President Donald Trump lauded the massive “one big, beautiful bill” that narrowly passed the U.S. Senate on July 1, which includes tax cuts, slashes clean energy incentives, increases spending for defense and border security, and chops more than $1 trillion from Medicaid and other health care benefits as part of a domestic agenda aimed at eliminating “waste, fraud and abuse” from the federal budget.
Democrats, including Michigan Gov. Gretchen Whitmer, joined a chorus of health policy analysts, leaders of medical associations and others this week, warning that if the bill passes the U.S. House and is signed into law, it could have “a devastating impact” on access to health care for the most vulnerable Americans.
Medicaid — the joint federal and state program that provides health insurance benefits to children, people with disabilities and poor people — covers about one-quarter of Michigan’s population — 2.6 million people — through traditional Medicaid, the Healthy Michigan Medicaid expansion plan and the Children’s Health Insurance Program (CHIP).
About 45% of all pregnancies and childbirths in Michigan are covered by Medicaid and about 60% of people with nursing home care are covered by the program, according to data from the state health department.
At least 200,000 Michiganders would lose health insurance coverage as part of the bill’s planned cuts, according to a report from the Citizens Research Council of Michigan, a nonprofit, nonpartisan public policy organization. The report noted that some analyses estimate the fallout could be as high as 700,000 people.
“If this One Big Beautiful Bill is signed into law as currently written, it would be the first time in the history of our country that Congress has moved to eliminate as opposed to expand health insurance coverage,” said Dr. Mark Fendrick, a professor at the University of Michigan and director of the U-M Center for Value-Based Insurance Design. “It would impact millions of Americans … and hundreds of thousands of Michiganders.”
Worse, he said, is that the legislation piles on by also cutting Supplemental Nutrition Assistance Program (SNAP) funding, which provides food for the very same people who could lose Medicaid coverage.
The Michigan League for Public Policy reported that 1 in 7 Michiganders — about 1.4 million people — rely on SNAP benefits. Among them are 41,000 military veterans with food insecurity.
“The shock of this bill is hard to overstate,” the nonprofit Michigan League for Public Policy said in a statement issued shortly after the bill passed the Senate. “Republican leaders just voted to spend trillions of dollars to increase poverty and hunger, to strip away health coverage, and to create the biggest redistribution of wealth from poor to rich in U.S. history.”
Fendrick said the cuts are likely to have a ripple effect.
“There’s the people who will lose Medicaid and then … another 120,000 Michiganders will lose their ACA (Affordable Care Act) Marketplace plans. … And then, it’s the billions of dollars that would no longer flow to hospitals and the increases in the uncompensated care,” he said.
‘Irreparable harm’ to vulnerable people, including children
The American Hospital Association said the legislation would do “irreparable harm” to the U.S. health care system, “reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients,” said Rick Pollack, its president and CEO, in a statement.
Among those vulnerable patients is 6-year-old George Johnson, of Warren, who was born with Down syndrome and relies on a Michigan Medicaid program called MIChild to cover appointments with about a half dozen medical specialists, said his mother, Taylor Johnson, 31.
George can say some words but mostly uses sign language and a device to help him communicate. He works with a speech therapist every week to “help him work the muscles in his mouth, connect his thoughts to his brain, and kind of learn how to get those expressed to us,” Johnson said.
“Kiddos with Down syndrome are predisposed to a variety of both severe and very minor medical issues — things like heart defects all the way to sleep apnea.”
George, who finished kindergarten a few weeks ago and loves music, has a heart defect. He wears glasses because of low muscle tone in his eyes and ankle braces because of low muscle tone in his feet. He sees an ear, nose and throat specialist for tympanostomy tubes and an endocrinologist to treat hypothyroidism.
“All these things sound really daunting in comparison to a child without a disability,” Johnson said, “but we have really great supports and connections. Those things don’t dictate his life as much as they sound like they might because they’re so well-controlled.”
George is “absolutely thriving,” said Johnson, who has a job teaching theater, working mostly in the summertime. Her husband, Kyle Johnson, 39, serves on the Warren Consolidated Schools Board of Education and works gig jobs in mortgage lending and politics.
“We have jobs that are great and provide a great family situation, but don’t often have workplace health insurance accessible,” she said. They bought a health plan for themselves and their daughter, Vera, who is 3, through the Affordable Care Act Marketplace.
“We have looked into adding George on our plan,” Taylor Johnson said, in the event that the Medicaid cuts in the bill leave George uninsured, “… but it would be just unbelievably expensive. It would be very difficult and we’d have to potentially sell our house or downsize to ensure that he could have this quality of care and quality of life.
“It’s very personal.”
Michigan to lose $2-$4 billion, forcing hard choices
Even people who have employer-based insurance plans could see fallout from the legislation, as hospitals, nursing homes, clinics and other health care providers would have to balance the books with fewer paying customers.
