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142 Organizations Call on Senator Toomey and Senator Casey to Protect Medicaid

June 16, 2017

June 15, 2017

Dear Senator Toomey and Senator Casey:

Our organizations write to express our strong opposition to legislative proposals, such as the American Health Care Act (AHCA), that would cause millions to lose their health care. In particular, we are deeply troubled by proposals that would undermine state Medicaid programs by capping federal funding on a per capita (or block grant) basis and phase out the Affordable Care Act’s Medicaid expansion.

For more than 50 years, the federal government has matched state Medicaid spending on health and long-term care for low-income children, parents, women, seniors, people with disabilities and other vulnerable populations. Medicaid has been a resounding success, providing cost-efficient and high quality health care to our state’s most vulnerable citizens. In fact, a 2016 national survey by the Commonwealth Fund found that Medicaid beneficiaries are just as likely to have a regular health care provider as those with private coverage and they rate the quality of care more highly than those with private coverage.

A critical component of Medicaid’s success has been the guaranteed federal payment match, which automatically adjusts to help states respond to public health crises and other factors that drive up health care spending. But under a capped payment system, our state would be on its own to manage higher costs. For example, our state could not count on increased federal funds to address a Zika outbreak or a worsening of the opioid epidemic. Our state could not count on increased federal funds to help grapple with higher costs due to treatment breakthroughs as experienced with the development of drugs for HIV/AIDS and more recently with hepatitis C. States with increasingly older senior populations like Pennsylvania would be on their own to manage the higher health costs resulting from such a demographic trend.

Under a per capita cap (or block grant), Pennsylvania would be forced to make up for the loss of federal support by narrowing eligibility, cutting health care services, reducing payments to providers or, more likely, all three. Because services for low-income older Americans and people with disabilities are costly, it is likely that they will be a focus for state spending cuts. Home care services are especially at risk since they are an optional service under Medicaid.

Once restructured, federal Medicaid payments would be at frequent risk of being reduced, or dialed down, in order to pay for tax breaks or other federal spending. This concern is validated by the budget proposed by President Trump which would further ratchet down per capita cap payments to states. This would upend the federal-state partnership and create even more uncertainty for budget planning in the state.

The AHCA is bad policy for children and would result in tens of thousands of Pennsylvania’s children whom are living at or near the poverty level to lose their Medicaid coverage. With 43 percent of Medicaid enrollees in the commonwealth being children, the program ensures that children who are identified with possible delayed or impaired development receive the services they need to become healthy adults. With the AHCA making essential health benefits a state option, the pediatric and preventative services children sorely need, including oral and vision care, could go away. Many early intervention and special education services required to be provided by Pennsylvania school districts that rely on Medicaid as a source of funding would be in jeopardy, driving schools to increase local property taxes to provide them. In addition, the Early and Periodic Screening Diagnostic and Treatment component of Medicaid, more commonly referred to as EPSDT, would be threatened. EPSDT ensures children, particularly those with complex needs, receive the check-ups and treatments they need.

We are also strongly opposed to the phase-out of the ACA’s Medicaid expansion under AHCA or any other proposal. More than 703,000 Pennsylvanians have gained Medicaid coverage through the expansion. These individuals, and those who become eligible in the future, are likely to lose this coverage once the enhanced federal match is ended. Proposals to phase out the expansion more slowly do very little to mitigate the ultimate harm of ending coverage for these low-income adults, many of whom work in low-wage jobs that do not provide insurance. This is especially true in rural areas where low-wage jobs are less likely to provide health coverage than jobs in urban areas.

We also caution you to consider the impact of Medicaid cuts on the state’s economy. The Medicaid program is a critical part of our health care infrastructure. There is no doubt that withdrawing $834 billion from health care over the next ten years will have a significant impact on health care employers and on the jobs they provide. The economic impact will be especially harmful in rural communities where hospitals and other providers are often the largest employers in the community.

For all of these reasons, we urge you to oppose any legislation that would cap federal Medicaid payments to the states or end the Medicaid expansion.

Sincerely,

ACLU of Pennsylvania

Action Together NEPA

AFSCME DC47

AIDS Law Project of Pennsylvania

All About Children Pediatric Partners, PC

Allegheny Intermediate Unit

Allies for Children

American Academy of Pediatrics, PA Chapter

Amy Requa Health Consulting, Inc.

