written by Michael Bacon, Westbrook, Maine
The “big, beautiful” budget reconciliation bill that Republicans passed in the House of Representatives last month includes massive cuts in spending on healthcare that, according to the latest estimate from the Congressional Budget Office, would cause 10.9 million Americans to lose their coverage. The cuts to Medicaid, which assists those with limited income and resources and is known here in Maine as MaineCare, would total about $700 billion over 10 years.
It is not widely appreciated that loss of healthcare coverage, in addition to putting one at risk of financial ruin due to unexpected medical bills, can result in increased mortality. This is shown in a letter published in The Lancet, a highly regarded medical journal. It is shown there that potential excess deaths could reach 14,600 over a one-year period for people aged 25-64 years, the equivalent of the seventh leading cause of death in that age group across affected states. It is also shown that approximately 623,000 additional individuals would face catastrophic healthcare costs annually.
It is encouraging to know that Senator Susan Collins opposes the cuts to Medicaid. She knows well the devastating effects the cuts would have on patients and on care providers, especially rural hospitals, many of which are already on the brink of closures that would affect all of those who rely on their services.
Senator Collins has indicated that she may support work requirements for those on Medicaid. She should be urged to reconsider. In the states where they have been tried, they have been shown to necessitate a wasteful bureaucracy that frequently denies coverage to those who actually qualify.
This is explained in a guest essay published in The New York Times, where it is shown that, based on data from the Census Bureau, only three percent of those receiving Medicaid benefits are long-term unemployed. It is likely that even some of those have other extenuating circumstances. The freeloader problem is miniscule.
The cuts to healthcare go beyond Medicaid. The Congressional Budget Office has reported that the reconciliation bill would also induce cuts to Medicare of $500 billion. The deficits brought on by the massive tax cuts would be large enough to trigger a large sequestration of funds. This would affect the rates paid to care providers, which could lead them to stop taking Medicare patients.
The reconciliation bill is also an attack on the Affordable Care Act. It would eliminate about half of the ACA’s coverage gains, which brought the U.S uninsured rate to historical lows.
There is one place where one could very easily reduce what the government spends on healthcare: the excess payments to Medicare Advantage insurers. A report last year by MedPAC, the Medicare Payment Advisory Commission (a non-partisan government agency that advises Congress), showed that Medicare spends an estimated 22 percent more for Medicare Advantage enrollees than it would spend if those beneficiaries were enrolled in traditional Medicare, a difference that translates into a projected $83 billion in 2024 or $830 billion over 10 years.
To anyone who cares about access to healthcare for all, Donald Trump’s “big, beautiful bill” would be a giant step backwards. Let us all contact Senator Collins and encourage her to remain steadfast in her opposition to the cuts and to, in addition, oppose Medicaid work requirements. She might also wish to challenge the assumption underlying the bill that large transfers of resources from the poor to the rich are good for the country.