In a feat of alchemy, the U.S. Senate managed to turn the “Big Beautiful Bill,” which passed in the U.S. House and was already laden with terrible policies, into something far more terrible.
It might seem amazing that a bill that the Congressional Budget Office projects would add $3.3 trillion to the national debt could also decimate the social safety net. But give the Senate credit – offer Alaska enough pork and whaling tax credits, and you can find 50 votes for anything, I guess.
Provider taxes like our state’s Medicaid Enhancement Tax create a federal funding return that benefits hospital care and our state budget generally, but the Senate would cut an estimated $232 billion from hospitals by slashing the ability to use this funding mechanism. That cut would happen on top of House-passed policies estimated to cost rural hospitals alone $50.4 billion, $753 million of which would come from New Hampshire.
Much cutting occurs under the pretext of compelling those on Medicaid expansion under the Affordable Care Act to work, which sounds reasonable enough. But most of this population is working. Those who are not working cannot, for the most part, due to reasons like caregiving, disability and school attendance.
The bill’s savings are really predicated upon discouraging a huge number of those legitimately on Medicaid, or who are eligible for it, from enrolling through various new bureaucratic barriers.
The state of Washington identifies the employers of those on Medicaid. In its most recent report the two employers with the most associated Medicaid clients were Amazon and Walmart. So, a cruel irony of the Senate-passed bill is that these big corporations, and their executives, will have their preferential tax treatment subsidized, in part, by denying Medicaid coverage to those who cannot afford weddings in Venice.
The Senate would also change the law and shortchange providers by a month for Medicaid care they have provided. For an average New Hampshire nursing home, this might mean a loss of around $100,000 a year. There is no room to absorb cuts.
The Medicare Payment Advisory Commission reported to Congress that the average nursing home margin was .4% nationally by the most recent measure. This microscopic margin was attributed to fee-for-service Medicare payments, which are a declining share of nursing home revenue as big insurers gobble up Medicare funding and use algorithms to deny, or limit, life-sustaining nursing home care.
Medicare isn’t spared either.
Because the legislation would add such a stupendous amount to the federal deficit, it will kick in automatic Medicare cuts under the 2010 Statutory Pay-As-You-Go Act. This will further impact home health, hospitals and nursing homes.
Separately, the Trump Administration announced on June 30 a 6.4% cut to Medicare home health payments. That will put many home health agencies out of business and add to the challenges of hospitals looking to discharge patients into long-term care settings.
It did not have to be this way.
In New Hampshire, support for health care providers — though not as robust as needed given our state’s aversion to taxes — has been bipartisan, and nursing home care advocates were grateful to Gov. Ayotte and legislators for funding in the current budget.
Congress is poised to make such state support immeasurably more difficult through federal cuts and new unfunded mandates for our Department of Health and Human Services.
In providing the critical 50th Senate vote for this shameful legislation, Sen. Lisa Murkowski (R.-Alaska) condemned an “awful process” and stated that while the bill was improved for Alaska “it is not good enough for the rest of our nation[.]”
I will leave it to those fearing health care and food assistance cuts to find comfort in those words.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.