Medicaid: First Cut is the Deepest?

The Big Story – Josh Hawley: Don’t Cut Medicaid

“It’s safe to say the Trump coalition was not pulling the lever for Medicaid cuts in November…But many of my House and Senate colleagues keep pushing for substantial cuts, and the House will begin to hash out its differences in negotiations this week.”

From worst to less worse

By Tim Stewart

3-minute read

Over the last several months, health system leaders across the country have held their collective breath, straining to read tea leaves on what the new administration and a potentially hostile Congress might do to Medicaid. Many feared the worst, as draconian cuts seemed to be an inevitability.

As the events of the last week have shown, the inevitable has run into political reality. It turns out Medicaid is one issue where the Republican caucus in Congress is not moving in lockstep. What was once looking like catastrophic cuts is heading towards something bad – but perhaps not catastrophic.

While sometimes “It could’ve been way worse” can qualify as a win in the healthcare policy sphere, now that there is now an actual bill with specifics means there’s no need for provider organizations to sit back and wait for the worst to happen.

Instead, jump in – the deal space is open and that’s an opportunity to be seized.

This week’s op-ed by Sen. Josh Hawley, a Republican from Missouri, puts the opportunity in stark relief: The majority party doesn’t know what to think about Medicaid, and there are enough fractures in the Republican coalition that it seems the final bill will “cap, rather than cut” funding. This is not the “transformative change” to Medicaid that Rep. Chip Roy, Republican from Texas, and other hard-liners are seeking.

The fracture among Republicans is something hospitals would be wise to use in engaging with their representatives. The populist wing of the majority party feels strongly that extreme cuts hurt their voters. Hospitals know that extreme cuts hurt their patients. Turns out those voters and patients are the exact same people, so it would appear there’s common cause to be explored.

The goal now is to advance health system interests while at minimum keeping the changes where they are, but also pushing back against more extreme measures. Doing that will require healthcare organizations to demonstrate the following:

A clear sense of agency, not hopelessness. This is a moment to speak up. Not only are there differences between lawmaker factions, but patients/voters are also against cuts. We just showed that yes, people want change to our healthcare system but no, they don’t want it in the form of Medicaid cuts. It’s not outlandish to proactively and vocally move into the conversation and advocate for Medicaid. Your patients want that, their voters want that. It’s a safe space.

A nuanced perspective. While this is a moment to get involved, it may not be a moment to go scorched earth. There remains the possibility that the current bill is as good as it’s going to get, and the risk that cuts will deepen through bill negotiations. While the deal space is open, getting to a no-change position probably won’t happen. Again, the public is for some change (even if the form of that change is murky). So, take this initial bill as the first step toward a win and work from there.

A local voice. In what qualifies as a stunner in our current political environment, we might actually be looking at a moment of conversation and dealmaking in DC. Based on what’s in the budget bill, there’s an opportunity for further education and partnership with legislators. That opportunity can be maximized by using your deep familiarity with the people you serve and the people who represent them to have substantive, nuanced conversations about the local environment. This is hard, face-to-face work. How will you educate your representatives and local officials, along with the patients in their districts about the ramifications?

Be against the cuts but also be productive. Determine what your representatives need to hear and what you’re willing to contribute to the conversation. Provider organizations have – and therefore should take – some responsibility for change. If you don’t want that change to come from Capitol Hill, you need to clearly articulate the changes that your organization will pursue. Operate in good faith and bring what else you can do to the table. Need a message template? How about:

We’re working hard to innovate and address gaps and challenges. We see the cost of care, we see the gaps in access. Regardless of policy and regulation, we have a mission to address those things anyway. But you can’t expect us to do those things with funding suddenly gone. Let’s have a conversation about how we can innovate together.

Key to all of this is remembering that there is no one size fits all approach here. Only you and your team can speak to your local situation. The conversations happening in DC illuminate the broad national dynamics. But your tailored outreach will win the day, with local leaders and local organizations speaking to their representatives with local nuance. The deal space is open, how will you take advantage?