GEORGE

By VICTOR WOODDELL

Special to the Journal

MARQUETTE — A proposal in Washington would slash trillions of dollars from the Medicaid program that is jointly funded by the federal government and the states to provide health care coverage to low-income and disabled people.

If passed by Congress, that would be potentially catastrophic for beneficiaries and health care providers, according to experts at the Michigan State Medical Society, Marquette County Health Department and Michigan State University.

In Michigan, more than 3 million people are enrolled in Medicaid and associated programs like the Children’s Health Insurance Program, according to the U.S. Center for Medicare and Medicaid Services.

That’s almost 30% of all state residents.

Tom George is the CEO of the Michigan State Medical Society and a retired physician.

“This will have a disproportionate effect on rural Michigan because so many recipients live in rural counties,” he said.

According to the American Council on Aging, Medicaid in Michigan covers most services if a single person earns less than $2,901 per month, or $5,802 for married couples.

“There is no good path for the state to follow if they pull the funding out of Medicaid,” George said. “If the federal government cuts back the funding, then it will be up to the state to decide how to make up the shortfall.”

According to George, the state has few options: It can cover fewer people, leaving more uninsured, or it can cover fewer forms of care, or it can reduce the amount it pays for covered care.

Any of those would have negative consequences for both recipients and caregivers, he said.

According to George, there are people who earn too much to qualify for Medicaid but too little to afford private insurance.

“If they cut back the eligibility requirements, then more people will fall into the cracks because suddenly they earn too much to qualify anymore,” he said.

Others might still be on Medicaid but face more out-of-pocket expenses if payments are reduced, he said.

“Recipients and their families will then receive less health care, and caregivers may have to cut back on the number of patients they can see, or close their practice altogether, if Medicaid no longer covers the cost of the service,” he said.

“Medicaid already pays poorly compared to private insurance. If we cut the amount it covers, then fewer providers will be willing to take these patients because they won’t be able to afford to provide care.”

Cutting Medicaid could actually increase the total cost of health care, he explained.

“Many conditions are chronic diseases that are easy to treat, but if untreated lead to more extreme conditions that are more expensive to treat in an emergency room setting,” he said.

“For example, take high blood pressure. If the medication isn’t covered anymore, then the person is at higher risk for a heart attack or a stroke, which would ultimately be treated in an ER at the public’s expense. Obesity, diabetes, cancer are all similar conditions. Without proper care, a person can die or be disabled,” he said.

David Walsworth is a family physician and the associate chair for clinical affairs in the Department of Family Medicine at MSU.

“This is a big deal., I am concerned that people are going to be hurt,” he said. “I know of critical access hospitals that are afraid they will not be able to stay afloat.”

Walsworth’s practice consists of 15-20% Medicaid recipients.

If many lose coverage, they will have to pay out of pocket for the same services, he said. And if Medicaid payments decrease, then he’ll have to make difficult decisions about what services to offer.

“Many private practices in the state are concerned about their ability to maintain care for their patients, or maintain employment for their staff,” he said.

Kathy Mell is a public health nurse working for the Marquette County Health Department and has been a public health nurse since 2002.

“The county doesn’t have the resources right now to cover more uninsured people,” Mell said.

There aren’t many alternatives for the uninsured, she said.

“Nonprofit organizations like the Healthy Michigan Access Coalition give free services but are limited by their funding and can’t provide full care. Health care centers have a very limited ability to see people for free,” Mell said.

Another consequence is that people might not get reimbursed for transportation any more.

“In a rural area, people often have to travel miles to see a provider,” she said, “and with no reimbursement, they may not be able to afford that. There’s just one hospital in the county, so it’s a long trip for some.”

“So, a lot of people may choose just not to get care.”

Those without insurance who can’t pay personally may end up in emergency rooms, she said, “which will end up costing everyone more, without even delivering the care they need.”

“The most vulnerable people will be affected,” she said. “The loss of Medicaid will be catastrophic for many people.”