Maryland advocates resist efforts to target Medicaid in federal funding fights – Baltimore Sun
Things began to unravel for Ramar Robinson about three years ago when he was laid off and hit with a diagnosis of depression and mania. The illnesses would require costly therapy, which he could no longer afford.
So the 26-year-old Baltimore County man wound up on Medicaid — the federal program for low-income families now at the center of the debate over Republican efforts to repeal Obamacare and President Donald J. Trump‘s $4 trillion budget proposal.
“Medicaid really did save my life,” said Robinson, who was able to access regular sessions with a therapist and psychiatrist, put his illness into remission and get back to work. “It is due time for society to know what those services really provide and the lives that are being saved daily.”
Congressional Republicans return to work Monday after the Memorial Day recess facing enormous pressure to make progress on replacing the Affordable Care Act — a years-long campaign promise — but also fissures within the party about how to do so. A leading cause of the internal strife is how to handle proposed cuts to Medicaid.
The 52-year-old program serves some 75 million beneficiaries nationwide, including 1.3 million in Maryland. Deep cuts approved by the House last month have become a key stumbling block for the Senate, where members are hearing criticism from governors in both parties.
The House-approved American Health Care Act would cut $834 billion from Medicaid by 2026, the nonpartisan Congressional Budget Office has estimated. The agency predicted enrollment in the program would fall 14 million by 2026.
Estimating the impact in Maryland is trickier because it is not clear how the state would respond if the measure became law.
The left-leaning Center on Budget and Policy Priorities, which performed a state-by-state analysis, said the legislation would cost Maryland $14 billion in federal funds over a decade. And the state’s nonpartisan Department of Legislative Services estimates a proposed reduction in funding for so-called expanded Medicaid — an Obamacare provision that allowed more people to enroll — would, on its own, mean a $1.27 billion loss for the state in 2018.
Trump’s budget proposal would deepen those reductions by another $600 billion nationwide — leading to an estimated $2 billion annual loss in Maryland, according to the Maryland Center on Economic Policy.
That number, which represents just under 5 percent of the state’s $43.5 billion budget, may explain why Republican Gov. Larry Hogan has been more vocal on the Medicaid cuts than any other provision included in the federal care legislation.
It also partly explains why the legislation is facing skepticism on Capitol Hill, even among some Republicans who support doing away with Obamacare.
“The health bill that passed the House will threaten health care and therefore worsen the lives of hundreds of thousands of Marylanders,” said Benjamin Orr, executive director of the Maryland Center on Economic Policy. “It’s a devastating bill.”
House Republicans and the Trump administration counter that the legislation gives states, which contribute about half the cost of Medicaid, more control to tailor the program to their needs. By doing so, they said, local officials can address inefficiencies inherent in a top-down approach.
“We happen to think, for example, that Medicaid is designed for more of an urban poor population than a rural poor, as predominates in South Carolina,” White House budget chief Mick Mulvaney, a former Palmetto State congressman, said recently. “And we would ask them every single year — would ask … the federal government — [to] give us more control over how this money gets spent. And the federal government always said ‘no.’”
Rep. Andy Harris told The Baltimore Sun he agreed with that assessment. The Baltimore County Republican, a Johns Hopkins-trained anesthesiologist, acknowledged that Maryland would have to find some way to cover the loss of federal funding “if the state does not handle the program efficiently.
“We give the states the option to tailor the program to individual needs in the state,” Harris said. “We think there are efficiencies in the market that could be obtained at the state level, through waivers and through experimentation.”
But just how much efficiency can be squeezed out of the system — and whether that savings would cover the proposed cuts — is an open question. Administrative costs for Medicaid are less than 7 percent, about half the rate frequently cited in private insurance, according to the nonpartisan Kaiser Family Foundation.
The program is more efficient, in part, because it pays doctors and hospitals less than private insurance.
Sen. Chris Van Hollen, a Maryland Democrat, said the argument that efficiencies could cover the proposed cuts is “not just wrong, it’s dead wrong.”
“You cannot cut Medicaid by $1.4 trillion and not have devastating consequences to people’s health care in Maryland,” he said.
Democrats are not alone in that view. Four Republican senators, including Rob Portman of Ohio and Shelley Moore Capito of West Virginia — states that Trump won last November — sent a letter expressing concern that the House legislation “does not provide stability and certainty for individuals and families in Medicaid expansion programs.”