‘Big Beautiful Bill’ health impacts

There are many parts of the so-called “Big Beautiful Bill” passed by both houses of Congress and signed by President Donald Trump, but the large reductions in payments for Medicaid to persons with low incomes or disabilities, I believe (and so do many others in health care), will have far-reaching adverse effects on the whole health care system in the United States.

Medicaid is a federal-state partnership program, and under provisions of the Affordable Care Act, also known as Obamacare, most states expanded Medicaid. South Carolina was not one of those states. Under the BBB, the states lose the federal funds to pay these new Medicaid beneficiaries. Without the federal funds, states have two choices: They can continue to pay Medicaid beneficiaries by using state funds or they can eliminate the benefit, with the result of millions losing those Medicaid benefits.

How will the rest of our medical care system be affected? Here is a partial list, with a few explanatory comments for each.

Hospitals, especially those with emergency rooms, will be harmed. The Emergency Medical Treatment and Labor Act requires that hospitals that participate in Medicare have an emergency department that provides care without regard to a patient’s ability to pay. The BBB will result in more than 30 million patients without medical insurance who are more likely to use emergency rooms for their medical care. If you have ever been to an emergency room, you know that it is a very expensive place to get routine care. That leaves the hospital with many bills for folks who have a limited ability to pay the hospital. And that leads to medical debt, which is like an anchor around the debtor’s neck.

America’s Essential Hospitals, a coalition of nonprofit safety net hospitals, reported a 9 percent loss in 2022. Those losses will increase as more patients without insurance show up for emergency care. Hospitals cannot continue to operate at a loss. Hospitals will have to adjust to lower levels of income. They will cut services, delay purchases of equipment or capital improvements, and eventually face closure. Teaching hospitals like the Medical University of South Carolina likely will be harmed disproportionately by decreases in Medicaid enrollment because the federal government compensates hospitals for the cost of teaching. Payments are based on Medicaid volume, but no payments are made for uninsured patient care.

Physician offices don’t have an EMTALA requirement for delivering care to those unable to pay. Physicians who see patients with Medicaid will be forced to continue to see patients who are not able to pay or “transfer” them to other sources of care — hospital emergency rooms or free clinics. Hospital-affiliated clinics will not be able to bill for physician services provided to uninsured patients, so many important specialty services will not be available to poor patients.

It doesn’t take a health care specialist to recognize that these changes are very likely to lead to delayed diagnoses and more severe illnesses in patients without primary care access.

Even federally qualified health centers, such as our Fetter Health Care Network, aren’t immune to the damage from the BBB. These centers receive a higher rate of payment for patients with Medicaid compared to other private physicians’ offices in exchange for their commitment to provide care to the uninsured. But if fewer people have Medicaid, the enhanced rate for those remaining Medicaid recipients is unlikely to cover care for all the new uninsured individuals.

Medicaid is the primary payer for 63 percent of residents of Certified Nursing Facilities. Even though most patients in nursing homes have Medicare, it pays only for a limited number of weeks of care and requires a hospital stay prior to any payment for nursing home care. The BBB’s decreasing Medicaid benefits make it more difficult for skilled nursing facilities to provide care for older adults and the disabled.

Even people with private health insurance will not be able to avoid the impacts of the BBB. Private insurance subsidizes hospital care for those who are uninsured or underinsured. If the percentage of patients without insurance increases, hospital systems will demand higher rates of payment from insurance companies, leading to higher insurance rates for insurance purchasers, such as you and me. Higher rates result in fewer persons being able to afford insurance, continuing the vicious cycle of more uninsured persons and more cost of care increases. Care received in our medical system likely will deteriorate because care sites will have less money to invest in new equipment, buildings and staffing.

With expansion of Medicaid, employers are able to avoid providing health insurance for low-income workers. Without it, employers need to either purchase insurance for their workers or leave their workers uninsured. Paying more to purchase insurance will likely limit future pay increases for all workers.

In the larger world, there are many businesses that support our medical care system, such as pharmaceutical companies, laboratories, device manufacturers and health care construction companies. All of these businesses will experience losses due to Medicaid cuts. The Commonwealth Fund has estimated that the BBB will lead to a million job losses and a $113 billion decline in states’ gross domestic product by 2026.

But the economic effects on the country don’t measure the costs to the poor. Without Medicaid, low-income people will avoid seeking care. This will result in lost opportunities to prevent disease and to treat serious disease at an earlier stage. Those costs are immeasurable.

What can we do? Write your legislators and tell them you value human life and want better care for all our citizens, not just those who can afford it. Health care is a right, not a privilege. Elections are coming up this fall. Look for, and work for, candidates who share your values and priorities.