This is what happens when Congress values politics over policy: Medicaid payments to Erie County Medical Center are about to be hacked by two-thirds because Congress failed to renew a key portion of the federal-state program by Oct. 1.
The precise consequences are as yet unknown, but they will likely be paid by ECMC, which will continue to serve the poor and uninsured patients whose care those Medicaid payments helped to underwrite. In a just world, every congressman who ignored this issue would pay a high price, as well.
It’s going to be a blow. The state has notified ECMC that its payments would be slashed by $29 million. The hospital had requested $44 million. In 2015, it got $59.2 million in similar payments, or just over 10 percent of its total revenues of $553 million.
Congress can’t protest ignorance. Although members are inundated with issues that demand attention, a coalition of state officials, including Gov. Andrew M. Cuomo, has warned about the consequences of inaction.
“For months, Governor Cuomo has repeatedly and publicly warned of the devastating impact these federal cuts will have on New York’s hospitals,” said State Medicaid Director Jason A. Helgerson. “These cuts directly impact your institutions – the public and safety-net hospitals that provide critical care to millions of our most vulnerable citizens.”
It’s true that Washington is in the midst of what might charitably be called a review of national health policies. Changes are certainly likely, given the problems of the Affordable Care Act and the disdain that President Trump and many members of Congress hold for the law.
But surely it’s not too much to ask that Congress not weaken hospitals that provide care to the country’s most vulnerable citizens. Those people will still be able to secure care at ECMC and hospitals like it; the only question is who is going to pay the bill.
If it’s ECMC, other costs will rise or the hospital’s health care will be put at risk. One way or another, though, someone is going to pay.
Medicaid, created in 1965 and expanded as part of the 2010 Affordable Care Act, has been a critical part of that cost equation. The program, funded by Washington and the states, varies from state to state, but at its root ensures that poverty isn’t a bar to medical care.
It’s not perfect. New York’s costs are notably higher than other states and Albany requires counties to pay a share of the costs. But, by and large, it does what it was intended to do and in that, meets an important social need.
If Congress wants to make changes to the law, it can do that. It can hold hearings. It can review how doctors, hospitals, counties and states implement the program. It can, and should, look for greater efficiencies so that poor people are able to get health care whose costs are controlled.
But that’s different from gutting the program with a fish knife. To deprive the hospital of two-thirds of its Medicaid funding, and to do so all at once, is unconscionable and has nothing to do with good government. It is, in fact, immoral.
Perhaps members of Congress were just inattentive. If so, they can fix this and they can resolve to do better next time. If so, they should do it now, before the consequences assert themselves.
But if the national legislature is now in the sway of people who are cavalier about the continued functioning of health care systems that benefit those with the least, then it has turned a corner and is dragging the country down a dark alley. It’s not somewhere we should go.