White House photo by Pete Souza
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This month’s congressional Republican tax legislation is a planned first strike against Medicare, Medicaid, and many other essential federal programs. Senator Marco Rubio admitted as much last week when he said that Republicans will have to institute “structural changes to Social Security and Medicare” to pay for the increases in federal debt created by their tax plan.
The published House Republican plan, known as “A Better Way,” raises the eligibility age for Medicare from age 65 to 67. And it does not allow newly retired seniors to receive traditional Medicare, but rather forces them into buying medical insurance with a government voucher. As the voucher could be for much less than the prices of available insurance, these seniors could have to pay large premiums.
The insurance available for those seniors to buy would be inferior to current Medicare. House Republicans have specifically called for a 20 percent copay for all services, including hospital care. This plan would also raise the deductible for outpatient care to about $1,500 per year. With such a high deductible, many seniors would likely forego essential care, leading to illnesses and injuries getting out of control and, in some cases, deaths.
It would add up to giving seniors insurance choices similar to those under the ACA: largely high deductible/high copay insurance that often doesn't cover necessary medical care.
The Republican plan would allow “balance billing” in Medicare, meaning that, even after the 20 percent copay, physicians would not have to accept Medicare insurance payment as payment-in-full and medical groups could send supplemental bills to patients. If the patients didn’t pay those bills, physicians could then send collections agents after Medicare patients.
This would add up to giving seniors insurance choices similar to those under the Affordable Care Act (ACA): many would only be able to afford high deductible/high copay insurance, often not covering necessary medical care. And, just like many under the ACA, some seniors would then not buy insurance. Consequently, for the first time in over fifty years, America would have an uninsured senior crisis.
The Republican plan for Medicaid is no less draconian. Republicans would use block grants or per capita formulas to drastically cut federal funding for Medicaid, forcing cash-strapped states to cut back on vital services such as education, healthcare, and income support benefits, and raise taxes, hurting lower-income residents the most.
To help states kick people off Medicaid, the Republican plan would allow a “work requirement.” This would mean more people forced into full-time caretaker mode for family members, more people with disabilities unable to obtain benefits, more with temporary injuries like a broken leg, and more too old to get work but too young for Medicare could lose Medicaid coverage.
Republicans would also allow states to charge premiums for Medicaid, further lowering enrollment. Their plan would also let states make the top income eligible for Medicaid even lower than it is now. It would allow wait lists for Medicaid. The Republican plan would allow states to eliminate coverage for essential health benefits.
As two-thirds of Medicaid spending is for older and disabled adults, primarily for services like nursing home care, these cuts would force states to reduce spending on nursing home residents. More nursing homes would stop admitting Medicaid patients or patients who would soon need Medicaid. With less money, Medicaid nursing homes would lay off staff, endangering the quality of care for those who remain.
The Republicans have more attacks planned for other essential federal programs. But these assaults on Medicare and Medicaid alone are reason enough to demand that Congress kill the Republican tax-cuts-for-the-rich bill. Otherwise, this plan would leave fewer Americans with health care, staggering out-of-pocket costs for many more who still get it, millions thrown off Medicaid, and growing misery in our nursing homes.
Ramón Castellblanch is a professor of health education at San Francisco State.