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Senate committee's Medicaid cuts imperil coverage, outcomes
Outside experts say ACA changes and Medicaid cuts could threaten insurance coverage and cause thousands of preventable deaths.
The Senate Finance Committee has released its draft text of the budget reconciliation bill promising changes to Medicaid, as separate healthcare firms release new data outlining the consequences Medicaid cuts could have.
In one report from the Urban Institute, researchers concluded that changes to the Affordable Care Act's insurance marketplace subsidies could halt enrollment for some 5 million people. In another article published in the Annals of Internal Medicine, researchers stated that Medicaid cuts could result in an estimated 16,642 preventable deaths.
Senate committee's draft text
Perhaps one of the draft text's topline items remains unrelated to Medicaid enrollment: the provider tax.
While the House of Representatives passed a version of the legislation that would cap the provider tax at 6%, the Senate Finance Committee called for progressively lowering the provider tax to 3.5% by 2031. Experts say the proposals could create conflict between the two chambers of Congress.
In terms of Medicaid eligibility and enrollment, the Senate Finance Committee echoed the House version in calling for federal Medicaid work requirements for able-bodied enrollees age 19 and older.
While the House version of the bill exempts adults with dependent children, the Senate version requires at least 80 hours of community engagement -- work, school or community service -- each month for adults without dependents or with dependents over age 14.
House version imperils ACA marketplace enrollment
Just as the Senate Finance Committee released its version of the federal budget reconciliation plan, the Urban Institute published its own numbers outlining how certain provisions of the House-passed bill would impact insurance enrollment.
In particular, changes to the ACA health insurance marketplaces and Basic Health Program (BHP) would imperil insurance coverage for nearly 5 million people.
"The bill includes an array of eligibility cuts, subsidy reductions, and new paperwork barriers that would substantially reduce enrollment in the Marketplace and result in some people becoming uninsured," the Urban Institute researchers explained.
Most states would see enrollment declines by at least one-third, but in eight, those enrollment reductions would reach up to 40%. These declines are on top of what other experts have predicted might happen as a result of reduced premium tax credits.
Coverage declines might adversely impact marketplace stability and lead some participating insurers to withdraw, the researchers predicted.
The researchers also found that the first year or two of the proposed provisions would lead to the greatest enrollment declines because the legislation institutes changes in enrollment processes. This would cause disruption for insurers, states and consumers, the Urban Institute experts said.
"Considering the compounding impacts of Medicaid cuts, the scheduled expiration of premium tax credits, and the policies modeled here, stakeholders are unsurprisingly raising alarm about risks to individuals and the viability of health insurance markets," the Urban Institute researchers stated.
Medicaid cuts could lead to 16,000 preventable deaths
Meanwhile, researchers examining the consequences of Medicaid cuts have concluded the provisions could result in tens of thousands of preventable deaths.
Writing in the Annals of Internal Medicine, researchers noted that loss of Medicaid coverage would discourage many from accessing care, resulting in adverse health outcomes and preventable mortality.
"Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans," the researchers wrote.
The proposals passed by the House of Representatives in May would have consequences for healthcare access with serious downstream effects. Medically preventable deaths caused by uninsurance and subsequent lower healthcare utilization would total anywhere from 8,241 deaths to as many as 24,604, with the 16,642 figure being a midrange estimate.
These numbers could fluctuate based on how states ultimately balance their budgets in response to changes in Medicaid funding. According to the researchers, states will have to balance "politically difficult" decisions between state tax increases and cutting of services or enrollment.
"Today, despite its many shortcomings, Medicaid enjoys wide support from the electorate and serves as the foundation of the nation's healthcare safety net," the researchers concluded. "The cuts under consideration, intended to offset the cost of tax cuts that would predominantly benefit wealthier Americans, would strip care from millions and likely lead to thousands of medically preventable deaths."
Sara Heath has covered new related to patient engagement and health equity since 2015.
