes up more than 44 percent of the population and the median age is 51.3, according to the U.S. Census estimates for 2015, the effect could be hard-felt.

"It particularly hurts people in their 40s, 50s and 60s," Rosman said.

-- Follow Cynthia McCormick on Twitter: @Cmccormickcct

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