Crippling Medicaid cuts could upend rural health services
When her pregnancy hit a crisis, Ginger Peebles rushed to her hospital in Swainsboro, Ga., where daughter Brenlee Pepin was born healthy. But that hospital closed a year later, a casualty of the financial problems plaguing rural areas. (Family photo courtesy of Kimberly Howell)Each day as Ginger Peebles watches daughter Brenlee grow, she sees the importance of having a hospital close by that delivers babies.
Brenlee’s birth was touch-and-go after Peebles realized something was wrong. “I couldn’t feel the baby move, and my blood pressure was sky-high,” said Peebles, a nurse.
Dr. Roslyn Banks-Jackson, then an OB-GYN specialist at Emanuel Medical Center in Swainsboro, Ga., diagnosed preeclampsia, a potentially lethal complication of pregnancy, and induced labor to save Peebles and the baby. Brenlee was born on Oct. 28, 2014, completely healthy.
Had Peebles given birth the following year, she might not have been so fortunate. Emanuel shuttered its labor and delivery unit the next spring, becoming one of a handful of such units in the state to close from 2010 to 2015, most because of budget problems.
Republican bills to replace the federal health law would worsen rural areas’ financial straits through reductions in Medicaid funding. Patient advocates predict that would lead to fewer enrollees, more shutdowns of rural facilities, reduced payments to doctors and fewer programs for people with health needs or disabilities. In the aggregate, such changes threaten the health of thousands of state residents, especially those in rural areas.
“I’ve seen changes, and I’ve seen cuts, but I’ve never seen changes like what’s being proposed in this bill,” said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. “This is the first time it’s been this scary.”
Possible Strains on a Lean Budget
One of the key aims of the House and Senate bills is reversing the Affordable Care Act’s expansion of Medicaid. But they also would institute changes to the federal-state health program for low-income residents that could devastate states such as Georgia that didn’t expand Medicaid. Georgia already ranks 45th in the nation in per capita Medicaid spending, according to the Georgia Budget and Policy Institute.
The nonpartisan Congressional Budget Office concluded in a report released June 29 that the Senate plan would slash 35% of expected federal Medicaid funding by 2036.
“Cuts now would cripple rural Georgia,” said Dr. Ben Spitalnick, president of the Georgia chapter of the American Academy of Pediatrics.
He said that is because most primary care visits, which include OB-GYN, pediatric and adult care, in the sparsely populated areas rely heavily on Medicaid reimbursements.
The federal cutbacks would have to be offset by the state. But that means taking money from other programs or raising taxes. As a result, state officials facing those shortfalls would likely scale back an already lean Medicaid coverage.
“If you cut back, [people] still go to the hospital, they’ll still need care. No matter what you do, the buck stops somewhere,” said Renee Unterman, a Republican state senator who chairs the health and human services committee. In the end, she added, the cost for that uncompensated care gets passed to taxpayers and consumers through higher health costs and insurance premiums.
Improving Pay for Doctors
For 15 years, Georgia Medicaid reimbursed primary care doctors at only 60% of the amount that the federal Medicare program reimbursed similar services, said Ward.
But in 2015, the Legislature implemented three rounds of pay increases to primary care doctors, including pediatricians and OB-GYNs, to bring them in line with the Medicare reimbursement.
Many of these doctors are now concerned those rates would be the first to be lowered. “That’s our big fear,” said Rick Ward, executive director of the Georgia chapter of the AAP. “We just clawed our way back and to deal with it again would just be unbelievable.”
Key among those concerns are prenatal care in rural areas. With a maternal mortality rate that is among the worst in the country, OB-GYNs are worried that the cuts would eliminate fragile solutions to doctor shortages that the state has implemented.
For example, pregnant, low-income women in 17 counties around Augusta can arrange for a ride in a van, paid for by Medicaid, for their prenatal visits at the medical school at Augusta University. The service has been vital in keeping these women healthy and insuring successful births. Advocates fear it is the type of program that could face problems if Medicaid funding becomes tight.
People With Disabilities Fearful
Advocates for residents with disabilities are concerned that home health care would be likely to suffer from the cuts.
That’s because while states are required under Medicaid to pay for nursing home stays, care for people living at home has been optional.
About 38,000 people in the state get the services, also called community-based benefits. Almost 10,000 Georgians are on the waiting list, according to Jacobson.
One of those who is getting coverage is Joshua Williams, 22, who has severe cerebral palsy and needs constant care at home and school.
“I’m terrified” that funding cuts could end the program, said his mother, Mitzi Proffitt, 53. “I’d have to quit my job” to take care of him.
Williams, who is on the dean’s list at East Georgia State College in Swainsboro and loves NASCAR, also admits to being “very scared.” He says if his coverage is discontinued, he would have to drop out of college, ruining his hopes of becoming a sports broadcaster.
A supporter of President Donald Trump’s, Williams said he is counting on the president to keep disability benefits in place and to ensure that health care is affordable for all.
“I like him because he’s a businessman, but he said he has heart,” Williams added.
Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
The original article was published on July 10, 2017 on Kaiser Health News
The article was reposted:
- July 10, 2017 by USA Today
- July 10, 2017 by Stateman Journal Online
- July 10, 2017 by Ruidoso News Online
- July 11, 2017 by The Gilmer Mirror Online
- July 11, 2017 by WUSF Public Media Online
- July 11, 2017 by My Informs Online (This link is no longer active.)
- July 12, 2017 by Health Leaders Online
- July 12, 2017 by GBP PBS NEWSHOUR
