Last week I saw a 10-year-old boy — I’ll call him Omar — with asthma in my primary care clinic. As I listened to his lungs and checked his breathing, I couldn’t help but think about what President Trump, his administration, and the Congress might do to Medicaid, which Omar’s family relies on to pay for his medical care.
Omar is part of a very large group. Two-thirds of the patients in my clinic at Boston Children’s Hospital are enrolled in Medicaid. More than 1 in 3 children in the United States, or nearly 30 million Americans under age 18, get their health insurance through Medicaid. Many of their families, like Omar’s, are the working poor — both of his parents work very hard but are barely able to make ends meet.
In Trump’s address to Congress two weeks ago, he said that “we should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.” That sounded promising. Yet all other signs from Washington are that many Americans will be left out.
House Republicans released the American Health Care Act, their replacement for Obamacare. It would freeze any expansion of Medicaid until 2020, and then phase out the expansion completely after 2020. It would also change the funding mechanism of Medicaid to “per capita caps” that would set limits to federal funding over time. Together these changes would reduce federal funding for Medicaid for states by 25 percent, or $880 billion over the next decade. Millions of Americans would become uninsured or underinsured.
Medicaid provides tangible benefits that save lives. I witness its impact every day with my patients. Through Medicaid, they receive access to primary care and preventive health services, vaccines, vital medications, mental health services, specialists, and hospital care. The national impact is striking. Having health care covered by Medicaid lowers infant and child mortality and improves self-reported mental health.
The benefits go beyond health. Children covered by Medicaid are more likely to graduate from high school and college and, on average, pay more taxes at age 28 than children who did not receive Medicaid. Amanda Kowalski, an economist at Yale, worked with tax analysts at the Treasury department and found that for every dollar the government spends on Medicaid for children, it would recover 56 cents in tax revenue by the time they turned 60. And this does not even include the increased value to the economy that these healthier, better-educated individuals would provide.
As a physician, I know firsthand that there is a lot of waste in our health care system. Many argue that cutting Medicaid would help chip away at this waste by putting financial pressure on state Medicaid programs to be more efficient. But even successful system redesigns have achieved only modest gains in efficiency, not nearly enough to keep up with the funding cuts proposed in the GOP-sponsored plan. States would inevitably have to make hard decisions about cutting Medicaid enrollees, benefits, or both.
If Omar lost Medicaid coverage, his family would struggle to pay for the medications that keep his asthma in check. He would have more, and more severe, asthma attacks that would keep him out of school and likely put him into the hospital. With each health scare, his family could face a debilitating financial hit that destabilizes their home life. If Omar became depressed about his illness and his family’s financial struggle, he wouldn’t be able to pay for treatment. He would be less likely to finish high school, let alone college. His job prospects would be worse. And he would be more likely to depend on government benefits as an adult.
It’s abundantly clear to me that Medicaid helps kids like Omar climb higher. I urge our lawmakers in Washington to think twice before repealing the expansion of Medicaid and reducing overall funding for the program.
Providing health insurance for children whose parents would otherwise be unable to afford it has been one of the shrewdest long-term investments our government has made. Pulling the rug from underneath millions of our country’s children by crippling Medicaid will only imperil our nation’s future prosperity.
Ali Alhassani, MD, is a resident physician at Boston Children’s Hospital and Boston Medical Center. As a Rappaport Public Policy Fellow, he worked at the Massachusetts State House in the Joint Committee on Health Care Financing. The views expressed here are his own, and not necessarily those of his employers.