Neighboring senators, Medicaid's fate is on you

Six Republican senators from Minnesota's neighboring states could cast critical votes as early as next week on the U.S. Senate's rushed and reckless plan to overhaul the nation's health care system.

With just days before the bill could come to the floor, North Dakota's John Hoeven, South Dakota's John Thune and Mike Rounds, Iowa's Chuck Grassley and Joni Ernst, and Wisconsin's Ron Johnson ought to do some soul-searching about their responsibilities as representatives of a mostly rural region. Reports from respected health care researchers indicate that those who live in small towns and farming areas would be disproportionately affected by the Senate plan's harsh cuts to Medicaid.

Medicaid is the federal-state funded program that provides medical coverage for the poor. It also pays the bulk of long-term care for the elderly and disabled. In general, people living in rural areas rely more heavily on Medicaid. Rural hospitals and nursing homes, whose revenue is reliant on Medicaid reimbursement, also are typically large employers, meaning that cuts could lead to job losses in struggling communities.

Much of the spotlight on Republican reforms has focused on changes in the individual market, such as whether the estimated 10 million Americans who buy coverage on their own would still have protections for pre-existing conditions. But because Medicaid is so much bigger, serving about 69 million Americans, scrutiny of the Senate cuts is even more vital.

The Senate bill appears to more gradual than the House reform plan in its phaseout of Medicaid's expansion for needy adults. But the bill alarmingly goes beyond the House version to unravel the federal government's historic funding commitment to the program. These unprecedented changes kick in this decade and ramp up dramatically after 2025.

On Thursday, the Minnesota Department of Human Services put out a sobering estimate of the changes' impact just in this state: The "$1.6 billion in federal funding lost in 2021 alone is roughly equal to the state cost of covering the more than 700,000 children, pregnant women and parents currently on Medicaid in 2018." Lost state revenue would reach $11.4 billion by 2025.

Asked how the GOP changes would improve care, North Dakota's Hoeven said this week that he is "reviewing the legislation" and will wait for the Congressional Budget Office (CBO) to determine how many people could lose coverage. The CBO score is expected this week. Hoeven and his Midwestern colleagues would do well to use their time to consult people who were left out of the secretive Senate bill-writing process — those on the front lines of providing care.

In Winona, hospital administrator Rachelle Schultz, CEO of Winona Health, said the proposed reforms would add to the challenges already faced by rural facilities like hers and could limit their ability to innovate. Mary Maertens, the CEO of Avera Marshall Regional Medical Center in southwestern Minnesota, said it's important to be upfront about Medicaid cuts' consequences — reduced provider reimbursement, rising uncompensated care or limited eligibility.

Minnesota's long-term care providers are also sounding the alarm. "This is nothing short of disaster for seniors in Minnesota at probably the worst possible time," said Kari Thurlow, a senior vice president for LeadingAge Minnesota, a nursing home trade group. Thurlow noted that the worst cuts would come as baby boomers need nursing home care. The cuts might also unravel a 2015 state reform to boost long-term care reimbursement — a step that improved these facilities' ability to hire and keep staff.

Care providers in North Dakota, South Dakota, Iowa and Wisconsin almost certainly have the same concerns. The senators who represent them should pay heed. The GOP plans call for using Medicaid cuts to fund a massive tax cut for the wealthy. How can that possibly take priority over heartland constituents whose health depends on this vital program?