In Michigan, the loss in federal health care spending could total between $2 billion and $4 billion if the bill is enacted, according to the Citizen Research Council’s report.
With millions of Americans joining the ranks of the uninsured, Pollack said it could “force hospitals to make service line reductions and staff reductions, resulting in longer waiting times in emergency departments and for other essential services, and could ultimately lead to facility closures, especially in rural and underserved areas.”
Although the Senate’s version of the bill added $25 billion to a rural hospital relief fund, it’s unclear whether that will be enough to prevent closures.
“Just because the government will not be providing insurance to these people does not mean they will not get sick,” said Fendrick, who also is a primary care physician. “It does not mean they will not seek health care, and it does not mean that someone will not have to pay for it. And if they can’t pay for it, there will be significant ramifications of that.
“That’s why the hospitals and clinicians are all extremely worried — and particularly in those rural areas because a higher percentage of their revenues come from public payers. If they don’t get paid, then they shut down.”
The Citizens Research Council report concluded that the loss of insurance coverage also “generally leads to less preventative care, which in turn makes individuals more likely to end up needing emergency care down the road.”
Nursing homes at risk
Megan Callahan, 39, of Shelby Township, said she worries about what the legislation might mean for her family.
Her parents, Robert and Colleen Callahan, both 72, were high school sweethearts who have been married for 51 years. They worked hard all their lives to tuck away money for retirement.
“They’re very proud of the fact that they financially planned so well, when they retired, they were ready,” said Callahan, whose parents live in Oconto Falls, Wisconsin. Her dad worked at a paper mill and often took a second job to save extra money; her mom did clerical work and also worked for a local government office.
But two years after they both retired, Colleen Callahan got sick.
Now, “she has advanced dementia,” Megan Callahan said. “She started progressing last year to the point where my dad, who was her caretaker and was doing an amazing job … needed more support. She needed 24-hour care.”
They tried hiring in-home nurses, but it was too expensive. In December, Colleen Callahan moved into a nursing home that costs about $10,000 a month.
Megan Callahan, who works as a counselor at Macomb Community College, said she helped her dad apply for the federal Spousal Impoverishment Program through Medicaid, which could provide coverage for her mother to stay in the nursing home and allow her dad to keep the house they’ve owned for the last 20 years — if they’re approved.
With Medicaid cuts in the legislation now under consideration in the House, Callahan is on edge. Without it, she said, the options will be limited.
“I may have to quit my job and move back to Wisconsin,” said Callahan, who has lived in Michigan for 15 years and whose husband works in the automotive industry.
“I enjoy living in Shelby Township. I would love to stay here, but my mother does need 24-hour care, and without these programs to ensure that my mom can get that care and my dad’s needs still can be met, we would have to make some drastic changes to our lives.”
Her mom seems happy where she’s living now.
“You should see the way my mom smiles in this care community — we use that word instead of facility,” Callahan said. “They’re trained to take care of my mom. … It would be so heartbreaking to come this far to get her this care, and then have to lose it.”
Even if her parents get approved for the Medicaid Spousal Impoverishment Program and Callahan is able to stay in Michigan, she still worries about whether this “big, beautiful bill,” as Trump calls it, could lead her mother’s nursing home to cut back on staffing, programs that support the residents, or even to close its doors.
A survey from the American Health Care Association, which represents more than 15,000 long-term and post-acute care centers, found that 27% of nursing homes said they would have to close if the proposed Medicaid cuts are enacted.
Three-quarters said they would delay improvement projects and wouldn’t invest in new technology. Nearly 60% said they would reduce staffing and 44% said they would scale back on making new hires.
“I feel worried about all the what if’s,” Callahan said. “Even if she gets to stay, even if we figure out the financial piece, we might lose that smile from my mom’s face because they might have to cut funding for her care. … They might have to lose staff. … They might even have to close. … There’s no way we’re not going to lose anything.
“And then, let’s say that my family is protected, at the end of the day that just means some other family going through their own version of the hoops and loops for Medicaid will be affected. That’s where I’m losing sleep at night. I know how much pain and sorrow and fear we had, and I know that’s what other families are going through as well.”
While Fendrick said he agrees with Trump and Senate Republicans that the United States spends too much money on health care, he said they should use a scalpel rather than a sledgehammer when it comes to cuts like these.
“We need to be much more nuanced … about how we approach these things,” he said.
“Things are already very bad for really vulnerable populations and it’s only gonna get worse,” he said. “I think about support for pregnant people, I think about nursing homes, and I think about rural hospitals — all of which are in great peril if this bill were to be signed into law.”
The U.S. House began its final consideration of the bill July 2. Trump is pushing Congress to pass it before the July Fourth holiday.
Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Free Press.
This article originally appeared on Detroit Free Press: ‘Big, beautiful bill’ Medicaid cuts could affect 700,000 Michiganders — including George
Reporting by Kristen Jordan Shamus, Detroit Free Press / Detroit Free Press
USA TODAY Network via Reuters Connect
