A sign displayed by U.S. Senate Democrats at a Washington, DC press conference on Feb. 19, 2025. (Photo by Shauneen Miranda/States Newsroom)
Among the North Carolinians who will have the stability of their lives disrupted by the massive Medicaid funding cuts and policy changes making their way through Congress right now in the so-called “one big, beautiful bill” are many of the people I and my colleagues work to assist at the Raleigh-based nonprofit, Healing Transitions.
As our website explains, Healing Transitions offers innovative peer-based, recovery-oriented services to homeless, uninsured and underserved individuals with alcoholism and other drug addictions. Our program is specifically designed to rekindle a person’s desire and ability to return to a meaningful and productive life.
Over the last year, we have made some especially encouraging progress by getting clients with medical issues enrolled in Medicaid. Now, when they finish the program after a year or more, they leave with a job, drug-free housing, connectivity to the recovery community, and a relationship with a primary care physician through Medicaid coverage. The latter arrangement results in better management of chronic medical conditions such as high blood pressure and diabetes. These men and women have less emergency visits and less hospitalizations.
Unfortunately, under the terms of giant budget reconciliation bill advancing in Washington, this progress is in jeopardy. Under the Medicaid changes contained in the legislation, enrollees will be subject to new work requirements and mandated to undergo periodic re-registration to verify their employment. While work requirements themselves will not be a problem for our clients, the administrative hassle of complying will undoubtedly cause problems.
The inevitable result: Medicaid coverage will lapse in some cases and so too will the patient’s relationship with their primary care physician and their management of health issues. Health care costs will inevitably increase, and health quality will decline.
In the few states where work requirements for Medicaid coverage have been previously implemented, administrative costs have exceeded savings in healthcare expenditures. Also, deficient compliance with these administrative steps have brought interruption of Medicaid coverage.
In the United States, we spend twice as much per person as other industrialized nations on health care, and we have worse health outcomes. Our average life expectancy is lower, and we have more preventable deaths. We are the only industrialized nation without health insurance in one form or another for all citizens. Why can we not learn from those examples?
Sadly, the proposed Medicaid cuts will double down on our failed model. With congressional approval of this “big, beautiful bill” our nation will move in the wrong direction when it comes to both healthcare costs and health outcomes.
Do we care? By all indications, far too many of our elected leaders do not.
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