This week, Nevada state lawmakers heard worst case scenarios if Congress significantly reduces federal Medicaid spending. There’s a lot of uncertainty as state lawmakers are required to pass the biennial budget over the next 100 days.
One in four Nevadans is insured by Medicaid, the health care insurance program for low-income and disabled Americans. In Nevada, Medicaid covers about 42% of births and 60% of nursing home residents.
On Tuesday, House Republicans voted to potentially eliminate $880 billion or more from Medicaid in their budget proposal. President Donald Trump has reiterated that he won’t touch Medicaid, but he needs to pay for his agenda for wealthy tax breaks and border security.
Even though Medicaid isn’t outright mentioned, this money needs to come from somewhere, said Katherine Hempstead, senior policy advisor for the Robert Wood Johnson Foundation.
“There really isn’t another place to find the kinds of cuts that they’re talking about,” Hempstead said. “We are experiencing a little bit of cognitive dissonance, where some people [are] saying they love Medicaid, they don’t want to touch it. Other people have circulated a list of ideas with numbers, and the biggest numbers are things that have to do with Medicaid.”
One of those changes is capping the amount the federal government spends per Medicaid enrollee per year. Hempstead said this would drive a wedge between how much the federal government pays and the rising cost of health care services. Caught in the middle would be states, and how much they would have to pay.
Senate Majority Leader Nicole Cannizzaro is worried about the enhanced federal Medicaid expansion rate being rescinded. In 2012, Brian Sandoval became the first Republican governor in the country to opt-in to allow Medicaid to cover a wider group of low-income individuals.
According to the Kaiser Family Foundation, if this happens, more than 300,000 Nevadans could lose their health care insurance. Cannizzaro said the state would be on the hook for up to $1.9 billion dollars, money it doesn’t have lying around.
“Governor Lombardo will have to submit a plan of which people and what programs he is going to cut in health care, what health care services we will no longer be able to offer as a state, and which Nevadans will ultimately lose their health care,” Cannizzaro said.
During a three-hour hearing in Carson City on Wednesday evening, six agencies told lawmakers how the cuts could devastate health care providers and facilities.
Nancy Bowen, CEO of the Nevada Primary Care Association, said community health centers, primarily serving Medicaid and uninsured patients, could experience tremendous revenue losses.
“If they don’t have the revenue to pay for the staff, then there’s nobody to provide the services. Wait lists continue, and then, unfortunately, visits to the emergency room for things that should be covered in the primary care clinic,” Bowen said.
Blayne Osborn, president of Nevada Rural Hospital partners, said the 13 critical access hospitals he represents are resilient and have even expanded some services lately, but reductions to Medicaid could put those gains in jeopardy, especially in Lovelock and Yerington.
“The hospitals that I worry about the most are our smallest volume hospitals. They have almost no margins to be able to absorb any substantial cuts to Medicaid,” Osborn said.
But some Republicans are applauding the federal government’s efforts to “root out fraud and waste.” Republican Senate Minority Assistant Leader Jeff Stone said that Medicaid is fair game during the hearing.
“It is important to emphasize that neither budget resolution mentions the word Medicaid,” Stone said. “I would like to assure the public not to panic and not worry. The sky is not falling. The Joint Health and Human Services hearing is premature, a political theater, and a waste of staff resources.”
Minutes before that hearing, Republican Gov. Joe Lombardo published a letter stating he’s shared concerns with the White House.
“Nevada remains committed to being a constructive partner in efforts to ensure fiscal responsibility at the federal level, but federal funding cuts to essential programs alone will not solve Washington’s spending problem or the rising cost of health care,” Lombardo said.
Nevada Medicaid administrator Stacie Weeks said just 3% of Medicaid’s biennial budget of more than $15 billion goes toward administrative costs, with the rest paying providers.
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