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Spokane, Washington  Est. May 19, 1883

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Congress ignoring Medicaid’s vital role

While health care exchanges and Medicare occupy most of the health care debate, Medicaid has played an unsung role in providing a rosier outlook. It has surpassed Medicare in the number of people served: 74 million, or one in five Americans.

Slashing it would exacerbate current crises and create future ones.

The American Health Care Act, passed by the U.S. House, would reverse the direction the nation needs to go. That doesn’t mean the Affordable Care Act is the answer either, but it is more realistic about the future.

The Senate is working on its own plan, but most of the early talk has centered on pre-existing conditions, deductibles and premiums. Improving coverage is important, but senators cannot ignore Medicaid.

Under the ACA, 31 states and the District of Columbia accepted expanded Medicaid. Washington said yes; Idaho said no. But under the AHCA, this expansion would be phased out by 2020, blocking access to new enrollees. In addition, the feds would also pay less per person for traditional Medicaid by affixing budget caps that wouldn’t keep pace with medical inflation. The bill’s total changes to Medicaid would cut $834 billion in federal Medicaid spending between 2017 and 2026, according to the Congressional Budget Office. An estimated 14 million Americans would be removed from Medicaid rolls.

Pressure on states to fill the gap would grow, which explains why even Republican governors are worried.

In Washington state, the expansion has covered 595,000 people. In Idaho, it would’ve covered 90,000 people, according to calculations by Families USA, a nonprofit health care organization. Two-thirds of those Idahoans have jobs.

Though health care coverage has been expanded, more than half of people with mental illnesses do not get necessary treatment, according to Mental Health America, a nonprofit advocacy group. Cutting Medicaid would aggravate this problem.

As it is, Medicaid reimbursements are low, causing many providers to reject Medicaid patients. In addition, there is a shortage of mental health professionals; more than half of U.S. counties have none. The state is struggling to staff its hospitals. The Department of Veterans Affairs faces the same crisis.

Carlyle Care Center in downtown Spokane recently announced it’s closing its doors to more than 100 residents with severe mental illnesses and complex medical problems. Part of the problem is that Medicaid subsidies have not kept up with the cost of care.

The criminal justice system is trying keep those who need care out of jails, but slashing Medicaid would undermine that laudable effort, and costs would shift back to courts and incarceration.

Meanwhile, 70 percent of older Americans favor a government-administered long-term care insurance program, according to a recent Associated Press-NORC Center for Public Affairs Research survey. More than half are counting on Medicare to help cover this. It currently doesn’t. Medicaid does, though it’s limited to low-income people.

Like it or not, Medicaid is a critical component of the health care equation. Cutting it would cause real suffering and merely shifts costs elsewhere.