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Wednesday, June 28, 2017

Dangers of Trumpcare

Mitch McConnell has postponed the Senate vote on Trumpcare.  One reason for the bill's extreme unpopularity is its impact on Medicaid.

One mechanism to reduce per enrollee costs would be to restrict covered benefits. States could eliminate, restrict the scope or impose new or tighter utilization controls for “optional” services (those not required by statute). All states offer some optional services, including prescription drugs. Adult dental or chiropractic services are key examples of benefits that some states have restricted or eliminated during economic downturns. Nearly all home and community based long-term care services (HCBS) are also an optional service. (Figure 2) Over the last 2 decades, state spending for long-term care has moved from institutional care to home and community based settings. HCBS accounted for over half of long-term care spending by 2013. With restrictions on federal financing, an aging population and statutory requirements to cover nursing home care, states’ ability to invest in HCBS could be strained.
Emma Brown reports at The Washington Post:
The Republican plan for Medicaid is likely to hurt schools in several ways, said Sasha Pudelski, who tracks healthcare policy for AASA. [American Association of School Administrators] Most directly, states may decide to prohibit schools from receiving Medicaid dollars because of what is likely to be stiff competition against doctors and hospitals for limited resources, she said.
Less directly, states struggling to cover healthcare costs now covered by the federal government would have to seek cuts elsewhere in their budgets, including in education, which accounts for a large share of many states’ spending.
“The kids who will be hurt first and foremost are special ed kids and kids in poverty, but then everybody will be hurt, because we’ll have to shift dollars from the general education budget,” she said.
Schools receive less than 1 percent of federal Medicaid spending, according to the National Alliance for Medicaid in Schools. But federal Medicaid reimbursements constitute the third-largest federal funding stream to public schools, behind $15 billion they receive each year for educating poor children and $13 billion they receive to educate students with disabilities under the Individuals with Disabilities in Education Act (IDEA).
Jeff Horseman reports at The Riverside Press-Enterprise:
Under the House bill, California, which spends more than $100 billion a year on Medi-Cal, would have to replace about $24 billion in federal Medicaid dollars by 2027, according to the state Department of Health Care Services.
Caps would vary depending on the type of enrollee and growth in those caps would be indexed to the rate of inflation. But the Senate bill eventually uses a general inflation measure, rather than one tied to medical expenses. That would lead to even deeper Medicaid cuts than the House bill, opponents argue.
While children with disabilities are technically exempt from per-capita caps, “As soon as they turn 19, they would be affected by cut services,” Flory said.
“There are also a number of children who are not categorically disabled but are receiving a high level of services due to trauma, et cetera,” she said.
“I imagine there will be some dispute in which children to exclude from the cap … I just see more pressure and administrative bureaucracy on the horizon to administer this, not funding going to services.”