In the big picture of health care policy, it is impossible to overstate how profoundly Medicare and Medicaid have contributed to the health, safety and security of our nation in the 60 years since they became law. Medicare, Medicaid and Affordable Care Act (ACA) marketplace coverage are now cornerstones of our U.S. health care system, ensuring that everyone can access health care without fearing whether they can afford it.
As the Senate considers provisions and policy changes contained in the sweeping reconciliation bill recently passed by the House of Representatives, it is critical that our nation ensures that Medicare, Medicaid and the ACA marketplace remain reliable sources for health insurance coverage. This is especially important for seniors and lower-income Americans, including millions of children and other patients across the country for whom subsidized coverage is their only viable option.
The significant changes to Medicaid and the Children’s Health Insurance Program (CHIP) outlined in the House-passed reconciliation bill include creating new administrative barriers to coverage, reducing retroactive coverage requirements and increasing cost-sharing for certain enrollees—all of which could reduce access to coverage, hinder the ability of Americans to access timely medical care and drive up overall health care costs.
The package proposes similar changes to ACA marketplace coverage rules including shortening enrollment periods, imposing burdensome income-verification requirements and weakening coverage requirements. As the AMA recently outlined in a letter to House leadership (PDF), we agree there is room for targeted reforms that ensure these federal insurance programs and funding are preserved for those who most need it, but as currently drafted, this legislation could cause millions of Americans to lose access to coverage for which they are otherwise eligible.
Health coverage drives improvements
Medicaid coverage is associated with improved long-term health, lower mortality rates, better health outcomes, fewer hospitalizations, and even gains in educational achievement and financial security. More than 40% of all U.S. births are covered by Medicaid, including nearly half of all births in rural areas. Medicaid expansion has driven impressive improvements in maternal health outcomes, including a sharp drop in hospitalization rates among postpartum women. ACA coverage has similarly been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations.
Medicaid and ACA coverage do more than ensure access to care. In many rural and underserved areas, where these programs are major sources of insurance coverage, they are an economic driver in communities and a lifeline to physician practices as well. Reducing this funding could force physician practices and medical clinics—already facing financial hardship thanks to two decades of plummeting Medicare payment rates—to close altogether, exacerbating physician shortages and making it difficult for patients to get physician care in many rural and medically underserved areas.
The AMA has long fought to expand health coverage to those who could not otherwise obtain it. Today, health care coverage has reached record levels, which means more patients than ever have better access to care when they need it, whether from their employer, Medicare, Medicaid or ACA exchange plans. Reducing access to Medicaid and ACA coverage could lead to deferred care and more expensive interventions down the road and higher rates of uncompensated care—all of which increase system costs. Numerous studies find positive effects of Medicaid expansion on a range of economic measures, including uncompensated care costs, employment and state economies.
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A snapshot from my practice
Roughly 15% of patients we see at my small otolaryngology practice in Louisville, Kentucky, have Medicaid coverage. And for this patient population—statistically at higher risk for certain chronic conditions—access to insurance is the difference between obtaining a cancer screening for a concerning lump or getting a prescription for medicine at a price they can afford or simply not doing anything at all. This is not a formula for a healthy, thriving society, which should be everyone’s goal.
As is the case with any large health insurance program, Medicaid, CHIP and ACA plans have a small percentage of waste, fraud and abuse, and we support legislative efforts to address these program-integrity issues in a targeted fashion. However, sweeping changes that would lead to significant funding reductions for vulnerable patient populations—or erect new bureaucratic obstacles for physicians and health care providers participating in these federal programs—could reduce our ability to address chronic disease, cancer, and other diseases that impact health over a lifetime. Such cuts could detract from ongoing national efforts to improve maternal mortality, improve access to mental health care and fight our nation’s opioid and drug-overdose epidemic.
The health threats facing rural and underserved communities in the U.S.—affecting children and seniors alike—are real and growing. Our policy decisions should be driven by the goal of ensuring that health insurance coverage remains affordable and obtainable. Medicaid, CHIP and ACA coverage are far from perfect, but they are vital components of a health system that strives to help people live longer, healthier lives.
Editor’s note: Physicians should contact their senators today to tell them to protect the health of America by protecting access to Medicaid, Medicare and strengthening the physician workforce.
