22 Sep H.R. 1 Could Create Hardships for Medicaid Enrollees in Three Chronic Disease Areas
The following is a special discussion about a new report published by the Health Equity Collaborative, in partnership with Magnolia Market Access, on the impact of H.R. 1 (One Big Beautiful Bill Act) on anyone navigating the complexities of chronic illness and Medicaid.
The conversation features Amy Hinojosa, Founding Member of the Health Equity Collaborative and Michael Murphy and Tracy Baroni Allmon from Magnolia Market Access. The group explores how this new legislation could impact your care, your coverage, and your ability to live a healthier life.
Full Report: The One Big Beautiful Bill Act and Medicaid: What Chronic Disease Patients Need to Know.
Transcript
The following transcript has been lightly edited for clarity.
Amy Hinojosa: The One Big Beautiful Bill Act introduces major changes to Medicaid that could jeopardize healthcare access for millions, particularly in those communities that we all work with who have chronic conditions like mental health disorders, diabetes, and cardiovascular disease. This new report reveals how these policy shifts, including work requirements and potential funding cuts, could exacerbate health disparities among vulnerable populations.
To present the report highlights, we’re thrilled to have the experts who authored the report. Following, we will have a Q&A, so please feel free to begin adding questions to our chat for our presenters. We’ll get to as many of those questions as we can. And now for our speakers. Tracy Barone-Almond is the Vice President of Market Access and Health Policy for Magnolia Market Access. She joined Magnolia with over 25 years of pharmaceutical industry and healthcare policy experience. Tracy also has experience in reimbursement, payer and PBM strategy, and pharmacy practice. She’s a champion for patient access with deep knowledge of patient support programs, funding, and limitations. Tracy is recognized for her extensive knowledge and has publicly faced some of the industry’s toughest critics during perilous times, including pre-Part D and pre-enactment of the ACA.
We also have Michael Murphy, who is a Director of Real-World Evidence and HEOR Strategy at Magnolia Market Access. For over 15 years, he’s used real-world data to generate evidence for payers, providers, governments, and life sciences companies. An expert in RWE analytics, he’s conducted burden of illness, comparative effectiveness, and safety studies using a wide variety of real-world databases, resulting in over 20 peer-reviewed publications and dozens of conference abstracts. So, I’m going to turn it over to Mike and Tracy. Thank you so much for being with us.
Tracy Barone-Almond: So, thank you everyone for joining us today. We’re really happy to be here to talk about the HR1 or the One Big Beautiful Bill Act. HR1 is so much easier to say, so I will refer to it as HR1. We know that HR1 enacted significant policy changes, not just to Medicaid, but what we’re going to talk about today will be the impact on state Medicaid programs and the patients who rely on the Medicaid program.
Part of the analysis, well, the entire analysis was looking at the potential for some of these changes on drug access for patients with one or more three chronic disease diagnoses: cardiovascular, mental health, and diabetes. A quarter of the employed Medicaid patients with these conditions could lose coverage due to the reporting requirements included in HR1, and we’ll talk a little bit more about what that looks like. And then finally, other changes to federal funding could result in state program changes that will have a significant impact on all three disease areas with cardiovascular being the hardest hit. So Mike will walk us through the graphics and who’s going to be impacted the most as I walk through the policy aspects of it. So with that, Mike also gets to walk through the data and methods section.
Michael Murphy: Thanks, Tracy. So we used data from the 2022 Medical Expenditure Panel Survey or MEPS, which is a large-scale survey conducted by the Agency for Healthcare Research and Quality that collects data on how Americans use healthcare, the cost of services, and how they are paid for. These data contain sampling weights that allow us to project the survey population to the civilian non-institutionalized population of the US. And within the MEPS data, we identified respondents who were enrolled in Medicaid and who had either a mental health condition, a cardiovascular condition, or diabetes. And we use data, including age, geographic region, employment, income, and children in the home, to estimate the number of Medicaid enrollees that would be at risk of losing coverage due to work and reporting requirements, federal funding cuts, and potential state actions.
Tracy Barone-Almond: Thanks. So, if we think about what Medicaid work requirements and reporting is going to entail, it’s important to understand who is in Medicaid. And while many of you might know, I think it’s worth a refresher to say that there are currently about 80 million people enrolled in Medicaid, about 60% of whom are children. So that means that Medicaid is actually the primary health insurance for over half of all children in the United States. And predictably, children are not driving the Medicaid expenditures. Most expenditures are from a small segment of disabled and dual eligible enrollees. As of February of 2025, 23% of Medicaid enrollees were elderly and or had at least one disability. This population accounted for over half of Medicaid spending and much of that spending being for long-term care, which of course is not covered by Medicare.
After level setting on that, I think we’re ready to jump into what we see whenever we think about the unemployed Medicaid or the employed Medicaid population. According to Kaiser Family Foundation and other sources, a significant portion of the adult non-disabled Medicaid population is employed. 92% were working either full or part-time in 2023. And yet these people still qualified for Medicaid or Medicaid expansion, which covers up to 138% of federal poverty levels. So what that tells us is that they are either in low-wage, minimum-wage jobs, or they are working for companies that are not required to provide insurance under the Affordable Care Act. The various reasons for unemployment include caregiving, disability or illness, inability to find work, and school attendance.
