For Charles Barnett, 92, the possibility of losing coverage for his 89-year-old wife’s care at a Colorado Springs nursing home is unfathomable. A stroke left her unable to walk and without the use of her left hand, unexpectedly leaving them in dire financial straits.
“If Medicaid were not picking up most of the bill, I could not afford it,” Barnett said. “And I couldn’t take her home, because I couldn’t take care of her. We’d be out on the street.”
When Medicaid was conceived in 1965 as part of former President Lyndon B. Johnson’s anti-poverty push known as the “Great Society,” it was intended to help the most vulnerable – impoverished children and seniors and people with disabilities. Now, they are among the most vulnerable as congressional Republicans seek to scrap former President Barack Obama’s health law.
House and Senate Republicans have proposed ending Medicaid as an open-ended entitlement program and, for the first time, putting it on a budget. The move signals a broader effort at remaking America’s health care system beyond repealing the Affordable Care Act, and it could imperil benefits children, seniors and the disabled have relied on for decades before Obamacare was passed.
The exact effects remain far from clear. But experts, Democrats and patient advocates say the move could affect coverage for a broad cross-section of Coloradans, from newborns to nonagenarians and beyond.
That’s because Colorado could have billions of dollars less to work with, forcing state lawmakers to pick winners and losers among doctors, hospitals, children, seniors and disabled Coloradans.
“It’s not going to make Colorado any healthier,” said Bob Murphy, AARP’s Colorado state director.
Congressional Republicans argue the proposals give states greater flexibility to tailor care to their residents, while keeping fast-rising health care costs from overwhelming the federal budget. The goal: Make Medicaid more financially sustainable, while reining in a program that’s grown far beyond its 1960s-era roots.
Some Republican state lawmakers say they welcome the greater autonomy that would come with transforming the program into a block grant.
“Can you really run a patient-based system from one office in Washington D.C., and expect them to be flexible enough to adapt to people’s needs?” said Sen. Kent Lambert, R-Colorado Springs, who leads the state’s Joint Budget Committee. “Or to the needs of different regions or different states? Because they haven’t been.”
The program’s ballooning budget following passage of the Affordable Care Act highlights the need for change, they say.
For decades, the federal government has matched state spending dollar-for-dollar in Colorado. It also paid a premium for people who gained expanded Medicaid coverage under the Affordable Care Act, which includes adults living just above the federal poverty level.
Together, they provided coverage for about 1.3 million Coloradans in the fiscal year ending June 30, 2016 – nearly a third of whom gained coverage under Obamacare.
The House and Senate proposals propose scrapping Medicaid’s expansion, though exactly when remains up for debate.
They also have proposed varying means of capping federal spending on other, decades-old benefits offered by Medicaid. If passed, state lawmakers would be left to fill that fiscal gap.
It’s anyone’s guess where those cuts could be made, and who would bear the brunt of them. The options include lowering provider reimbursement rates, changing supplemental payments to hospitals and rolling back programs that cover the cost of helping people live at home by reimbursing relatives and caregivers.
Also, scaling back access may become unavoidable.
The Senate’s proposed opening caps, for example, could leave Colorado with $15 billion less in federal Medicaid payments than currently projected over the next 10 years, according to the Colorado Health Institute. The House proposal cuts nearly as deep.
The problem is that capping the federal government’s spending on Medicaid does little to address the deeper issue of this nation’s skyrocketing medical care costs, said Joe Hanel, a Colorado Health Institute spokesman.
“Medicaid’s having the same long-term funding crisis as insurance, and that’s that the cost of medical care is unsustainable,” Hanel said.
The proposed Medicaid changes have drawn sharp rebukes from across the health care sector, including from the Colorado Hospital Association and myriad patient advocacy groups.
Backlash over the bill came to a head Thursday evening, when about 10 protesters with the disability rights group Denver ADAPT were arrested and removed from Gardner’s office while chanting “Rather go to jail than to die without Medicaid.”
Gardner’s office did not respond to multiple requests by The Gazette for comment for this article.
People with disabilities and seniors 65 and older comprise 10 percent of Medicaid’s enrollees, but they made up 42 percent of the program’s more than $8.1 billion cost in Colorado during the 2015-16 fiscal year.
By contrast, adults who gained coverage under the Affordable Care Act comprised nearly one-third of the state’s Medicaid population that year, and accounted for about a quarter of its costs.
At the Sunny Vista Living Center in central Colorado Springs, at least 50 percent of the nursing home’s roughly 115 residents rely on Medicaid to pay for their care.
Medicaid offers the lowest reimbursement rates, said Janet Burns, Sunny Vista’s CEO, but without it, some nursing homes may be forced to close.
“It’s just scary times right now,” Burns said.
Few alternatives for care exist for that population, said Lorri Orwig, Silver Key Silver Services’ chief development officer. The nonprofit serves as the legal guardian for 30 nursing home patients on Medicaid. “The trickle-down domino effect ultimately means that people who are sick, who shouldn’t be independent, will not have any choice but to remain in their homes, or on their own somewhere, longer than it’s safe,” Orwig said.
State Sen. Kevin Lundberg, R-Berthoud, dismissed concerns that children, nursing home residents and people with disabilities could face cuts in Colorado.
As a member of the Joint Budget Committee, Lundberg would be among those state lawmakers left to grapple with those spending caps, should Congress transform Medicaid into a block grant program. He said many people currently enrolled in the program have no such pressing medical needs.
“It’s just a lot of fearmongering,” Lundberg said. “Where they start saying ‘They’re going to be hurt.’ Well, not if the (state) Legislature is doing its job.”
Children’s Hospital Colorado leaders aren’t so sure.
Slightly more than half of the children receiving care at the provider’s four facilities in Colorado Springs and Pueblo rely on Medicaid, said Greg Raymond, the provider’s vice president for southern Colorado operations.
In all, children and adolescents make up 42 percent of Colorado Medicaid’s enrollees, but only 18 percent of its cost.
Children’s Hospital leaders have been prodding Gardner to stave off cuts to children, and that’s paid off. Many children with disabilities appear to be excluded from the Senate’s spending caps, said Zach Zaslow, the hospital’s government affairs manager.
However, that’s not the case for the vast majority of children on Medicaid. They include impoverished children, and specialized care, such as speech and physical therapy.
“When you remove that kind of surrounding constellation of services, they don’t have the quality of life you’d like,” said Benjamin Miller, director of the Eugene S. Farley Health Policy Center in Aurora. “It’s a hard thing to think about, because these kids need every single service they can get.”
The proposed spending caps also vary. The Senate’s version, for example, is far more stringent than the House-passed bill.
Its fate remains unclear. Senate leaders delayed a vote on it until after the Fourth of July recess, which lasts through the week.
For his part, Barnett doubts lawmakers on Capitol Hill appreciate the possible impact of their repeal and replace promise.
“It’s ridiculous,” Barnett said. “They’re dealing with people’s health, for heaven’s sakes.”