Local opinion: Medicaid cuts: a win-lose proposition

I am a physician who appreciates the value of Medicaid. Medicaid is a safety net program, costing $914 billion in 2024, which provides healthcare for 1 in 5 Americans, from infants to seniors, who cannot afford to pay for their healthcare. It is heading for a congressional overhaul, pegged at saving about $880 billion over 10 years.

There are multiple potential ways for the federal government to cut into Medicaid.

1. Decreasing eligibility and enrollment will save dollars as millions will lose their Medicaid benefits. It can be accomplished by increasing the complexity of application and reporting requirements. Medicaid applicants and enrollees will have to navigate increased red tape and paperwork plus prove they are working or have an exemption. These application and reporting obstacles plus administrative errors will result in people being unable to qualify or unable to stay qualified even if they legitimately meet all the criteria to be Medicaid enrollees.

2. Adding a work requirement might save dollars as millions will lose their Medicaid benefits. It would require individuals to report that they are working, are looking for work, or qualify for an exemption for disability, illness, being in school, job training, volunteering or caregiving. Every three to six months each Medicaid recipient would have to report their status or risk losing their Medicaid.

Currently, most Medicaid recipients are either working or exempt from a working requirement. Kaiser Family Foundation has found that 64% of adults on Medicaid are working and 30% qualify for exemptions. This leaves only 6% of Medicaid recipients vulnerable to losing their insurance via work requirement.

The GAO (government accounting office) has estimated that the cost of administering a work requirement can be tens of millions of dollars per state, potentially eclipsing any potential savings from dropping people from the Medicaid rolls.

3. Decreasing benefits and services offered will save dollars as millions will lose comprehensive Medicaid benefits. This might consist of decreasing or cutting dental, vision, mental health and drug abuse treatment and/or preventive health services.

4. Decreasing reimbursement to providers and hospitals will save dollars and would place an extreme strain on the system, especially in rural areas. The result may be closures of hospitals and nursing homes.

5. Decrease the federal matching rate will save dollars. The federal government currently pays 50-80% of Medicaid costs in all the states. If Congress decreases its financial support to Medicaid, without cuts in either services or enrollments, this will shift a huge financial burden to the states, which most would find impossible to cover.

6. Decreasing fraud and abuse will save dollars and should already be an ongoing program, always vigilant and with resources ready to take action to address abuses such as $2.5 billion in fraudulent billing from sober-living programs in Arizona. This is the work for Inspectors General and their dedicated staff. Trump recently fired the Medicaid IG.

The upcoming full-frontal assault on how America cares for its most vulnerable will soon be front and center. If one asks why this is being done, the answer is to generate funds for Trump’s tax cuts, primarily benefiting millionaires and billionaires.

An estimated 500,000 Arizonans are at risk of losing their Medicaid benefits.

I was part of a group of health care providers who recently met with Rep Juan Ciscomani’s senior staff about proposed Medicaid cuts. We were told he would protect and not cut Medicaid. We were lied to our faces.

We can do better.