This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The health care bill that the Senate will vote on this week makes it difficult for me to recognize my country. We are the richest, most prosperous nation in the history of the world, but our elected representatives are seriously considering enacting a law that will deny medical care to children, the poor, the elderly, the disabled and those of us who now suffer or will suffer someday from cancer, strokes, heart disease and other diseases or injuries.
The House version of the bill was shocking, but the Senate bill doubles down on the damage it will inflict. Both the House and Senate versions will cut Medicaid deeply, and Medicaid is the primary source of care for poor children, pregnant women, the elderly and the disabled.
For 52 years, Medicaid has been a federal-state match program; state appropriations are matched by federal money based upon each state's per-capita income. High-income states such as New York and California get a one-to-one match. Utah, however, has a lower per capita income because of its many children and receives three federal dollars for every dollar our state appropriates to Medicaid. Who wouldn't invest heavily in anything that generated a 3-to-1 return? Even more important, there is no limit on how much the federal government will contribute.
Both the House and Senate bills would radically change all this. Both bills cut the federal portion of Medicaid by $834 billion dollars over the next 10 years, imposing per-capita caps going forward and inflating these caps by the Medical Consumer Price Index (CPI-M). The Senate version is worse – it imposes the same per-capita caps and inflates them initially by the CPI-M but, beginning in 2025, uses the much lower Urban Consumer Price Index (CPI-U). So, as our population ages and falters, Medicaid will receive less and less federal money.
The actuary of the Centers for Medicare and Medicaid Services (CMS) estimates that this much lower inflation index by itself will shave an additional $64 billion off Medicaid over 10 years. And both bills expect the states to make up this nearly $ 1 trillion reduction of federal Medicaid money out of their own revenues.
Our state Legislature refused to expand Medicaid under Obamacare, when the federal government would have paid 100 percent of the cost of the expansion. How likely is it then that our Legislature will increase Medicaid funding when 100 percent of the money must come from state revenues alone? Medicaid dollars are a necessary part of the revenue of our rural hospitals and nursing homes statewide, and there is a genuine question whether they will survive if any version of the House or Senate health care bill is enacted.
The media has largely overlooked it, but both bills also eliminate any penalty for violating the employer mandate – the Obamacare provision that requires companies with more than 50 full-time employees to provide health insurance with "minimum essential coverage" or pay a hefty penalty. If, in the future, employers face no penalty at all for failing to provide health insurance as an employment benefit, it is a safe bet that many or even most large employers will do so and keep that money as profit. Their employees and their family members will be forced into the private marketplace or simply become uninsured.
The House and Senate bills make it harder to get insurance in the private marketplace as well. Whereas Obamacare permitted commercial health insurers to charge older enrollees no more than three times what they charge younger enrollees for their premiums, both the House and Senate bills permit them to charge five times more. And subsidies for insurance premiums will be much reduced.
Our own Sen. Orrin Hatch is the chairman of the Senate Finance Committee, which has jurisdiction over this and all health care bills. The Finance Committee and Hatch intend to vote on the Senate bill this week – without a single hearing. We must call Hatch and tell him that if he votes in favor of this bill or any version of the House or Senate bills, we will vote against him the next time we can.
We are Americans, and we take care of each other, even if our congressional representatives do not.
Janet I. Jenson is a Salt Lake City attorney who specializes in health care and the former general counsel for Utah's Medicaid program.