Budget cuts to Medicaid would hurt all of us

Maryland cannot allow federal actions or state budget shortfalls to erase the progress we have made expanding access to quality, affordable health care for our residents. Medicaid, a joint federal and state program that helps low-income residents get health insurance, is currently threatened by hundreds of billions of dollars of potential federal budget cuts. These cuts could include federal match reductions, block grants, narrowed eligibility, and administratively burdensome work requirements.

During a Medicaid budget hearing in Annapolis, the Maryland Department of Legislative Services estimated these cuts could cost the State more than $1 billion to maintain enrollment. These costs are considerable, but what is the cost of ripping health care away from Medicaid enrollees?

One cost would be higher health insurance premiums for all of us. When people do not have health coverage, they do not receive comprehensive and preventive health care and have to resort to receiving care in the emergency room, the most expensive place to receive care. This uncompensated care drives up health insurance premiums and taxes that support Medicaid and Medicare for everyone else, contributing to what the late Maryland Speaker Michael Busch referred to as the “hidden health care tax.”

During his time in leadership, the State expanded Medicaid eligibility in 2008 and implemented expanded access to care under the federal Affordable Care Act in 2014. In 2023, Steve Ports Consulting released a study that showed that following these health coverage expansions uncompensated care in hospitals declined by at least $460 million, helping to stabilize health insurance premiums for Marylanders across the board. Cutting Medicaid would cause this hidden health care tax to rise once again.

Cost increases and worsened population health also puts other federal funding at risk. Maryland is embarking on a new Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model that prioritizes reducing all health care costs, and improving the health of Marylanders, including advancing health equity. If Maryland cannot continue to succeed under this model the State’s health care system could lose almost $2 billion a year in federal payments.

But these are just dollars and cents. At the Medicaid budget hearing Dr. Melanie Townsend Diggs shared that during a tough time for her family Medicaid ensured she had health care throughout her pregnancy. When her baby daughter had a case of extreme eczema that left her skin red and bleeding, she was able to receive treatment from a dermatologist. Now, as a Regional Director for a library system in Maryland, Dr. Diggs assists people who are able to get health coverage through Medicaid and she worries what will happen to them if they do not have the same access to health care that did.

Of course, the real cost of Medicaid cuts is that many Marylanders will have to once again go without care and will not receive the primary and behavioral health services that they need. Seniors living in long-term care, low-income families, and people with disabilities will lose health care access. The already overflowing emergency rooms will become even more crowded. Diabetes and high blood pressure will not be managed. Critical mental health and substance abuse services will be unobtainable for many. Cancer patients will not be able to afford treatment. Without access to comprehensive services, the health of Maryland’s population will decline, impacting all aspects of life.

It’s clear that reducing access to coverage and care in the community will have serious and broad consequences to quality of life and Marylanders’ wallets. Thankfully, the Maryland General Assembly is considering various measures to maintain access to health care and insurance coverage regardless of what actions are taken on the federal level. While it will be a challenge to address these issues, we cannot afford to go backwards on health care access.

Stephanie Klapper is Deputy Director at Maryland Citizens’ Health Initiative, a nonprofit that oversees the Maryland Health Care for All! Coalition and whose mission is to advance policy that furthers access to quality, affordable health care for all Marylanders.