Medicaid cuts...people will die

Eight years ago, when the Affordable Care Act (ACA) was up for repeal, then-Governor Jim Justice and Senator Capito helped walk the nation back from the brink.

 Justice described the consequences of undoing Medicaid expansion, which covered around 175,000 West Virginians at the time, as “beyond catastrophic.” Capito said that “I have serious concerns about how we continue to provide affordable care to those who have benefitted from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis.”

They were right then and still are today.

Recently, public health experts from Yale University and the University of Pennsylvania calculated the butcher’s bill that would happen if the House version of the budget bill passes as is and it’s pretty awful. They estimate that proposed Medicaid cuts could cause 51,000 premature deaths per year, just to pay for tax cuts for the rich.

That’s more than the combined populations of Calhoun, Tucker, Gilmer, Pleasants, Doddridge, Pocahontas, and Clay counties. Or several thousand more than the populations of either Charleston or Huntington. 

According to the Yale School of Public Health, “The researchers estimate that 42,500 lives could be lost each year from disenrollments in Medicaid and Marketplace coverage and the rollback of nursing home staffing rules. An additional 8,811 deaths are projected from the expiration of the enhanced Affordable Care Act (ACA) Premium Tax Credits, bringing the total to more than 51,000.

To be specific, 7.7 million people would lose Medicaid or ACA marketplace coverage, with a loss of an estimated 11,300 deaths per year. 

Eliminating the Medicare Savings Program would disenroll 1.38 million seniors, at a cost of 18,200 deaths per year. 

Ending nursing home staffing rules could cost 13,000 lives. 

Ending ACA premium tax credits is likely to push another 5 million off, at a cost of over 8,800 preventable deaths a year. 

In addition, the bill’s failure to extend the ACA’s enhanced premium tax credits is expected to push another 5 million Americans into uninsurance, resulting in 8,811 more deaths each year.

This isn’t a matter of random number generation. According to Yale, researchers relied on peer-reviewed studies that “quantifying the relationship between insurance coverage, access to prescription drug subsidies, and nursing home staffing levels with all-cause mortality.” This data was then applied to projections released in May by the nonpartisan Congressional Budget Office.

Recently, Iowa Representative Joni Ernst stirred up controversy by dismissing concerns like these, saying “we are all going to die.”

Maybe so. But working class people don’t have to die prematurely in the tens of thousands every year just to enrich the wealthiest. 

This is totally preventable.

(This appeared as an op-ed in the Charleston Gazette-Mail.)

Big bad ugly bill

 British author and poet George Orwell wrote in his 1946 essay Politics and the English Language, “In our time, political speech and writing are largely the defense of the indefensible.”

While confronting the monstrosity of the so-called “big beautiful bill” that recently passed the House of Representatives, one might imagine Orwell hollering at us from the past, “Did I call it or what?”

If this bill didn’t have life or death implications for millions of Americans, we could almost laugh at the recent image of moneyed politicians, victorious after the bill narrowly passed the House, their pockets lined with corporate cash, standing behind a sign that reads: “One Big Beautiful Bill Act.”

But nothing funny nor beautiful can be found in a bill that adds trillions of dollars to the national debt, strips health care and food assistance away from millions of Americans, all to pay for an extension of tax cuts, the lion’s share of which benefit the wealthiest one per cent. 

How could we be fooled into not seeing that this budget bill is what economics columnist for the Washington Post Catherine Rampell calls “a transfer of wealth from the poor to the rich”?  

At over 1,000 pages, I’ll concede that the bill is big, which is by design.  The sheer volume of it, the number of programs and tax policies it touches makes it difficult for most of us to understand all the implications of a budget bill this size.  My friend and colleague with American Friends Service Committee Rick Wilson has often quipped, “Taxes and budgets are boring. Breathing is boring too until someone starts choking you, in which case it’s fascinating.”

We should be fascinated – and equally horrified - by what is in this bill. According to Urban-Brookings Tax Policy Center, two-thirds of the proposal’s tax cuts benefit only those earners in the top quintile of income brackets.   

Cuts to the corporate tax rate, which decreased from 35 per cent to 21 per cent after the tax cuts were originally passed in 2017, would be made permanent.  Those corporate tax cuts have helped drain our federal coffers.  From 2018 to 2021, according to an analysis from the Institute on Taxation and Economic Policy, the top corporations in the US saved a combined $240 billion in taxes.

This massive transfer of wealth from the poor to the rich is made plain by the fact that the tax cuts would be paid for largely by cutting people off Medicaid and SNAP.  

Words like “waste, fraud and abuse” hide the bill’s true aims.  Stereotypes of an unworthy poor person are updated.  President Ronald Reagan used the racialized trope of “welfare queen” to defend welfare reform in the 1980’s.  Today Speaker Mike Johnson describes “29 year old males sitting on their coach playing video games” to gin up anti-poor resentments and peddle the myth that food and health care are luxuries only for those who are deserving.

Political dog whistles are used to support radical changes to the Medicaid program via “Medicaid work requirements” that would, by design, drown people in bureaucratic paperwork.  Quite cynically those who support this bill are not hiding the math: the tax cuts will be offset in part by the number of people projected to be cut off Medicaid.   

