Right before the July 4th holiday, the Congressional Budget Office (CBO) released a new analysis of the Better Care Reconciliation Act (BCRA)—the Senate’s Trumpcare plan—showing that the bill would cut Medicaid by a whopping 35 percent by 2036, an astronomical figure that would devastate the program.

A previous CBO report showed that federal Medicaid spending would be cut by 26 percent, or $770 billion, by 2026. The latest report extended the CBO’s analysis another 10 years to show how the BCRA’s Medicaid caps would further slash funding for the program by over one-third,  shrinking funding available to the states.

Cutting Medicaid by 35 percent over 20 years will have a devastating impact.

The CBO concludes:

Under this legislation, after the next decade, states would continue to need to arrive at more efficient methods for delivering services (to the extent feasible) and to decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches.

In other words, to continue their Medicaid programs, states will have to raise taxes, cut other areas of their state budgets, pay providers less, cut benefits, and/or decrease the number of people covered under Medicaid.

The CBO had previously estimated that 15 million people would lose access to Medicaid by 2026 under the BCRA. As a result of its extended analysis, the CBO now reports that it expects Medicaid enrollment to continue to fall even more in the decade following, meaning more people without access to healthcare, including lifesaving services.

Women make up the majority of Medicaid beneficiaries, and nearly 70 percent of adult women in the Medicaid program are of reproductive age. Medicaid is the largest provider of publicly-funded family planning services and pays for roughly half of all U.S. births. Medicaid covers more than 1 in 3 nonelderly women with disabilities, and nearly 60 percent of senior women on Medicare supplement their coverage with Medicaid. Medicaid pays for more than half of all long-term care costs, including nursing home care (women are two-thirds of nursing home residents) and home health care (women make up 62 percent of home health care patients).

With these dramatic caps and cuts to Medicaid, which services will be cut? Will there be cuts to care for postpartum depression, eating disorders, and/or reproductive health services? Forty-two percent of Medicaid funds are spent on providing services to people with disabilities. If funds are cut, which services will have to go? What about nursing homes? Medicaid pays for two-thirds of nursing home care, but when benefits are cut, will women be forced out?

Far from a healthcare bill, the BCRA is an attack on women’s health and lives. It decimates Medicaid and puts millions of lives in jeopardy in order to produce $541 billion in tax cuts for corporations and the wealthy.

Medicaid is a lifeline for millions of people. It allows women of all ages to receive basic healthcare. It allows older women, many of whom have gone through their savings and assets, to receive long-term care. It allows people with disabilities to receive appropriate care, whether medications, therapy, or community-based or in-home services, which free people to pursue jobs or an education, or simply to live with their families instead of in institutions.

Medicaid also creates jobs in the health care industry and is critical to state economies. Medicaid pays health care providers who hire and pay staff and purchase goods and services. Without Medicaid, jobs will be lost, hospitals—and in particular, rural hospitals—will be threatened, and states will lose additional revenue. Women will be disproportionately affected. Research by the National Women’s Law Center shows that women make up the vast majority of certain health care workers—80 percent of ambulatory health care employees, 76.6 percent of hospital employees, and 80.3 percent of nursing home and residential care facility employees, among other jobs. Medicaid spending supports these jobs in every state, and many of these jobs are held by women of color.

It is still expected that the Senate will vote in the coming weeks on a revised version of the Senate Trumpcare plan. Majority Leader Mitch McConnell has reportedly been trying to make tweaks to the BCRA to get the 50 votes he needs to pass the bill, but Medicaid still remains on the chopping block. Caps and cuts, however, would devastate the program and jeopardize the lives and livelihoods of millions—all so wealthy GOP patrons can get billions in tax cuts they don’t need.

Media Resources: Congressional Budget Office 06/2017, 6/26/17; Kaiser Family Foundation 6/22/17; The Commonwealth Fund;  National Women’s Law Center 6/26/17.

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