Senate Majority Leader Mitch McConnell is trying to wrangle the votes he needs to pass a health care bill by the end of the week. But a growing number of Republican senators have said they will not support it. Conservatives want costs slashed even further, but moderates are concerned about the proposed rollback of Medicaid benefits for millions of people.
Here & Now's Robin Young speaks with Matt Salo, executive director of the National Association of Medicaid Directors, about what a rollback would mean at the state level.
On whether the Senate health care proposal includes cuts to Medicaid
"I think there very clearly are cuts, and I think it's probably not useful to get caught in the semantics of, you know, what a cut means, but, you're talking about taking hundreds and hundreds of billions of dollars away from this program, a program that is already very lean, very efficient, very effective. And I think it's also important to keep in mind there are two things going on in this debate, one of which is a rollback of the expansion that was a part of Obamacare. But the other is something that is completely unrelated to the Affordable Care Act at all, and that's converting the Medicaid program to a per capita cap."
On whether there is fraud or abuse of the Medicaid program
"There is no more fraud or abuse or waste or inefficiency in Medicaid than there is in Medicare, or than there is in private coverage. It is an effective, efficient, high-quality program."
On the potential effects of a rollback of the Medicaid expansion
"I think what you're seeing in the expansion, and what we've heard from Sen. [Dean] Heller, is what we've heard from governors across the country, which is saying when you look at the data, when you look at the numbers of who we're covering and what we're spending in the expansion, it's a really, really large amount of money spent on mental health and substance abuse. And there's no question that the Medicaid expansion has been the tip of the spear that many states have used to try to confront the opioid crisis in this country. And so what you would be doing is, as you are starting to stabilize individuals who have mental health or substance abuse issues or both, you'd be pulling the rug out from underneath them, and that is going to be highly problematic. That is not going to help these individuals get a job."
"Medicaid directors on a bipartisan basis have been calling for years for reforms, for changes to help us better manage the program -- but that's not what this is."Matt Salo, on the proposed health care bill
On what's wrong with a per capita cap plan
"What's wrong with this is that Medicaid directors on a bipartisan basis have been calling for years for reforms, for changes to help us better manage the program — but that's not what this is. This is simply saying, this partnership, this state and federal financial partnership that has existed for 50 years is going to be unilaterally revoked, and that the federal government would essentially wash their hands of the responsibility if costs started to rise beyond a certain level. And I think the problem there is that, you know, Medicaid is, and health care is, predictably unpredictable. There are spikes in costs when we have things like a new treatment for hepatitis C, Medicaid has been used to address catastrophes like Hurricane Katrina, the Flint water crisis, and when one side of that partnership walks away from that commitment, you're really talking about the greatest intergovernmental transfer of financial risk in our country's history."
"When you look at Medicaid — and I think this is really, really important — two-thirds of the Medicaid program is spent on seniors, people with disabilities and long-term care. That's where the money is. And if you're taking hundreds of billions of dollars out of it, that's where you're gonna have to go to find the saving. States are just not gonna raise taxes in order to cover $800 billion in cuts, and anyone who thinks that's gonna happen has been ignoring the dynamics, the political and fiscal dynamics in state capitols for the past decade. That's not gonna happen."
This segment aired on June 26, 2017.
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