Like many Americans coping with an approaching Trump administration, I have enjoyed clever political jokes and cartoons at Trump’s expense, and I have expressed outrage over his ridiculous tweets. I get some fleeting solace in sharing sarcasm, frustration, and legitimate criticism. However, we all need to direct more of our stamina toward fighting a barrage of dangerous policies coming our way. I am calling upon my colleagues in health care to stand up for our fellow Americans, the majority of whom did not vote for Donald Trump and the majority of whom will suffer dire health consequences from vouchers for Medicare and block grants for Medicaid.
Medicare has had a proven track record of providing high-quality, cost-effective health care for 55 million Americans. Since its inception in 1965, Medicare has evolved with modern medicine and the needs of patients. Program eligibility was expanded to include patients with kidney disease and long-term disabilities. Improvements to Medicare include benefits and services like home health visits, skilled nursing facilities, and hospice care. More recently, the Affordable Care Act is helping Medicare get more bang for its bucks. Over these fifty-plus years of adjustments, the fact remains: Medicare is a vital cornerstone of American healthcare.
Medicaid and the Children’s Health Insurance Program (CHIP) are similarly vital to the health of 6 million seniors, 10 million Americans with disabilities, 27 million low-income working adults, and 45 million children. Medicaid and CHIP are not “other people’s health care.” About 1 in 3 Americans are covered by Medicaid/CHIP and Medicare, meaning someone you care about gets health care through these programs. As a pediatrician, I am especially appreciative of how Medicaid gives dignity to childhoods nationwide by financing nearly half of all births and providing a reliable source of healthcare to 97 percent of children in the program. That lifeline of dignity extends to the elderly, as Medicaid covers over 60 percent of all nursing home residents.
Medicaid also plays a unique and under-appreciated role in American health when times are tough. During the most recent recession, when the number of uninsured Americans increased, Medicaid and CHIP actually helped decrease the uninsured rate for children while continuing to provide high-quality healthcare. When there is a natural disaster or a sudden epidemic (like the dramatic rise of HIV in Indiana), Medicaid acts like a first responder, coming to the rescue of Americans because federal funding can be adjusted to meet the increased costs of healthcare in those circumstances.
Following the 2016 election, what should be abundantly clear for American health policymakers is that there is no mandate for any drastic changes, especially for programs like Medicare and Medicaid. Despite the fact Trump lost the popular vote, both House Speaker Paul Ryan and Congressman Tom Price (whom Trump wants for Secretary of Health and Human Services) are eager to fulfill the Republicans’ dream of privatizing Medicare and transform it into a voucher system. This ill-advised plan gives eligible patients a pittance of “premium support” and leaves them to the whims of the health insurance industry. This is the same health insurance industry jacking up premiums for patients right now on the individual market with little to no justification. This is the same health insurance industry that will leave seniors with insurmountable medical bills because insurance will not cover rising healthcare costs. Such unreliable behavior should be warnings to Speaker Ryan and Congressman Price as they look to dismantle Medicare. The health insurance industry can not be trusted to take on a bigger role in the healthcare of 55 million seniors and Americans with long-term disabilities.
The other disastrous idea shared by Trump, Speaker Ryan, and Congressman Price is block grants for Medicaid. There are minor differences in the details of their plans, but what they all intend to do is cut Medicaid spending drastically at the federal level (by a third over 10 years), and then set arbitrary limits on how much the federal government will contribute to a state’s Medicaid program. These harsh budgets force states to change who is eligible, meaning people will be kicked off Medicaid. For those who are allowed to stay on the program, there will be reduced benefits (like physical therapy, mental health services, speech therapy, rehabilitation services, etc) in order to contain costs. Under Medicaid block grants, opening or expanding new hospitals and clinics will be extremely difficult because of budget constraints. When times get tough because of a recession, natural disaster, or epidemic (just think about Zika returning next summer), a block granted Medicaid will struggle to support the health of Americans in need because federal and state governments will not have the necessary flexibility in funding.
To my fellow healthcare providers, we must do everything we can to stop disastrous policies like vouchers for Medicare and block grants for Medicaid. Donald Trump may be a star of reality TV, but he and his new allies are out of touch with the reality of how Medicare and Medicaid work for millions of American children, seniors, disabled, and families down on their luck. There is no mandate for drastic changes that jeopardize our health care. Now is the time to tell House Speaker Tim Ryan, Congressman Tom Price, and every member of Congress that Medicare vouchers and Medicaid block grants are unacceptable. Don’t let Trump’s Twitter tantrums distract you from doing your part to save American health care.
ADDENDUM based on the American Medical Association’s endorsement of Congressman Price for HHS Secretary: I want to speak directly to the AMA doctors who support Congressman Price and his plans for Medicare, Medicaid, and the Affordable Care Act. You are, once again, on the wrong side of history. Since the AMA was founded in 1847, its doctors have repeatedly stood against progress in health care: banning Black physicians from joining its membership; opposing national health insurance proposed by both President Roosevelts (Teddy and FDR); opposing Medicare in the 1960’s, and so on. Some apologies and gestures have been made, and some late support has been begrudgingly offered here and there for some causes, but when the AMA makes endorsements for policymakers like Congressman Price, it demonstrates that nothing substantive has genuinely changed for the organization over all these years. I urge my colleagues in healthcare to reject the AMA’s lack of leadership and vision and fight for our patients.