Medicaid and the AHCA

Thursday, May 25, 2017 8:00 AM | Jodi Hogue (Administrator)

Here is a report on where we stand with the repeal and replace the ACA regarding Medicaid sort of at the halfway mark. There are some issues that are becoming clearer that I wanted to share with you.  We need to be educators for our members of Congress and state Governors right now.  There is much confusion about what the proposed ‘fixes’ and cuts to Medicaid would do. The interconnectedness of Medicaid, Medicare, private insurance, and employer based insurance is being ignored so that the only ones who will have access to affordable health care are the wealthy.

First, the Congressional Budget Score (CBO) for the House American Health Care Act (AHCA), which came out yesterday almost two weeks after the bill passed, has little difference from the first version of the bill.  The tax breaks for the wealthy, lowering the deficit, and leaving 23-24 million currently covered by insurance uncovered are the same, though there are some minor changes.

What is clearer is that those on Medicaid specifically are the group that is targeted.  We all know the difficulties with Medicaid from a LCSW point of view – the restrictions in some states for our providing care, the low reimbursement rates in many states, the paperwork hassles, etc.  Nevertheless, CSWA believes that our ethics and values compel us to make the effort to include some Medicaid clients in our practice.  There is a pragmatic reason for this.  If Medicaid enrollees do not have health insurance, they will wind up using emergency rooms.  This is the most expensive form of care and will raise premiums for everyone.

I was on a conference call with several national Medicaid advocates yesterday and learned that the Senate is not planning to protect the Medicaid enrollees in their version of the AHCA bill.  Keep in mind that 50% of the 74 million Medicaid enrollees are children; 25% are disabled (many with mental health disorders), and 20% are elderly.  States will have to cover these people if federal funding ends.  Most members of Congress, especially the ‘gang of 13’ who are writing the Senate version of the AHCA, are in denial about this. The main attitude is still that there are a majority of people on Medicaid who COULD work and are just lazy, as opposed to at most 5% who are able to work (and unlikely to be lazy).  


  • 1.       Medicaid is not part of AHCA; cutting insurance for Medicaid enrollees will not solve the cost problems with the ACA, it will increase them.
  • 2.       The “per capita caps”, a new mechanism for cutting Medicaid enrollees by having a block grant that is an absolute limit with NO adjustment for Medicaid increase or decrease in enrollees. This eliminates the current extra Federal help if Medicaid enrollees increase. It is especially important to get this point across to Republican Governors who will be on the firing line if this goes through.
  • 3.       CHIP, the main coverage for children, sits on the shoulder of Medicaid.  If Medicaid is cut, CHIP will fail.  No one can justify preventing children in poverty from having access to health care.
  • 4.       The current plans in the AHCA will cost shift Medicaid to the states.  Congress seems unwilling to look at how devastating that will be for state budgets.


 Here is what we need to do this next week of Memorial Day.  Congress is in recess and members are back in district.  This is the time we need to have meetings with them and clarify the following:

  • 1.       Explain the above issues to all your members of Congress or staff next week in person.
  • 2.       Ask Republican Senators to commit to NO per capita caps.
  • 3.       Ask Republican Senators to commit to maintaining Medicaid expansion.
  • 4.       Stop making absolute caps the way to cut services.

Set up visits now!  Even if you have senators who are unfriendly to our views, visit them.   Go with a group from your Society if you can.  Let me know what the results of these meetings are.  It will also be useful to meet with your representatives.

Medicaid is the stepchild of health care but it is also the way to improve the overall health care system.  Please help educate our members of Congress and governors.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
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