Very Low-Income Households Relying on Medicaid for Healthcare at Greatest Risk
Monarch Housing has been writing about the devastating effect that the potential appeal of the Affordable Healthcare Act (ACA) and Medicaid expansion would have on low-income adults.
This population includes very low-income homeless individuals and families who are often also disabled.
Vann R. Newkirk II reports “Almost two-thirds of Medicaid costs come from low-income elderly and disabled people with serious—and thus expensive—health-care needs.”
On February 16, 2017, House Speaker Paul Ryan, his committee leadership and the new secretary of health and human services, Tom Price, presented a policy brief around the House Republican plan to repeal the ACA.
The House Republican plan “Would repeal Obamacare’s taxes and mandates, and replace the tax subsidies for purchasing insurance on the exchanges with tax credits and incentives for health-savings accounts”
Especially concerning to those working to end homelessness. “The plan would also roll back enhanced federal funding to states for the Medicaid expansion, although there would be an unspecified ‘period of stability … to ensure we are not pulling the rug out from underneath states or patients.’”
The plan would “Age-rate the credits, granting more affordable coverage to older people, who tend to be sicker than younger Americans, but would not control for costs among poorer individuals, who also tend to be sicker and more prone to disability than their middle- and upper-class counterparts.”
Regarding block granting Medicaid program funding, the Republican gives some guidance. “In general, it would establish a per capita cap on federal Medicaid funding for individuals based on state economic and health factors, as well as the category of beneficiary (whether they are aged, blind and disabled, children, or otherwise able adults).”
Writes Newkirk, “The logic behind block grants and per capita caps on federal funding is that they force states to be efficient with Medicaid dollars since they’re on the hook after that money is gone. But there are no guarantees that states wouldn’t simply create that “efficiency” by dropping people from coverage, diminishing the services covered, or reducing payments to providers. In fact, the House plan appears to encourage just that, as it only specifies coverage of mandatory services for disabled and elderly people in its requirements for block grants.”
Newkirk write that he worries that “the people for whom the country built the safety net in the first place” can be the “losers” under the Republicans’ strategy.