As the nation pauses Monday to remember those who died serving in the armed forces, a new report concludes that proposed cuts to the federal Medicaid program could affect health care coverage for some 29,000 South Carolina veterans.
Nationwide, about 1.75 million veterans are enrolled in Medicaid, the federal health care program for the poor, according to Families USA, a nonpartisan consumer health care group, and VoteVets, a veterans advocacy group.
The Trump administration’s newly proposed 2018 budget would chop more than $600 billion from Medicaid over a decade, leaving states to cut services to all enrollees, including veterans, said Andrea Callow, associate director of Medicaid initiatives for the consumer group.
And that’s on top of the $880 billion cut to Medicaid that’s being proposed in the American Health Care Act — the Obamcare replacement bill, she said.
“Taken together, that represents about a 40 percent cut in year 10,” she said. “Everyone is at risk with cuts of this magnitude.”
Medicaid is a lifeline for one in 10 veterans, according to Families USA Executive Director Frederick Isasi.
“This is nothing but a betrayal of the men and women who have served our country and rely on Medicaid for their health care,” he said. “This nation simply must not abandon those who have sacrificed so much for our nation.”
But South Carolina Congressional representatives said it’s too soon to worry about budget cuts.
“Congress will have its say, as no presidential budget — including this one — is ever passed directly into law,” said Kevin Bishop, spokesman for Sen. Lindsey Graham.
Others say part of the reason veterans are on Medicaid is because the Department of Veterans Affairs is poorly run.
The proposed budget includes an increase for the VA, they say, including $29 billion over the next 10 years for the Veterans Choice program — which allows vets to seek private medical care if they’re more than 40 miles from a VA facility or have waited more than 30 days for an appointment. That would account for any Medicaid funding cuts for vets who live too far from a VA facility, they say.
And the White House said the budget will reduce the national debt to below 60 percent of GDP by 2027 and shrink the deficit.
Getting needed care
About 340,000 veterans are insured through the Medicaid expansion under the Affordable Care Act, also known as Obamacare, while another 1.4 million are in the traditional Medicaid program, according to the report.
While many veterans get their care through the VA, many others live in rural areas far from VA facilities and others have transportation issues, Callow said.
“If … the VA facility is four hours away,” she said, “when you need to see a doctor for care, you’re not able to get to the VA.”
Also, not all veterans are eligible to receive coverage through the VA for reasons such as minimum service requirements and disability status, according to the report.
Those with extensive health care issues, such as traumatic brain injuries, PTSD and musculoskeletal disorders, are particularly vulnerable to budget cuts, the groups report.
About half of veterans in Medicaid are 64 or younger and therefore ineligible for Medicare, and about half of them had no other source of coverage, according to the report.
“Options for health care are always important to our warriors,” said Charlie Hall, president of Upstate Warrior Solution, a nonprofit that helps veterans.
“At times, they may need to use Medicaid or Medicare before accessing VA health care, or when something isn’t completely covered by the VA,” he added. “Any reduction to health care for our nation’s warriors makes it harder for them to transition and become stable citizens, contributing back to society.”
Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, said Medicaid is the foundation of health care for low-income residents, including many veterans.
“The 29,000 (South Carolina) veterans who gave so much to our country deserve a strong and stable Medicaid program to ensure that they get the care they deserve,” she said. “When Congress votes to cut and cap Medicaid, it is voting against those who serve us.”
At least 417,000 veterans make South Carolina their home – 33,346 of them in Greenville County and 8,851 in Pickens County, according to the VA. Another 16,126 live in Anderson County and 6,998 in Oconee County.
Dan Holtel, commander of the Disabled American Veterans chapter in Greenville and national deputy chief of staff for the organization, said any cuts that impact veterans would be bad.
But any veteran whose income is below the federal poverty level who was honorably discharged and served at least 180 days is entitled to a VA pension that covers all medical costs at VA or private medical facilities, he said. He added that the VA is working to improve the troubled Veteran’s Choice program.
While it isn’t clear how states will respond to funding cuts, historically they have reduced optional services like prescription drugs, mental health coverage and community-based services that keep people out of institutions, Callow said.
“Optional programs would be first on the chopping block,” she said. “All those services are at risk.”
States also typically tighten up eligibility requirements to cut the number of enrollees and reduce provider payments, which results in doctors dropping out of the program, she said.
“Medicaid is already a lean program,” she said. “If they keep slashing provider payments, we will see pressure on providers not to take patients.”
Without providers, people will go to hospital ERs for care, increasing the financial strain on those that are struggling, particularly rural hospitals, she said.
But Bishop challenged the report’s conclusions.
“Families USA is a very liberal group,” he said. “I’d take what they say about any Republican plans for health care – whether from Congress or President Trump – with a big grain of salt.”
Families USA said health care is not a partisan issue.
Michele Exner, spokeswoman for Sen. Tim Scott, said the Senate is in the process of drafting a health care bill that will return the nation to a “patient-centered healthcare system.”
“Sen. Scott is committed to working toward an American solution that will help provide access to quality, affordable health care to all Americans and protects our most vulnerable citizens,” she said.
More than 1 million South Carolinians are on Medicaid, including 662,000 children, 126,000 disabled adults and 67,000 elderly people, many in nursing homes, according to the state Department of Health and Human Services. And of the 13,400 in nursing homes, about 10,000 are 65 or older, spokeswoman Colleen Mullis said.
In fiscal 2017, DHHS’s Medicaid budget totaled $7.3 billion, including $1.2 billion in state funds and $5.1 billion in federal funds, she said. The department has asked for $7.6 billion in fiscal 2018, including $1.3 billion in state funds and $5.3 billion in federal funds.
So the proposed federal budget will devastate Medicaid overall, Berkowitz said.
“We will not be able to absorb the loss of federal dollars, which will mean reduction in services and potentially the number of people who get help,” she said. “It will pit the needs of children against the needs of seniors, hospitals vs. physicians.”
And adding to the roles of the uninsured hurts small business and the economy because Medicaid funds don’t go into the pockets of enrollees, but to local doctor offices, hospitals and community health centers, said Frank Knapp, CEO of the South Carolina Small Business Chamber of Commerce.
“If the Medicaid payments are reduced, so will be the number of employees in these provider businesses,” he said. “Fewer health care workers means less consumer demand in local communities, which hurts local small businesses and local economies.”
Nearly halving the Medicaid budget by 2026 will affect all enrollees, Callow said.
“You cannot cut that much out of the program and say someone won’t be hurt – seniors, disabled, children,” she said. “It’s impossible. Where’s the money going to come from?”