The Congressional Budget Office’s latest cost estimate shows that the Medicaid provisions would increase the number of uninsured people by 7.6 million. Over 90,000 people in West Virginia would eventually lose health care coverage.  

When Arkansas instituted work reporting requirements, more than 18,000 people lost Medicaid coverage, mainly due to failure to regularly report work status or document eligibility for an exemption. 

The hypocrisy of the proposed reporting requirements is staggering.  As New York Times columnist Ezra Klein points out, so-called work requirements are “an effort to weaponize the very bureaucratic inefficiency that they otherwise pretend to condemn and root out — against the weakest and most powerless segment of society: people who do not make enough money to get health insurance.”

“Medicaid work requirements” sound good which again is by design. The language obscures the fact that two thirds of people who receive Medicaid via expansion under the Affordable Care Act are already working full or part time.  The other third of people are not working due to caregiving responsibilities, unaffordable child care, or any number of life complications that crop up, particularly when facing economic hardship every single day.  

Orwell concludes in his essay on politics and language, “One cannot change this all in a moment, but one can at least change one’s own habits, and from time to time one can even, if one jeers loudly enough, send some worn-out and useless phrase into the dustbin where it belongs.”

I surely hope that the better and wiser angels of our nature carry the day, and that we all jeer loudly enough to send the “one big beautiful bill” into the dustbin where it belongs.  

(This op-ed by Lida Shepherd appeared in the Charleston Gazette-Mail)

Senate needs to step up for SNAP

 I hope that West Virginia’s congressional delegation brings some sanity and humanity into policy decisions being debated in Congress. 

A case in point is the reconciliation bill that passed the US House Agriculture Committee that would blow up Supplementary Nutrition Assistance Program (SNAP) food assistance for millions of Americans—and thousands of West Virginians-- to pay for more tax cuts aimed at the very wealthy.

Let’s start with where we are now. In West Virginia, around 124,000 households with around 279,000 people receive SNAP food assistance, including over 90,000 kids and almost 11,000 veterans. That’s around 15 percent of state residents. The program brings close to $50 million per month to the state’s economy.

That money goes directly to local businesses and farmers markets, keeps 2,170 retailers, including endangered rural grocery stores, open, and creates a lot of jobs. In fact, the annual amount of SNAP benefits in our economy is enough to support around 19,000 jobs at $30,000 a year.

According to the Food Research and Action Council, in recent years 69 percent of SNAP households here had at least one member working outside the home; 38 percent had at least one older adult; 43 percent had children; and 54 percent had at least one member with a disability.

All that would change and lots of people would be hurt if the House plan goes through. It would cut SNAP funding nationally by around $300 billion, resulting in a loss of food assistance to 11 million people.

Among other things, the plan would blow up already strained state budgets. It would require states to pay between 5 and 25 percent of the costs of benefits, while doubling state administrative costs. Given the ongoing budget woes facing our state, in part due to recently enacted tax cuts benefiting the wealthiest individuals and businesses, it’s highly unlikely that our state legislature would be willing or able to make up the difference.

It would erode the value of benefits as the price of food increases.

And it would double down on bureaucratic paperwork and work reporting requirements that do nothing to promote work and do everything to provide excuses to kick people off. It lifts the age of these requirements from 54 to 64 for older adults. It makes it harder for states to get requirement waivers.

It would completely eliminate SNAP-Ed, an evidence-based program that helps low-income families access fresh and healthier food.

It will eliminate food assistance for refugees and asylum seekers, many of whom are children and seniors.

One especially mean feature is that it would end exemptions from work reporting requirements for parents of children aged 7 to 17 without any allowances even for the months when school is not in session. It’s a mystery how they expect parents of young children to afford to pay for child care, which can cost more than college tuition, if their income is low enough to qualify for SNAP. And it totally disrespects the value of caregiving and raising children. SNAP eligibility changes may also make it harder for children to qualify for free school meals.

This will have negative social ripple effects that will be felt coast to coast and hit especially hard here. It will have negative effects on the economy, education, public health, and the quality of life.

And the purpose of creating all this unnecessary suffering (not even counting the even larger amount of proposed Medicaid cuts) is to pay for a tax cut bill that would overwhelmingly benefit the richest one percent at the expense of children, seniors, and working families.

I’d like to think that Representatives Miller and Moore would reconsider their support for this, but if not, it’s going to be up to the US Senate to stop this trainwreck. And a lot will depend on the voices and votes of Senators Capito and Justice.

(This ran as an op-ed in the Charleston Gazette-Mail. Text written before last night's house vote.)

Saving Medicaid: in their own words

 While going through some old files, I came across a copy of an interesting letter dated June 29, 2017, from then Governor, now Senator, Jim Justice to Senator Shelley Moore Capito. The subject was the looming threat of the repeal of the Affordable Care Act (ACA) and especially Medicaid expansion.

