Brace yourself: there are new attacks on public health, and this time the target is Medicaid. Earlier this month, the House of Representatives passed a budget proposal designed by Rep. Paul Ryan (R-WI) that would convert Medicaid to a block grant. Prior to that, Sen. McCaskill (D-MO) and Sen. Corker (R-TN) proposed a bill that would cap all federal spending, including for key public health programs, such as Medicaid. Meanwhile, we are about to hit our national debt ceiling, which has prompted further to demands to drastically reduce federal spending. So why do these proposals matter, and what do they have to do with reproductive health?
Medicaid is currently the largest provider of reproductive health care for low-income people. The program provides medical coverage for 54 percent of non-elderly women and it is has been credited for financing over 40 percent of births across the country. In addition, Medicaid is required to cover a wide range of reproductive health services, including: pregnancy-related services, prenatal care, delivery services, screening and treatment of sexually transmitted infections and family planning. The federal ban on abortion funding has three exceptions: when continuing the pregnancy would endanger the life of the woman or when the pregnancy resulted from rape or incest. For low-income individuals, Medicaid is the primary (sometimes only) source for reproductive health services.
All of the proposals mentioned above drastically reduce federal funding for Medicaid, which would result in serious cuts to who can get Medicaid health coverage and what services they can get. Currently, Medicaid utilizes a matching structure in which the federal government funds a certain percentage of a state Medicaid program’s expenditures. The federal government matching rate differs state to state, but it typically covers 50 to 75 percent of each state’s Medicaid costs. This structure allows states to accommodate increases in health care needs, enrolling more people in Medicaid, providing more services in their program, and meeting increased costs of services. For example, during the recession when so many people lost their jobs and their health insurance, an additional 6 million people enrolled in Medicaid. The federal government’s matching rate helped off-set states’ health care costs and ensured that all those who became eligible for Medicaid could enroll.
If the House has its way, however, Medicaid would be converted into a block grant. Instead of continuing the matching structure, each state would receive a set, finite amount of federal funding for its Medicaid program. And to make it even worse, the House budget sets the block grant at a rate that is significantly lower than current federal expenditures and then incrementally decreases the funding every year. According to Congressional Budget Office (CBO) estimates, under the House budget proposal, federal Medicaid spending would be 35 percent lower in 2022 and 49 percent lower in 2030. The cap would stay in place regardless if there was an increased need for Medicaid services.
Meanwhile, on the Senate side, the McCaskill-Corker bill (S.245) aims to cap total federal spending, and includes a “sequestration” process that would automatically make cuts if the cap was exceeded. While couched as a neutral proposal to address the deficit, this bill is nothing more than the House budget proposal dressed up in better rhetoric. Under the McCaskill-Corker bill, the federal cap is set at a low rate, and like a block grant, it will prohibit the federal government from spending more than the cap, regardless of an increased need for Medicaid services. The process will disproportionately affect entitlement and mandatory programs, like Medicaid. As such, the bill that pretends to simply reign in federal spending actually creates devastating funding cuts for Medicaid.
In the background of these two proposals looms another possible threat to Medicaid: across the board federal spending cuts. The nation is expected to reach the debt ceiling in early May, and legislation must be passed to raise it. President Obama has requested a debt ceiling bill that does not contain any policy riders, but Republicans have pounced on the opportunity to use the bill as leverage for spending cuts. To be fair, Republicans have not yet stated which programs they would want to cut; however, the House budget proposal and the McCaskill-Corker bill showcase Medicaid as a likely target.
Arbitrary federal caps or spending cuts - with or without a block grant - will drastically reduce federal funding for Medicaid. Inadequate federal funding leaves states with two possibilities: shouldering the costs so that they can operate their Medicaid programs at the pre-cut level, or cutting services to fit within the reduced federal funding limit. Given today’s economic and political climate, it is more likely than not that states will cut services.
Any cut to Medicaid is a threat to reproductive health care. During this political War on Women, it is not unreasonable to assume that the first thing on the chopping block will be reproductive health services and women’s health care. After all, it was just two weeks ago that the federal government came within an hour of shutting down because ideologues in the House wanted to prohibit Planned Parenthood from receiving Title X funding. While they lost that fight, they were able to reinstate the D.C. abortion funding ban. Even less “controversial” programs like maternity health services have experienced cuts, and hospitals across the nation are closing their maternity wards, in part, because of the lack of public funding to support operations.
Make no mistake: attacks on Medicaid are simply proxies for attacks on reproductive health services. As advocates for reproductive rights and health, it is imperative that we make sure Medicaid remains fully funded and that we work to defeat any proposal that would block grant, cap or cut funding for Medicaid.