What many people don’t yet know is that Price, House Speaker Paul Ryan, and Trump have proposed making significant changes to Medicaid, the health insurance program that covers low-income people, including those with disabilities. These changes are not to make the program more efficient. Medicaid is significantly more efficient than private insurance; these changes are to finance tax cuts. The plan is to slowly reduce the dollars available, so that at the end of ten years, $1 trillion will have been cut from healthcare for poor people and people with disabilities.

Not surprisingly,  these cuts would be devastating.  What is more, the changes in how the system is run would  risk the fundamental right to freedom for people with significant disabilities.

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But Price and many other members of Congress want to turn back the clock and undo all of our hard-fought gains. They seek a radical restructuring of Medicaid that will allow them to significantly cut funding to the program. They propose turning the program into a “block grant” or by instituting a “per capita cap,” meaning that states would receive a fixed amount of dollars, and the federal government would no longer provide oversight or incentives. The federal oversight and incentive programs are what have reformed state systems to move from institutional care to community-based services. The result would be dangerously reduced benefits that support the autonomy of people with disabilities.  

Here’s my two cents from working in health care:

This comes at the same time as repealing but not replacing the ACA.  The ACA has provisions to help fund rural and underserved area hospitals. The ACA expands the number of hospitals that qualify for Medicare Dependent Hospital (MDH) support – read rural poor hospitals here.  (The ACA mandate to expand Medicaid coverage in every state was supposed to help them out even further – but the Supreme Court blocked the mandate and the states got to choose.)  

Together cuts to Medicaid and repeal of the ACA leave people with disabling conditions even more underserved and at risk.  With these deep cuts, people will no longer be able to pay for care and care that is local to them is either likely to disappear or, if it’s still there, will be even less able to absorb the cost involved in providing services to people who can’t pay.    

And don’t forget, an average of half of enrollees in Medicaid are children.  Medicaid (along with CHIP and TEFRA) allows children with disabilities and chronic medical conditions to receive medical and therapeutic care that makes a huge difference in their lives.  It’s the great societal leveler that allows families who couldn’t afford it otherwise to access the kind of care that can make a huge difference in the child and family’s health and autonomy. Or just… continuance of life, to be honest.  If you want to know what the states are inclined to do with block grants without federal oversight, you have to look no further than Texas, that made $350 million in cuts in reimbursement to early childhood therapists just this December. 

Without decently funded Medicaid, it creates greater dependence on the school system to provide therapies – whose mandate is to only address those things that help the child benefit from instruction.  This comes at the same time as Betsy DeVos and her platform of vouchers and charter school, freeing up public funds for private schools.  Don’t forget, private schools are not mandated to serve children with disabilities.  The IDEA doesn’t cover private institutions.  Private schools can reject whatever student they want to.  Even public charter schools tend to discriminate against children with special education needs.  

And it’s all going to hit the rural poor first.