Health care providers warn of dire impact of Medicaid cuts

Health care providers warned of dire consequences for patients, including those with commercial insurance, from Medicaid cuts enacted by Congress in what President Donald Trump refers to as his “big beautiful bill.”

Their remarks came from a Medicaid roundtable held Tuesday by U.S. Rep. Frank Mrvan at Porter-Starke Services in Valparaiso. Providers from across Northwest Indiana designated as community mental health centers or federally qualified health centers were represented.

“It’s going to be absolutely devastating,” Mrvan said, when the $1 trillion in cuts over the next decade are put into effect.

About 211,000 people in the 1st Congressional District are at risk of losing Medicaid coverage, he said.

HealthLinc CFO Joan Bondi said the unknown, the undefined, “really makes it hard to plan. We’ve been running scenarios. We lose 10% of our population. They just go away.”

“That’s very hard to manage a business and very hard to calm our staff,” she said.

In gatherings across his district, Mrvan has heard horror stories from people who said their lives will be affected.

Providers are still trying to figure out how to cope with the coming funding cuts.

“There are so many things we cannot factor into creating a plan yet,” HealthLinc CEO Melissa Mitchell said.

Before attending the meeting Tuesday morning, she had to sign an invoice for an electric bill for one month for one site that reflected a big increase. “There’s no one giving us $4,000 more to take care of people,” she said.

Even as the providers expect to suffer from the cuts, so will their patients and staff.

“So many of our patients are one diagnosis away from total decimation of their lives,” Mitchell said.

Republicans in Congress said the Medicaid cuts are intended to address “fraud, waste and abuse.”

“We’re one of the most highly regulated industries in the world,” Regional Health Systems CEO Bill Trowbridge said.

“We get regularly audited by each payer, by the state,” Porter-Starke CEO Matt Burden said. “It sometimes feels as if we were to make a novel and make one typo, someone would say sorry, that’s not a novel.”

They’re looking not at how to help people but how to get people off Medicaid, Trowbridge said.

States are increasing the frequency of determining eligibility for Medicaid to twice a year or more. What happens if patients forget to turn in the forms and have to start the eligibility process all over again, wondered Nichole Lessard, Porter-Starke’s director of community support services.

Losing eligibility puts the patients in limbo because another provision of the legislation removes retroactive coverage for patients. They lose Medicaid, they can’t afford health care visits while uninsured, and then they lose their jobs and homes, she fears.

Lessing told of a patient who had Medicaid benefits previously. It took from February to July to get them restored. Under the new law, it would then be about time to have to go through the process again. And when the coverage is suspended, chronic conditions worsen.

Failing to seek preventative care can lead to emergency room visits and extended hospital stays.

“I do believe emergency rooms will be impacted greatly,” Marram Health Center Vice President Clarence Boykin said.

Community HealthNet CEO Janet Seabrook predicts an increase in the number of women not getting mammograms and Pap smears because of the Medicaid funding cuts. Expect increases in cancer rates as screening decreases.

“All of these things are in question when you look at this as a numbers game,” she said.

“Our working, commercially insured people are about to come under the thumb, too,” Mitchell said. Their premiums will go up to cover the cost of treatment for uninsured people.

Trowbridge said 17% of his organization’s patients are charity cases, receiving treatment for which they are unable to pay.

The human toll of the Medicaid cuts is difficult to quantify now, but the anecdotal evidence is already piling up.

Mitchell told of a painful conversation with a family member last week. “He has told me it is cheaper for him to just die than to go get the preventative care he needs,” she said.

People who lose their coverage will feel the same. “It’s going to be cheaper for them to just die.”

219 Health Network Executive Director William Cortes told of a patient who went to a wound clinic with a big ulcer on his leg that wasn’t healing properly. In this case, it’s a nutrition issue. “People can’t afford a good meal,” Cortes said, so this patient would buy five sandwiches for $5 at a fast-food place, eat one and put the rest in the freezer for later consumption.

That’s an issue with diabetes, where patients have to carefully plan meals.  “If you don’t prevent it, then you’re at a dialysis center,” Mrvan said.

Lessing told of a family in which the father became ill, was diagnosed with cancer, lost his job, lost his insurance and lost his home because he made too much money to qualify for Medicaid.

He finally got benefits and was able to reconnect with family, but he then died because he wasn’t being treated in time. “So two boys lost their dad because of a technicality on Medicaid,” she said.

It’s an example of how lack of access to health care can have terrible consequences for individuals, but it also shows how the workforce could be affected by having workers suffer and lose jobs because of delays in receiving health care.

“I wish there could be more time spent evaluating these realities” before making public policy changes, Trowbridge said.