The Affordable Care Act is a complex, multipronged health-care package. Most of the anti-ACA vitriol has focused on the mandatory health-insurance exchanges. Very little attention has been given to the Medicaid-expansion component.
As part of the battle to repeal the ACA, congressional leaders have stated that Medicaid benefits are on the table. This would include eliminating funds for the 31 states and the District of Columbia that expanded eligibility for Medicaid, converting the non-expanded part of the program from an individual benefit to a state "block grant" and capping services and payments.
Before taking any action, Congress should know who the Pennsylvania Medicaid beneficiaries are: overwhelmingly low-income people with disabilities who were too poor to participate in the ACA exchanges.
As of December 2015, there were about 69,000 disabled children and 233,000 disabled adults (ages 18 to 64) who received their health care through Pennsylvania's Medicaid program, according to Social Security Disability statistics. Nineteen thousand of those children, and 66,000 of the adults, were in Philadelphia.
These numbers do not include disabled people in the ACA's Medicaid expansion, which occurred in Pennsylvania only last year. With the expansion, according to the state Department of Human Services, about 659,000 additional Pennsylvanians now receive health care via Medicaid. There is no data by disability for these enrollees.
Medicaid benefits are absolutely essential for people with disabilities, and a reduction in federal reimbursements - one proposal would slash $160 billion by 2022 - would not only significantly cut state revenues, but would also be disastrous for the individuals involved.
Here is what's at stake:
Medicaid is currently the primary health insurance that pays for community-based services for the disabled. It is also the primary payer providing the long-term care that keeps people with disabilities (and residents older than 65 who receive Medicaid) in their own homes with their own families instead them being sent to nursing homes or other institutional settings.
Medicaid block grants would disproportionally impact people with the most serious and expensive health-care needs - people with disabilities and many people over 65. Block grants would result in reduced benefits and payments, pitting people with serious impairments against one another for their health-care needs. Providers, whether doctors, clinics, or hospitals, would opt out of the program. They won't participate in a program if they are going to lose money.
The impact on hospitals would be disastrous. Before the ACA, hospitals wrote off uncompensated care - bad debt - for people who couldn't afford to pay. The ACA's Medicaid expansion allowed hospitals to increase the number of Medicaid patients, and this offset previous losses. Cuts would mean the loss of the expanded Medicaid population and the compensation for their care.
During our national debate over the ACA, we must keep in mind Medicaid's most vulnerable beneficiaries: people with disabilities and low-income seniors. Let's hope Pennsylvania's representatives in Congress do not act to injure these citizens.