Medicaid cuts will lead to ‘people dying,’ healthcare leaders say

Healthcare leaders and researchers have said the federal tax package that President Trump signed this month will lead to millions of Americans losing Medicaid coverage.

Now, healthcare leaders and researchers are saying the package will lead to some Americans losing their lives.

Dr. Georges Benjamin, executive director of the American Public Health Association, tells Chief Healthcare Executive® that he fears there will be more deaths, due to the loss of Medicaid coverage and the potential reduction of services at hospitals.

“I’m always a little reluctant to say that people will die, but let me tell you something. These cuts will result in people dying. People will be delayed care,” Benjamin says.

A new study published by JAMA Health Forum this week also projects that there will be more than 1,400 additional deaths annually by 2034.

The researchers in that study estimate that there will be more than 94,000 hospitalizations annually that could have been avoided, while more than 1.6 million people could delay seeking medical care due to costs.

Healthcare organizations have denounced the tax legislation, saying it leads to unprecedented cuts in Medicaid. The Congressional Budget Office has estimated Medicaid spending will be reduced by about $1 trillion over the next decade, and has projected nearly 12 million Americans are projected to lose Medicaid coverage.

Larry Levitt, KFF’s executive vice president for health policy, said in a webinar earlier this month that even though the tax package wasn’t framed as an effort to reform health care, “It represents the biggest change to the health care system since the passage of the Affordable Care Act 15 years ago.”

“The scale of the change to the healthcare system is staggering,” Levitt said in the webinar. “This represents the biggest rollback in federal support for health coverage, ever.”

‘We’ll have less access’

Hospitals say they expect to treat more uninsured patients, which they warn could lead to facilities cutting services and possibly closing their doors.

“We'll have less access, not only because the facilities won't be there, because providers won't be able to afford to participate, much to the desire that they want to,” Benjamin says.

“It won't just be the traditional patients that you think of that are underserved, but also seniors, people with long-term care,” he adds. “We will lose capacity. Because many of our hospitals, particularly in our rural communities, are really surviving on the margins. And so this is a trillion dollars out of the healthcare system, even though it will come out over time, it will be terribly devastating.”

Healthcare leaders also say that emergency rooms will be more crowded as uninsured patients come to the only place they can get care. Jennifer Mensik Kennedy, president of the American Nurses Association, told Chief Healthcare Executive earlier this month that emergency departments are going to be forced to treat more people.

“People will have longer waits in the emergency room,” she said. “They're not going to get to the services that they need.”

• Read more: With Medicaid cuts, hospital emergency rooms could get even busier

People who don’t rely on Medicaid will also end up paying more for their care, as hospitals will likely pass on the higher costs they are facing to others.

“While we talk about these as Medicaid cuts, as you know, nothing's free, and, any dollar you pull out, somebody actually has to pay for it. It gets paid for by either private insurance employers or through uncompensated care, which, again, gets spread out to everybody,” Benjamin says.

Impact on rural areas

The JAMA Health Forum study also says that rural hospitals would be at heightened risk due to Medicaid changes. The study projects that 101 rural hospitals would be “at high risk of closure” by 2034.

“This analysis indicates that proposed Medicaid reforms would have far-reaching consequences beyond federal budget savings, including negative health outcomes, economic losses, and health care system disruptions, with rural and underserved communities disproportionately affected,” the study’s authors wrote.

The closure of rural hospitals would endanger more lives, Mensik Kennedy said earlier this month. In some rural areas, particularly in the western states, it’s common for residents to drive an hour or more to the nearest hospital today, and they could face longer trips if some rural hospitals close.

“If you have a heart attack or stroke, you're going to miss the windows for treatment that are going to help ensure that you can survive,” she said. “We know there are treatment times for medications for stroke and heart attack. If you can't meet those windows … you're more likely to die.”

Federally qualified health centers could see an additional 1.9 million uninsured patients annually, which would lead to losses of $3.3 billion in revenue, according to the JAMA Health Forum study.

Lawmakers included a $50 billion fund in the tax package to support rural hospitals. Healthcare leaders said they appreciated the recognition of the problems facing rural hospitals, but they said that aid won’t offset the other losses in aid.

More complications

George Huntley, CEO of the Diabetes Patient Advocacy Coalition and Diabetes Leadership Council, tells Chief Healthcare Executive® that patients with diabetes will have less access to care and help in managing their disease.

“There's no question that there will be deaths,” he says. “It's an eventuality. When you deal with a chronic disease like diabetes, uncontrolled, unmanaged diabetes leads to co-morbidities.”

Beyond an increase in mortality, more patients with diabetes are going to have more serious complications, and the prospect of fewer providers available to treat them.

“There's going to be an increase in amputations,” he says. “There's going to be an increase in cardiovascular issues, many of which will result in those deaths we're now speaking about, but the other complications of diabetes will also grow exponentially during this period.

“So you're going to deal with one of the leading causes of amputations from non-traumatic injury, kidney disease, heart disease, stroke, blindness … you're going to see all of these on the rise, all of which are preventable with access to care, and all of which cost far more than the management of diabetes,” he says.

Some Americans may not recognize that they could lose coverage, Benjamin suggests. Medicaid programs have different names in each state, and some aren’t specifically branded as “Medicaid.” The Massachusetts Medicaid program is called MassHealth, while Tennessee’s program is called TennCare.

“A lot of people do not know that their healthcare coverage is at risk,” Benjamin says.

• Read more: Children’s hospitals brace for overcrowding and staff cuts due to tax package