June 2, 2017

Letter Opposes Legislation that Repeals Medicaid Expansion

The Disciples Center for Public Witness joined other people of faith to oppose any legislation that repeals Medicaid expansion or institutes a Medicaid block grant or per capita cap. Read the letter below:

Dear Senator/Representative:
We represent religious organizations, denominations, and faith traditions from across the spectrum. We are united in a shared commitment to prioritize low-income, sick, elderly, disabled, and vulnerable populations in the health care decisions before Congress. Our scriptures affirm our moral responsibility to ensure all may live with dignity and the opportunity to recognize their full potential. Access to affordable, quality health care should not and cannot be a privilege; it is a requirement rooted in faith to protect the life and dignity of every person.
We have grave concerns about the future of the Medicaid program under current proposals to repeal and replace the Affordable Care Act. We urge you to maintain the Medicaid expansion and protect Medicaid from any harmful structural changes or federal funding cuts. We strongly oppose any legislation that repeals the Medicaid expansion or institutes a Medicaid block grant or per capita cap.
Medicaid enables one in five Americans to access quality health care and live with dignity. Medicaid covers populations our scriptures and faith traditions call on us to prioritize and care for: low-income children, seniors, and people with disabilities. Through the Medicaid expansion, 11 million low-income individuals were able to access quality, affordable coverage. But proposals to eliminate the Medicaid expansion and to institute a per capita cap would make individuals often in most need of medical care the least likely to get it. The Congressional Budget Office estimates that eliminating the Medicaid expansion and instituting a per capita cap, as under the American Health Care Act, would cause 14 million people to lose their Medicaid coverage within the decade.
Medicaid is a lean and efficient program. While Medicaid spending jumped to 10.5% in 2015 due to the expansion under the Affordable Care Act, spending dropped to 5.9% in 2016 and is projected to grow by just 4.5% this year.[1] Medicaid disproportionately covers many people with complex needs for health services and long-term care, particularly the elderly and people with disabilities, yet spending per person is lower than the private market and Medicare, mostly because of its lower administrative costs and provider payments. Furthermore, when adjusting for the greater health needs, Medicaid spending per person is an estimated 25% lower than in the private market.[2]
Medicaid, especially through improvements in the ACA, is increasingly a powerful tool in addressing the tragic opioid epidemic around the country. Medicaid and CHIP cover a third of people with opioid addictions, and Medicaid covers a variety of treatment services, including inpatient services and detoxification, partial hospitalization, intensive outpatient, and case management, depending upon the state.[3] The U.S. Surgeon General found that the Medicaid expansion enabled many people with substance use disorders to access health coverage and treatment services.[4] In states that took the Medicaid expansion, the percentage of people with substance use or mental health disorders who were hospitalized but uninsured dropped from about 20 percent in 2013 to 5 percent by mid-2015.[5] Repealing the Medicaid expansion and capping the program would reverse and severely restrict states' ability to respond to the opioid crisis.
Medicaid has an especially profound impact in rural communities and in Indian country. Close to 1.7 million people in rural communities gained health coverage under the Medicaid expansion.[6] People in rural areas are more likely to be covered by Medicaid, and Medicaid cuts would disproportionately affect these communities. Furthermore, the Medicaid expansion has been an enormous assistance to rural hospitals’ financial stability. Between 2013 and 2015, uncompensated care costs as a share of hospital operating budgets fell by about half in Medicaid expansion states.[7]
American Indians and Alaskan Natives have some of the worst health disparities and poorest access to health services in the nation, due partially to decades long underfunding of Indian Health Services. Given the disproportionately high rates of poverty among American Indians and Alaskan Natives, the Medicaid expansion provided arguably some of the largest gains for Indian health within a generation.[8] Repealing the Medicaid expansion would reverse these gains. Furthermore, instituting a per capita cap could jeopardize Tribes' access to Medicaid funding as they would become dependent on states identifying and passing through the funding. Tribes often have difficulty in getting states to pass through block grant funds to them.[9]
Rolling back the Medicaid expansion, regardless of whether it is next year or within three years, would leave millions without access to affordable coverage, and states would be unable to make up the difference. Instituting a per capita cap or block grant would dismantle the federal guarantee and undermine the program in a way it would not recover from. A per capita cap would prevent states from addressing the next opioid epidemic or Zika outbreak. Without addressing the underlying causes of growing health care costs, a per capita cap simply cuts federal funding for the program, compounding dramatically over time. Lower federal contributions shift costs to states which are then forced to cut services, eligibility, and/or provider payments. The only added flexibility given to states through a per capita cap is the flexibility to cut more people and more services from the program. No formula or indexing calculation solves these problems. A vote to institute a per capita cap is a vote to dismantle the program and shift billions of dollars of health care costs onto states.
Real problems exist within America's health care system and with the Affordable Care Act. Congress and the administration should act to stabilize the individual market and lower costs. However, Medicaid is unrelated to these problems and should remain off the table in any negotiations to repeal and replace the Affordable Care Act. The proposed cuts to Medicaid would exacerbate health care affordability and accessibility problems by dramatic amounts. They would turn our country farther away from health, farther away from our values, and farther away from a just society. We call on you to prioritize those populations at greatest risk and oppose any cuts to Medicaid. We urge you to oppose any legislation that does not maintain the Medicaid expansion and institutes a Medicaid per capita cap.

[4]     U.S. Department of Health and Human Services,

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