GOP healthcare bill's impact on the elderly and disabled

Until now, most discussions of the disastrous consequences of the Affordable Care Act (ACA), or "Obamacare" repeal have focused on issues such as the number of people who will lose coverage through the exchanges, the possible repeal of minimum essential coverage requirements, or funding for Planned Parenthood.

Almost unnoticed is the devastating effect the House-approved American Health Care Act (AHCA), or "Trumpcare" would have on seniors, the disabled, and the poor through benefit reductions and cost increases in two programs that have been a central part of the healthcare system for more than half a century: Medicaid and Medicare. The president's budget proposal adds to the misery.

For starters, this House version of Trumpcare, which is now being considered by the Senate, repeals the Medicaid expansion under the ACA. This expansion has provided simple access to health care for low-income residents in 32 states. The elimination of the Medicaid expansion and cuts to the basic program would eliminate nearly $1 trillion in funding for Medicaid over the next decade. Medicaid would be converted from an entitlement to a block grant to the states, and as is the nature of block grants, states would choose what to cover. Further cuts in to Medicaid in later years would be inevitable.

Medicaid currently is a federal-state partnership. The federal government reimburses each state for its share of any eligible expenses. (This reimbursement is 51.8% in Pennsylvania.)

Speaker Paul Ryan has been itching to get rid of Medicaid for years. Earlier in the House debates, Ryan cited the Medicaid block grant as a primary reason for conservative Republicans to support the AHCA. With a note of pride in his voice, he said: "We are de-federalizing an entitlement, block granting it back to the states, and capping its growth. That's never been done before."

Many people hoped that the Senate would moderate the disastrous House bill. Some even believed the President's campaign promise that he would protect Medicaid, Medicare, and Social Security. We already know Trump's promise was untrue, and it now appears that the Senate is considering even more radical legislation than the House passed. A team of Republican white men is working behind closed doors to craft the Senate version of Trumpcare.

If these proposals become law, they will force states to make tradeoffs between paying for the elderly and the long-term disabled. Disabled children will compete for funds against Alzheimers patients in long-term care, against the working poor, against disabled adults. Home and community-based care would be especially vulnerable. State legislatures will become the "death panels" that never existed in the original version of Obamacare.

These cuts will affect real people. Everyone has heard the stories. One Pennsylvania mother wrote: " relies on Medicaid to pay for the four therapies he gets every week so that he is able to grow and develop . to pay for the nurses who visit to provide care, the hospital visits , and the nightly intravenous feedings that I provide for him at home. Disability does not only affect the child. It affects the entire family, emotionally and financially. There is no way that our family could afford to pay for the therapies and medical care that Zachary receives without Medicaid. And, most importantly, if Medicaid is cut and the care that Zachary receives is taken away, he will not survive." (Pennsylvania Health Access Network, PHAN. healthcare stories collection)

A daughter of a Medicaid patient wrote: "Without Medicaid, we would have had to take mom into our home with round-the-clock care. That would have put my mom, my husband and I into poverty at some point, as we would have had to deplete our retirement savings to pay for her care." (PHAN)

Medicaid isn't a welfare program; it's a crucial part of our medical system. The Kaiser Family Foundation noted that Medicaid accounts for one in six dollars spent in the healthcare system and half of all money spent on long-term care. The inevitable result of converting Medicaid to a block grant is that funds will shrink year by year relative to the need. Who will Pennsylvania choose to cut? People with diabetes? Alzheimers? People needing nursing homes? Autistic children? People receiving opioid addiction treatments?

My parents had a successful business; my dad got a pension from his 42 years at the steel mill and they had social security payments. They were also the thriftiest people I ever knew. By today's standards, they had incredible savings when they retired. Yet even they outlived their savings and needed Medicaid at the end. If they needed Medicaid, most people will, sooner or later. Many disabled children and adults need it long before their final years.

Before Medicaid, often the only choice for families with an aging parent was to move the parent in with the family, often affecting the ability of a second spouse to work or the ability to afford college for the next generation. In other situations, children abandoned jobs and homes to move back in with parents. For more than 50 years, Medicaid has provided a measure of dignity for the aging and peace of mind for their families. The Republican proposals would end this.

Medicare would also be significantly impacted by adoption of Trumpcare. Medicare beneficiaries would experience increased deductibles, co-pays, and premiums, revenues to the Medicare trust fund would be reduced, and the insolvency date for Medicare would occur four years sooner.

Adams County has become an increasingly popular retirement destination. These seniors depend on the promise that was made to them when they were children or teenagers, when the Great Society Congress passed Medicare and Medicaid. Other citizens are equally reliant on these programs. Congress must not betray this promise.

Our member of Congress, Scott Perry, supports these assaults on safety net programs. He voted for the AHCA and is on record favoring massive cuts in Medicare, Medicaid, and Social Security benefits. Sen. Toomey is one of the leaders of the all-white-men committee of Senate Republicans working on a new bill that might match or exceed the viciousness of the House healthcare bill. It has been reported that Toomey is calling for even steeper cuts in Medicaid than the House bill made. Rep. Perry and Sen. Toomey are out of step with their constituents and they need to hear from us.

Leon Reed, guest writer for the DFA Healthcare Task Force, is a retired Congressional aide and defense consultant. He joined the Gettysburg chapter of Democracy for America shortly after he moved to Gettysburg.