Just before launching his presidential campaign, Donald Trump promised that if he were elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on.
Trump's budget proposal calls for more than $800 billion in cuts. It tracks the Medicaid provisions of the Obamacare repeal bill passed by Republicans in the House of Representatives, the American Health Care Act (AHCA).
In addition to the cuts, the AHCA would switch the basis for federal funding of the program from a promise of payment for all needed care to predetermined block grants or per capita amounts that do not change with the actual cost or amount of care.
The Medicaid cuts that Trump and House Republicans have proposed raise clear concerns for the more than 10 million Americans who would lose health-care coverage. Most of them would be unable to access anything more than stabilization in an emergency with health consequences that could be devastating.
In addition to the lives of poor and disabled Americans, there is something else at stake that the architects of these plans don't seem to care much about. The cuts would jeopardize the entire health-care system.
Medicaid is a financial mainstay for a large proportion of American hospitals. Without it, inner-city and rural hospitals would see huge spikes in the number of patients who are unable to pay for care, a cost that few of them could easily absorb. If these hospitals go under, emergency care, the only care available to those without insurance, goes with them.
Even if you don't live in an inner city or rural area, there is a good chance the next hospital that you or a family member uses will be affected. Academic medical centers, such as those at the University of Pennsylvania, Thomas Jefferson University, and Temple University, rely heavily on Medicaid for financial support, as well. These are the hospitals that offer high-end care, such as organ transplants, gene therapy, and advanced cancer treatments.
Most pediatric hospitals would also be affected. Medicaid covers one-third of American children and half of the patients in these facilities, not to mention 40 percent of all births. Pediatric hospitals train almost half of all pediatricians in the country. This physician education is supported in large part with supplements paid by Medicaid.
Proposals to drastically restructure and slash Medicaid would mean major disruptions for hospitals of many kinds throughout America, along with the doctors and other health professionals who work for them. No one would be safe, including potential hospital patients.
The Senate will soon consider the AHCA along with Trump's budget. If the lives and health of poor and disabled Americans, including one-third of American children, are not enough to make Senate Republicans think twice about the proposed Medicaid cuts, maybe the threat of chaos throughout the health-care system will.