Romney's health plans could hurt poor and minority communities

News analysis: Leaving critical programs to states and turning federal funding into block grants has a history that worries experts in the state.
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News analysis: Leaving critical programs to states and turning federal funding into block grants has a history that worries experts in the state.

Soon after the U.S. Supreme Court’s ruling to uphold the Affordable Care Act this year, GOP presidential nominee, Gov. Mitt Romney, and party strategists agreed on one overriding political imperative. In their bid to rally, and mollify, their conservative base, Romney issued an unequivocal statement: “What the court did not do on its last day in session I will do on my first day if elected president of the United States. I will act to repeal Obamacare.”

Senate Minority Leader Mitch McConnell, R-Kentucky, echoed that sentiment in a speech on the Senate floor: “There is only one way to truly fix Obamacare, only one way, and that is a full repeal.”

As the presidential race tightens, with less than a month before the Nov. 6 election, voters are faced with the daunting task of fact-checking fiction from reality about health care. While both major party presidential candidates have made questionable claims about the full impact of the Affordable Care Act  (ACA), Romney appears to be the less forthcoming.

In the first presidential debate last week, Romney made a number of questionable claims with regard to the issue of health care.  First, he believes that the ACA is a federal takeover of health care. Second, cutting Medicaid growth by more than half would restrain federal spending. And third, giving each state the power to craft their own health care reform plans would fix a broken healthcare system.

Those dubious assumptions aside, it is clear that dismantling the social-safety net would have devastating consequences not only for 48 million uninsured Americans, but also a significant proportion of minority communities as well. To cite one example, Seattle City Councilmember Bruce Harrell says: “Estimates suggest that 2.5 million Asian Americans would be uninsured in the absence of President Obama’s Affordable Care Act. Obamacare represents the opportunity to level the playing field in terms of protecting healthy communities.”

Romney has said that, as president, he would issue an executive order to provide Obamacare waivers to all 50 states, work with Congress to repeal the full legislation of the ACA, and give each state the power to implement its own health care reform plan.

Pamela Clouser McCann, assistant professor at the University of Washington Evans School of Public Affairs, said, “What’s important to remember is that before the Act, states already were left to come up with their own health insurance reform plans — some did, but most did not."

Romney proposes to turn the Medicaid funding stream into block grants and limit federal standards and requirements on both private insurance and Medicaid coverage. How would that affect minority communities? The answer again depends on how each state implements Medicaid, McCann explained. “The racial distribution of Medicaid enrollees varies tremendously by state due to differences and populations and state politics. In some states, a block Medicaid grant could disproportionally harm minority communities, and since in all but six states children make up the majority of Medicaid enrollees, minority children might bear the brunt of this choice.”

Gunnar Almgren, UW associate professor of social work and social welfare, makes the same point.  “Repeal of the Affordable Care Act would likely extend further the disparities in health care access for the poor and low-income populations in states that have historically been less able or willing to reduce their uninsured,” he said. Block grants would also place a cap on the federal dollars that are available to provide health care for the low income. 

According to Almgren and other national health policy experts, repealing the ACA would have broader implications. States that experience higher levels of unemployment and growth of the population of adults and youth without health insurance will not have the matching federal dollars to help offset the deterioration of employment-based insurance, he points out.

“Also the history with federal block grants is that they are very vulnerable to drastic reductions by Congress,” Almgren said. Emphasizing the long-term impact for low-income communities, Almgren is clear: “The reduction in federal standards for Medicaid allows states to lower the quality of services for poor populations and communities.”

Romney and Rep. Paul Ryan believe that Medicaid spends more for medical care than is necessary.  Harvard economist David Cutler takes issue with that conclusion. As Cutler wrote for the Forum of the Journal of the American Medical Association, “A meat cleaver is rarely appropriate for open heart surgery. The cumulative reduction in Medicaid spending that Romney proposes is substantially greater than the savings that he said would ‘end Medicare as we know it.’ ”

Scaling back on federal support for health care coverage assumes that states can pick up the slack, but ignores the reality that limiting federal standards would create additional risks for minority communities. As McCann notes, the details of turning Medicaid into a block grant and reducing federal funding would hurt minority communities are complicated. “Some states do an excellent job of attempting to ameliorate disparities in access to heath insurance, Medicaid, or other health services between subpopulations in the state, and other states do a poor job,” she said.

Advocates of low-income and poor populations worry that a retreat of federal authority in the regulation of health insurance benefits between states might allow large health insurance companies to choose to be licensed in the states with the most meager benefit requirements and consumer protections, Almgren points out. “That, in turn, would allow them to market these policies in states with more stringent consumer protections and thus gradually induce a competitive ‘race to the bottom’ in the quality and equity of health insurance coverage,” he said.

Seldom have Romney and Ryan addressed the unforeseen, and damaging, consequences that shredding the Affordable Care Act would have on American families. “I have seen the detrimental impact of not having medical coverage in my own life through the eyes of family members, friends, and colleagues,” said Harrell. “Obamacare will ensure that they are no longer one major medical emergency away from health and financial disaster.”

Finally, in a clever debate maneuver, Gov. Romney said that his Massachusetts health care law could be a model for the nation. “I think there are a number of features in the Massachusetts plan that could inform Washington on ways to improve health care for all Americans.  The fact that we were able to get people insured without a government option is a model I think they can learn from.” Obama reminded him that the ACA was modeled to a large extent on Romney’s original plan.

Notwithstanding Romney’s approach to solving the nation’s health care problems, Obama insists that reforming our present system is necessary to stave off disaster for uninsured Americans. Councilmember Harrell echoes the view that Obama’s leadership on health care has been consequential. “People can now seek solace knowing that their health is not tied to their employment status. This is absolutely critical in building a healthy Seattle.”


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About the Authors & Contributors

Collin Tong

Collin Tong

Collin Tong is a correspondent for Crosscut and University Outlook magazine. He served as guest lecturer at the Edward R. Murrow College of Communication at Washington State University. His new book, "Into the Storm: Journeys with Alzheimer’s," will be published in January 2014.