Here are some excerpts:

Since so many of our people count on Medicaid, any cut to Medicaid would destroy families in West Virginia. We can’t put the 175,000 West Virginians who benefit from the Medicaid expansion at risk of losing coverage. The consequences would be beyond catastrophic.

In the face of our drug epidemic, fewer people would have access to drug treatment programs under the current proposal. As the debate moves forward, I hope you and your colleagues will consider the fact that it will only make it harder to combat the drug problem that’s ravaging West Virginia.

I think he nailed it then—and his words still apply today, arguably more than ever.

To her credit, Senator Capito issued this statement on July 18 of that year:

As I have said before, I did not come to Washington to hurt people. For months, I have expressed reservations about the direction of the bill to repeal and replace Obamacare. I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis. All of the Senate health care discussion drafts have failed to address these concerns adequately.

My position on this issue is driven by its impact on West Virginians. With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.

I think she nailed it too.

Eight years later, we’re facing a similar threat. This time around, the issue isn’t directly repealing the whole ACA, although it might as well be. Instead, it’s a federal budget reconciliation package that would cut $880 billion from Medicaid (not to mention $230 billion in SNAP food assistance and $12 billion in school meal funding) to pay for more tax cuts for the very wealthy.

A cut that huge would truly be, as Justice said, beyond catastrophic across the US and especially in low-income states like West Virginia. Our already dismal health statistics would get worse. Minor issues will turn major. Substance use disorder will go untreated. The cost of emergency room visits and uncompensated care will grow and be passed on to others. Rural hospitals will close. Jobs will be lost. And people will die.

The margins in Congress are razor thin. Our senators’ votes could influence the final outcome, especially after the House voted to throw us under the bus. I hope they take their own advice and side with the people of West Virginia again.

(This appeared as a column in the Charleston Gazette-Mail.)

Budget bill a disaster for West Virginia

 The US House of Representatives recently voted on a proposed budget that would cut $880 billion from Medicaid and $230 billion from SNAP food assistance while also slashing other programs, including meals for school children…to give $1.5 trillion in tax cuts aimed mostly to benefit the very wealthy.

The measure passed by just a two-vote margin. Both of West Virginia’s representatives voted for it. 

If this becomes law, the damage done to West Virginians across the board would be incalculable. 

Medicaid alone provides health coverage to over 72,000,000 people nationwide and to more than 500,000 West Virginians, including working adults, children, seniors, pregnant women, people with disabilities, and people getting treatment for substance use disorder. That’s close to one out of three of us. 

We’d be hit harder by this than most other states. Nationwide, one out of five people are covered. It’s almost double that in West Virginia.

According to the Kaiser Family Fund, as of August 2024, around half of all childbirths are paid for by Medicaid here, while nearly the same percentage of children are either covered by it or the Children’s Health Insurance Program. It’s the major source of people needing long-term care, including 7 out of 9 people in nursing homes. It provides benefits for 40 percent of people with disabilities.

And while it covers many people who are too young or no longer able to work, most adults receiving it are employed.

The funding, most of which comes from the federal government, supports local economies, keeps rural hospitals open, and keeps people alive. It’s no exaggeration to say that if this goes through, people will die as a direct result. And people would lose their jobs.

If that wasn’t enough, the budget would reduce SNAP food assistance to 42 million people. As with Medicaid, we’d take a disproportionate hit here as well. Our state ranks third highest in the percentage of SNAP households, just behind New Mexico and Louisiana. Nationally, around 12 percent of people receive SNAP, while it’s 16 percent here.

According to the Food Research and Action Center (FRAC), SNAP helps 124,000 households here, or 279,000 individuals. It brings over $40 million a month to the state, helping 2,170 grocery stores and farmers markets and creating jobs. It’s estimated that each dollar’s worth of SNAP spending generates around $1.80 in economic activity.

Households receiving SNAP include children, the elderly, people with disabilities, and veterans. As with Medicaid, most SNAP households include at least one working member. And if you’re worried that these people are living high on the hog you can relax. The average daily benefit here is $4.54 per person.

On top of all that, the budget bill cuts $12 billion in funding for school breakfasts and lunches and makes sweeping restrictions to the Community Eligibility Provision (CEP), which supports meals for all. FRAC estimates this will reduce access to food in 24,000 schools with 12 million students. 

In West Virginia, we’re talking about impacts in 468 schools with over 180,000 students. This would undo years of progress at the national and state level. CEP has proven very popular in every county in West Virginia since it cuts bureaucracy, improves child nutrition and educational outcomes, removes stigma, and gives working families a break.

The combined impact of these proposed cuts would hurt people across all political and demographic lines. Fortunately, it’s not a done deal. There will be more votes on this over the next few months.  This could give time for people to voice their concerns and for lawmakers to reconsider their actions. 

It’s important to also urge our senators to put the brakes on this. To her credit, Senator Capito said back in 2017 “I didn’t go to Washington to hurt people,” when huge health care cuts were on the agenda. As governor, Jim Justice expanded food aid to low-income children when school was not in session and established the Jobs and Hope program.

Before it’s over, I hope at least some of our representatives will put the people of West Virginia above all else.

(This appeared as an op-ed in the Charleston Gazette-Mail)