The bill ends Medicaid expansion and introduces per capita caps and block grants. Combined, these changes spell the end of Medicaid in its current status as a successful, responsive program. For decades, Medicaid has allowed seniors and adults and children living with disabilities to get the homecare they need to live at home and in their communities.
At the same time, the bill includes multiple tax breaks for the wealthy, including retroactive tax breaks for high-income households.
The exact number of people who would lose Medicaid is not yet known due to the furtive and hasty way in which the bill was created, but the nonpartisan Congressional Budget Office has announced that by the year 2026, 22 million people would lose insurance under the bill and cuts to Medicaid would reach $772 billion. The CBO also predicts that few people who lose their Medicaid eligibility would be able to purchase insurance “because of the expense for premiums and the high deductibles” for individual market plans.
Because the ACA expanded healthcare access for many people, it additionally created positive growth in healthcare jobs, from doctors to home health aides. If the ACA is cut, there will be an estimated three million jobs lost by 2021. Between 305,000 and 713,000 homecare workers will lose their jobs if the Senate is allowed to restrict Medicaid through per capita caps alone. This estimate does not account for eventual job losses due to the end of Medicaid expansion.
Currently, most homecare workers subsist on poverty wages of under $12,000 a year, and as a result, have a turnover rate of up to 60 percent a year. As one of the fastest-growing sectors in the country, home care has the potential to provide good, stable jobs with wages that are high enough to support working families. However, the Senate bill sucks Medicaid’s resources dry, limiting any possibility for raising worker wages and locking this majority woman-of-color workforce into perpetual poverty wages.
Most families and individuals must rely on Medicaid-funded services to obtain homecare. However, the average yearly cost of a home health aide is $45,760 — unaffordable for most families. There are not enough homecare workers to meet current needs, let alone the growing needs of the nation’s seniors. The ACA expanded the supply of homecare workers in the United States, primarily by providing Medicaid-funded services to more people who needed homecare. With the Senate’s proposed Medicaid cuts, there won’t be enough funding for lower-income adults and seniors to get help from homecare workers. This means that more people living with disabilities and seniors will be forced into institutional homes, which are far more expensive than in-home care.