The American Health Care Act and preserving Medicaid

June 28, 2017 at 2:35 pm Leave a comment

headshot of claudia smilingLast week we wrote the following letter to Senator Rob Portman, which several of our members signed on to, regarding the American Health Care Act (AHCA).

Dear Senator Portman,

The Philanthropy Ohio Health Initiative began as a member-initiated coalition focused on improving the health of Ohioans. Our membership includes private and community foundations, corporate funders, public charity grantmakers and United Ways. The Health Initiative envisions a future where Ohio communities – including the philanthropic sector and the health care system – support health promotion, disease prevention and patient-centered, quality care accessible by all Ohioans. To do this we also work with other community organizations, government and partners who share our goals, many who have joined us in signing this letter. Like many others who invest in the health and welfare of our communities, we are deeply concerned about the impact on Ohioans of key changes being considered in the American Health Care Act (AHCA).

shutterstock_445553Senator Portman, we appreciate your leadership in directly confronting the impact of Medicaid changes proposed in the House-passed version of the AHCA. As you said in your letter to Senate Majority Leader McConnell (dated March 6, 2017), Medicaid “reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals…and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.” We could not agree more.

We respect the concerns about the cost to the state and federal government of providing Medicaid coverage and want to collaborate with good-faith partners in addressing these concerns. However, we believe the longstanding state-federal financing partnership is not fundamentally broken.

As you indicated with Anthem’s announcement to withdraw from the Obamacare Exchange (the Marketplace), “the status quo is unsustainable.” We agree. The Anthem withdrawal leaves 19,000 Ohioans in 20 Ohio counties without any option to purchase an individual plan on the Marketplace; that is 11% of Ohio’s total Marketplace enrollment. However, despite the need to fix the Marketplace, there is no need to alter the current underlying federal-state financing structure for Medicaid—it works.

Today, Medicaid efficiently provides comprehensive health care for 3.1 million Ohioans, including 723,000 receiving coverage through the Medicaid Expansion. The AHCA’s proposal to shift Medicaid financing to ‘per- capita caps’ will jeopardize Ohio’s ability to provide health care to all Medicaid enrollees, including children, seniors, and people with disabilities, and would have a significant negative economic impact on our state. Consider the following:

Per-Capita Cap, Children & Other Extraordinary Medical Needs

  • Ohio’s child protection system is seeing a dramatic increase in the rate of opioid-exposed babies. The life threatening medical issues these babies face result in immediate and long term needs for care and support. These babies are not covered by the Medicaid Expansion. Their needs require an ongoing, guaranteed federal- state partnership, which cannot be assured with “medical CPI plus 1%.”
  • Ohio spends $2,488 per child on Medicaid, the 11th lowest in the country. With per-capita caps in place, this would become a permanent federal funding ceiling. Can we absorb the short and long-term cost of care for the opioid-exposed babies or other unexpected emerging public health threats? Further, as we work to improve health care quality and efficiency for children, if our spending falls below the federal cap, the recently discussed idea of periodic “rebasing” would further lower our federal funding ceiling, making the per-capita caps even more damaging.
  • We ask: How do we absorb the short and long-term cost of care for the opioid-exposed babies? How would Medicaid financed by per- capita caps support our state’s needs in times of health and economic distress?

A Dedicated Pot to Replace Medicaid Funding for Opiate Treatment

  • $650 million of the $1 billion dollars Ohio spent last year to reduce drug use and overdose fatalities was paid for by Medicaid. More than 50% of all prescriptions in Ohio for Buprenorphine (an opioid recovery medicine) in 2016 were paid for by Medicaid. Our healthcare system and these services are increasingly integrated to serve individuals holistically across the continuum of care, whether the need is identified in primary care, emergency rooms, or specialized services locations.
  • We ask: Will the opiate funding pot that is being contemplated be large enough and grow commensurate with our $650 million need? How would this pot address each individual’s comprehensive needs and be integrated in a system of care? Why would we create a pot of funding for treating opiate addiction? We don’t pay for hip replacements or care for diabetes that way–these are part of holistic healthcare coverage.

Impact on Rural Communities, Veterans, Elderly, and Intellectually Disabled Individuals

  • old_lady_with_drA Medicaid per-capita cap and phasing out the Medicaid Expansion will have a disproportionate impact on rural communities. Roughly 21% of Ohio’s Medicaid Expansion are individuals who live in rural communities. From 2009 to 2015, Ohio had the third largest decline in the number of uninsured adults nationally, as an additional 115,000 adults received Medicaid or Marketplace coverage.
  • The uninsured rate among non-elderly Veterans has dropped 42% since 2014.
  • Medicaid home and community-based services are an optional service. Today Ohio is serving almost 100,000 individuals in community services; that is 65% of our Medicaid long-term services spending. While seniors and people with intellectual and developmental disabilities would have a more generous growth rate in the per-capita cap, from 2000 to 2011 Ohio’s growth rate was higher than most states; 3.5% and 5.1% for aged and disabled, respectively.
  • We ask: Faced with estimated reductions of $22 billion dollars over a ten-year period to Ohio, can we honestly assure families and individuals that these optional home and community based services will be supported at a level commensurate with their changing needs and will not be a prime target for reduced funding? Can Veterans and those in rural Ohio feel secure that there will not be disruption in their access to services, at the expense of others who also have significant needs?

A per-capita cap means that Ohio will have fewer resources over time to address these issues and will not be able to respond effectively to future public health crises. A federal funding cap cannot account for the specific spending pressures, needs and values of Ohio. The current federal matching formula already takes into account changes in each state’s demographic and economic conditions. Ohio’s health transformation is being driven by Governor Kasich and his Medicaid leadership team: the fundamental federal-state partnership doesn’t need to be abandoned, but deliberate progress continued. The President’s new team at HHS has many tools to continue and enhance this progress.

Capitol Hill2With this in mind, we strongly urge you to oppose any health reform bill that would cause Ohioans to lose health care coverage or benefits that they currently have. Specifically, we urge you to vote against any bill that would effectively end the Medicaid expansion, as we know it by completely phasing out the enhanced federal match or end the Medicaid program as we know it by shifting billions in Medicaid costs to states through a per-capita cap.

In closing, we, and the others who have signed on, pledge to work with you in any constructive manner to improve our state’s health care system. We appreciate your continued leadership on these important issues.

Sincerely,

Philanthropy Ohio

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Entry filed under: Health, Ohio Issues. Tags: , , , , , , , .

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