Proposed Changes to Medicaid Would Hurt North Dakotans Who Rely on Program

Congressional Republicans have finally introduced their long promised repeal and replacement plan to Obamacare. To say it has been met with less than flattering reviews could be considered an understatement. A lot of questions surround the new proposal. For starters, what do we call it? “TrumpCare”?  “RyanCare”? “CramerCare”?

Whatever they choose to call it, experts are still attempting to determine the plan’s cost and how many people will have coverage. These questions linger because the House Republican members are attempting to ram this overhaul through Congress before the nonpartisan Congressional Budget Office gives its analysis. Similar to their accusations of Democrats in Congress passing Obamacare without knowing what was in it, Republicans are trying to pass their plan without knowing its impacts on the economy or people’s healthcare coverage. We should demand the CBO analysis before Congress rams this overhaul through.

One thing appears clear, Medicaid coverage would see dramatic changes. Under their plan, in the year 2020 Medicaid will potentially change to something closer to a per-person allotment of federal dollars given back to the states. The state would then have discretion on how to spend that money. The concept sounds pleasant until you look at recent budgetary decisions in North Dakota when it comes to Medicaid. I think the proposed changes will be disastrous for North Dakotans who rely on it for coverage.

Let me give you an example. In 2015, the North Dakota budget began to slip. The Legislature eventually held a special session to determine where to patch its budgetary holes. One area the Republican majority rejected patches was in Medicaid programs hit by the across-the-board Dalrymple budget cuts. Programs that were negatively impacted helped children with autism, people with disabilities trying to stay out of nursing homes with in-home care, and nursing homes themselves. The Republican legislature refused to transfer $29 million from state budgetary reserves, or hell finding $29 million in deeper cuts elsewhere, to receive a $56 million federal match in Medicaid. The state would still have had tens of millions of dollars in reserves. They willingly left money on the table that would have helped the most vulnerable among us.

It was because of this failure in the Legislature with Medicaid that nursing homes and Governor Burgum considered raising revenue by trying to create a new tax on senior citizens who pay for their own nursing home care. In other words, the North Dakota Legislature, much like “CramerCare”, looks to transfer the cost of healthcare onto low-income families, children with disabilities, and senior citizens. Under CramerCare insurance CEOs get a tax cut at the expense of subsidies to working families to buy coverage. In North Dakota, the oil industry gets a tax cut at the expense of quality care for our most vulnerable through state Medicaid dollars.

If the cost of care were to continue to go up after this plan is implemented, would the federal government raise its Medicaid allotment to the states? Will the states be forced pick up more of the Medicaid tab? Could this lead to healthcare rationing if states decide not to make the necessary budget transfers? Remember, in North Dakota our Constitution requires a balanced budget. What happens if our budget sees wild swings because of our volatile budget structure? I think these are legitimate questions that need answering.