The U.S Senate’s plan to replace Obamacare, unveiled Thursday, would cut funding for Medicaid and other health insurance subsidies by more than $1 billion a year within five years. That has many lawmakers, doctors, hospitals and patients across Massachusetts in a state of alarm.
"Where in this bill is the protection for children," asks Dr. Jonathan Davis, the chief of newborn medicine at Tufts Medical Center, as he stands in the hospital's NICU among babies who weigh as little as 1 pound. He's worried because 60 percent of them are covered by Medicaid.
Davis pauses in front of an incubator that holds a tiny girl, born on Tuesday, weighing 2.5 pounds. Her little lungs pump several times a second.
"The fact is, she’s in room air, so she’s breathing entirely on her own, which is great," Davis says.
Doctors and nurses will work round the clock to give this baby and her roommates the best possible start. But Davis worries: Could Tufts provide this care for free if the baby or her mom didn’t qualify for Medicaid? And what would happen to these babies if they leave the NICU, but don’t have insurance that covers regular check-ups and immunizations?
"Because if those children don’t go home to get great primary care, follow-up, early intervention and support, all those gains that could potentially have been made are going to be lost," Davis says.
That threat seems likely under the Senate health care bill, says Blue Cross Blue Shield Foundation President Audrey Shelto.
"It is even more devastating than the House bill for low-income and vulnerable populations," she says.
That’s because as of 2025, the Senate would tie spending for each person on Medicaid to a standard inflation rate, not the rate of medical inflation, which is usually higher. On Beacon Hill, lots of lawmakers — Democrats and Republicans — are frustrated, if not angry.
State Rep. Jeff Sánchez, House chair of the Joint Committee on Health Care Financing, reviewed the details during a layover, on his way to a health care conference.
"They talked about repeal and replace," he says. "This is more like search and destroy because fewer people are going to get coverage that they need, and people will pay more out of pocket."
Sánchez says Massachusetts has a longstanding practice of making kids a priority and has enhanced MassHealth to make sure low-income kids get the care they need.
"Nobody’s clear on what’s the future of that program," he says. "Everything is up in the air."
Sánchez's co-chair, state Sen. James Welch, called the U.S. Senate bill "class warfare" because it would take money from poor kids and their moms and give it to wealthy adults in the form of tax cuts. But Welch says the state won’t have any good options if Massachusetts has to make up $1.4 billion in federal health care cuts in the future — on top of the state’s projected $1 billion budget shortfall.
"Do you raise taxes somewhere, do you cut back on eligibilities, do you cut back on benefits? Tough decisions are going to have to be made," Welch says. "But health coverage that children are currently receiving, we’ll fight tooth and nail to make sure that continues."
Eileen McAnneny, president of the Massachusetts Taxpayers Foundation, says the state should cut health care spending before any talk of raising taxes or moving people off Medicaid. But McAnneny says MassHealth, the state’s Medicaid program, is growing faster than the state can manage. About 60 cents of every new tax dollar goes to MassHealth.
"So we have to reduce the cost of the MassHealth program, or the state will deliver MassHealth services and few others because it will consume a lot of our resources," McAnneny says.
For kids, there is one bright spot in the Senate health plan that is not in the House Obamacare replacement bill: Kids with disabilities would be exempt from Medicaid cuts.
Kayla Klein, of West Roxbury, is watching what Congress is doing closely. She tugs at the dog on her son Robbie's T-shirt.
"Right Robs, where’s your port? Where’s it, where’s it, where’s it?" she asks him.
The dog hides a central line port through which Robbie gets medicine every day that tells his blood to form clots. Robbie, who’s 2, has hemophilia.
Robbie makes his mom and dad, Joel Klein, both public school teachers, laugh a lot. But they’re really worried. Hemophilia meds cost about $1 million a year. Robbie has private insurance through his parents, and Medicaid as a backup plan, for now.
The Kleins want to make sure members of Congress understand the decisions they’re making are really important.
"Our futures and our livelihood are hanging in the balance," Joel Klein says.
"It makes you feel very fragile. It makes you feel like you aren’t empowered when your child’s life is at stake," Kayla Klein adds.
Senate leaders say they expect to vote on their health care bill next week. It’s not clear whether it has the votes to pass.
This article was originally published on June 23, 2017.
This segment aired on June 23, 2017.
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