RYAN TAYLOR: Medicaid and North Dakota Healthcare

Real people, real issues, real close to home.

In October, 2010, I was campaigning for my third term in the North Dakota senate in the town of Rugby, the biggest city in my district with a population of 2,900 people. I was going door to door–introducing myself, leaving my brochure, asking to earn their vote. This particular afternoon, I was at one of the mobile home parks, and I came to a home with a young girl outside raking leaves. She said her dad was inside, so I knocked on the screen door, saw a young father inside peeling potatoes with a toddler nearby, and I said, “Hi, I’m Ryan Taylor, I’m running for the state senate. I just wanted to visit a bit and hopefully ask for your vote.”

He stopped what he was doing, looked up at me and said, “Are you Bud’s boy?”. Coming from a fella so much younger than my dad, younger than me, stopped me cold. I said, “Yeah, I am Bud’s boy.” He said, “I used to take care of your dad.” You could have knocked me over with a feather. My father had passed away about five months before, after spending a year and a half in long term care at the Rugby hospital with advanced Parkinson’s, dementia and the many difficulties of age. I visited Dad regularly and knew many of his caregivers, but this kind young father worked the night shift and I had not had the honor of meeting him.

He invited me in, and I sat down and visited with him a good long while about Dad, his work at the hospital, his new work at the manufacturing plant where he had just changed jobs, his family and some of our work in the senate. It helped me realize that when we discussed things on the senate floor like ‘FMAP’  and reimbursement rates for Medicaid and our long term care providers, we were talking about the care for my father and the other residents, half of whom, on average, depend on Medicaid for that care. It was about the wages this gentle caregiver would earn to do that physically demanding, emotionally difficult work and support his family. It was about the very financial viability of that rural hospital and clinic, the largest employer in my rural senate district. Medicaid hits close to home.

Now, far from home, after working behind closed doors and in the dark for several weeks, the U.S. Senate has now come out with their ideas to re-vamp health care and health insurance, including Medicaid, in the United States. Thirteen men have authored a proposal that will impact one-sixth of the U.S. economy–without hearings. It has become clear why the plans were kept under wraps: the proposals from the Senate make deep cuts to the programs that help us all care for the most vulnerable in our society: children, pregnant women, people with disabilities and seniors in long term care. The Senate cuts to Medicaid are even deeper than the cuts that passed in the House version last month.

The health reform proposals fundamentally change the Medicaid system. Medicaid has been in place for nearly 52 years. Many of us have lived our entire lives knowing that there is a safety net that will help to hold up those of us with the fewest resources and some of the toughest health challenges. The proposals take away the guarantee that the federal government will contribute a certain share of care for each person who needs it. In its place is a proposal to place a per person limit  or “per capita cap” on the federal share. How this plays out is that care will have to be cut, or a state budget will have to fill in the gaps. At a time when the North Dakota Legislature has just made significant budget cuts and the majority Republicans refused to even revisit previous tax cuts to out of state corporations and oil companies, things do not look good for the 118,000 people that we care for through Medicaid or Medicaid Expansion.

If the Senate bill passes, and then passes the House and is signed by the President, North Dakota will have some unsavory options to try to make up for cuts. States could raise taxes (unlikely), make other budget cuts (unimaginable for colleges, local governments, and agencies already hard hit), reduce Medicaid “optional” benefits through waivers, limit coverage of high cost enrollees, or reduce rates paid to providers including hospitals, doctors and medical caregivers, clinics, schools, and more.

No matter which version, House or Senate, of health care reform is considered, cutting services or limiting the numbers of people who can receive services will be a fact of life or death for these people who receive care thanks to Medicaid:

• About 1 of 3 kids in our state who can be seen by a doctor when they’re sick, including children with special and complex healthcare needs
• About 1 of 3 people with disabilities
• Half of all people living in long term care facilities
• 19,000 North Dakotans who are covered under Medicaid Expansion, about 58 percent of whom live in rural areas

Medicaid Expansion, by the way, would be totally phased out over 6-7 years. Cutting Medicaid Expansion could burden North Dakota hospitals with $542 million in loss of revenues and $24 million in uncompensated costs as it gets phased out. This could be a life or death situation to our rural hospitals like the ones I supported as state director for USDA Rural Development, who have rallied under Medicaid Expansion, but could find themselves back on life support. Hurt yet again would be Indian Health Service facilities in the state who are already under-funded. Medicaid Expansion reimbursements have allowed them to add staff and become more stable. Losing Medicaid Expansion would send them backwards.

Backwards: who would think that in a country as strong, advanced and admired as the United States, we would even think about going backwards when we have been taking care of each other for over half a century. Backwards: that is what these proposals are. Senator Heitkamp has pledged not to vote for bills that would take us backwards. Wouldn’t it be grand if Senator Hoeven could link his arm across the aisle and be part of a team of two U.S. Senators working for North Dakota’s people first. If you think that is how we should move forward, please contact Senator Hoeven’s office and let him know that.

Guest post by Ryan Taylor, former state senator. Written with Karen Ehrens, health and healthcare advocate.