APRI Philadelphia Chapter

Arc of Greater Pittsburgh/ACHIEVA

Art As Social Inquiry

Back Mountain Free Clinic

Bryn Mawr Peace Coalition

Bucks County Citizens for Health

Bucks County Women’s Advocacy Coalition

ButlerPA Indivisible

CASA of Philadelphia

Catherine McAuley Center

Catholic Social Services Scranton

Chester County Fund for Women and Girls

Children’s Hospital of Philadelphia

Clinician Action Network

Communications Workers of America 2-13

Community Check-Up Center

Community Health and Dental Care

Community Intervention Center

Community Legal Services of Philadelphia

Community Resources for Independence

Consumer Health Coalition

Crozer-Keystone Community Foundation

Delaware County Women’s Center

Dignity Housing

Disability Options Network

Disability Rights Pennsylvania

Education Law Center-PA

Emmaus Community of Pittsburgh

Face to Face

Family Practice &Counseling Network

For Pennsylvania’s Future

Free Clinic Association of PA

Friends Rehabilitation Program, Inc.

Genuardi Family Foundation

Give a Smile

Greater Philadelphia Coalition Against Hunger

Health Federation of Philadelphia

Health Professionals and Allied Employees

Healthy Philadelphia

HELP: MLP at Widener University Delaware School of Law

HIAS Pennsylvania

Homeless Advocacy Project

IHM Sisters, Immaculata

Insulators Local 14

Jefferson Regional Foundation

Jewish Social Policy Action Network

Juvenile Law Center

Keystone Progress

Lebanon Family Health

Legal Clinic for the Disabled

Linda Creed Breast Cancer Org

Lutheran Advocacy Ministry in PA

Machinists 1776

Maternity Care Coalition

Mazzoni Center

Mental Health Association in Pennsylvania

Mental Health Partnerships

Montgomery County Intermediate Unit

NAMI Keystone PA

National Physicians Alliance Pennsylvania

Nationalities Service Center

Nazareth Housing Services

One Pennsylvania

Pennsylvania Association of Community Health Centers

Pennsylvania Association of School Nurses & Practitioners

Pennsylvania Breast Cancer Coalition

Pennsylvania Chapter of the American Academy of Pediatrics

Pennsylvania Chiropractic Association

Pennsylvania Coalition for Oral Health

Pennsylvania Head Start Association

Pennsylvania Health Funders Collaborative

PathWays PA

Pennsylvania Association of Staff Nurses and Allied Professional

Pennsylvania Budget and Policy Center

Pennsylvania Council of Churches

Pennsylvania Federation BMWED-Teamsters

Pennsylvania Health Access Network

Pennsylvania Health Law Project

Pennsylvania National Organization for Women

Pennsylvania Partnerships For Children

Pennsylvania State Council of Machinists

Pennsylvania Statewide Independent Living Council

Pennsylvania Utility Law Project, on behalf of our low-income cl

People’s Emergency Center

Philadelphia Chapter of the Coalition of Labor Union Women

Philadelphia Council AFL-CIO

Philadelphia Unemployment Project

Philadelphia VIP

Pittsburgh Association for the Education of Young Children

Pittsburgh Center for Autistic Advocacy

Planned Parenthood Association of PA

Planned Parenthood Keystone

Planned Parenthood of Western Pennsylvania

Planned Parenthood Southeastern PA

POWER Northeast

POWER Philadelphia

PRO-A

PRO-ACT Public Policy Committee

Project HOME

Public Citizens for Children and Youth

Public Interest Law Center

QCHC

ReMed

Resources for Human Development, Inc.

Salisbury Behavioral Health

SEIU Healthcare Pennsylvania

Self Determination Housing Project

Senior Law Center

Southeast Lancaster Health Services

Southwest PA ADAPT

SpArc Philadelphia

Support Center for Child Advocates

Temple Association of University Professionals

The Arc of Adams County

The Arc of Cambria County

The Arc of Chester County

The Arc of Crawford County

The Arc of Dauphin County

The Arc of Erie County

The Arc of Jefferson & Clearfield Counties

The Arc of Lancaster County

The Arc of NEPA

The Arc of Pennsylvania

The Arc of Philadelphia

The Arc of Washington County

UAW Region 9

UFCW 1776

Visiting Nurse Association-Community Services

Voice of Westmoreland

Women’s Law Project

YWCA Greater Pittsburgh