Under HR 1, Medicaid expansion enrollees must complete a state-created report, must complete state-created reporting requirements to verify their employment status. There are a few exceptions, including if Medicaid enrollees have at least one dependent child under the age of 14 at home, or if they’re categorized, they themselves as the enrollee are categorized as disabled or frail.
That said, 41 states and DC have expanded Medicaid. And so you can see that this potentially impacts a large percentage of the Medicaid population. There has never been a federally mandated work requirement in Medicaid. And so that plus the reporting requirement puts us in completely new ground. In states that have attempted to implement work requirements, the most recent data being from Georgia and Arkansas, the inability of enrollees to meet the reporting requirement resulted in 25% of patients losing Medicaid coverage. And so, while there is no ideal way to implement the reporting requirements, Michigan recently did try to implement reporting requirements in 2020 and 2021 after they had passed a law under a Republican administration, the Democratic administration was left to implement.
And what we learned during that time period is that time reporting for the work requirements needs to be generous. So not every month, do it every quarter with a quarter lag, something like that. The state should not be afraid to use data that they have to help verify any gaps that could fill in the employment status and help the Medicaid enrollees meet the reporting requirement.
And so with that, I’m going to turn it over to Mike to discuss the impact of the work requirement on these disease states.
Michael Murphy: So, what we found in the data was that across each of the three conditions of interest among Medicaid enrollees aged 19 to 64, nearly 45% reported that they were employed. And about two-thirds of those who were employed reported working at least 80 hours per month. As Tracy said, based on the experience with reporting requirements in Arkansas and Georgia, we estimate that about 25% of these enrollees may lose their coverage due to administrative burdens, which means that about 8% of enrollees with one of the conditions of interest would be at risk of losing coverage.
Tracy Barone-Almond: Thanks, Mike. And so while we know that over 90% of the adults in Medicaid are employed, there are still many who are not. Approximately 1.1 million Medicaid enrollees with one or more of the three conditions of interest are currently unemployed and will be impacted by the work requirements and the reporting. Approximately one-third of the unemployed Medicaid enrollees who are aged 19 to 64 are disabled and receiving SSI or SSDI, which means that there’s a significant portion of the unemployed who are not disabled. And regional differences that we’re going to see could be a result of state programs that are promoting employment and job training for Medicaid enrollees.
Despite struggling economies, what we’re going to see is that one way for states to ease the burden of the work requirements is to create opportunities for work or community service that can assist those who are currently unemployed in not only spending their time at the 80 hours per month required by HR1 and then getting credit for it through the work requirement. Mike can walk us through by disease state what these patient populations look like.
Michael Murphy: All right, so here we look at the geographic distribution of Medicaid employees, excuse me, enrollees who are age 19 to 64, unemployed, without children under 14 and not disabled or in school. If we start on the left-hand side of the graphs, we see that for those who have mental health conditions, just over 40% of these enrollees reside in the Northeast compared to only 20% of those with diabetes or cardiovascular conditions.
We would see the reverse is true in the West, where only 15% of enrollees with a mental health condition live, whereas 40% of those with diabetes and cardiovascular disease are residing in the West region. And for the Midwest and South regions, we saw a similar proportion of enrollees across all three conditions of interest.
Tracy Barone-Almond: Thanks, Mike. Now we’d like to spend a little bit of time talking about the Medicaid funding changes and impacts on state budgets and the patients who are going to see changes potentially. There were several HR1 changes that impacted expansion states, including a re-enrollment verification provision that requires enrollees to re-verify every six months rather than every year.
And that places an additional burden on expansion states because it only applies to the expansion population. HR1 also prohibits the implementation of a rule that was promulgated by the Biden administration on eligibility and enrollment. And that rule actually simplified and standardized state processing of applications and renewals for Medicaid and CHIP. Both of those will impact patients who are enrolled in the Medicaid expansion population and some just Medicaid. Meanwhile, there are other changes that are disproportionately impacting expansion populations. Medicaid expansion states are going to see a difference in the federal matching rate for expansion population if that state had been providing state-funded coverage for the undocumented.
Provider taxes, which have long been used as a Medicaid funding mechanism by many states, were also targeted by HR1. Medicaid expansion states will be required to decrease their provider taxes to a safe harbor amount that was defined in HR1 as 3.5% by the year 2032. No states are going to be allowed to create or increase provider taxes, but those nine states that have not expanded Medicaid are not required to reduce the taxes that are currently in place, which means expansion states need to find funding that’s going to help them cover the deductions that they have to take to get to the 3.5% safe harbor. Non-expansion states under HR1 are required to cap their state-directed payments at 110% of Medicare rates. However, the Medicare rate of 100% has to be met by expansion states. So this also creates a disparity in reimbursements to inpatient and nursing facility services within the expansion states. Based on these changes, it’s easy to see why over half of the HR1 Medicaid savings are expected to come from these changes that only apply to Medicaid expansion states. Mike can explain where and what enrollees are likely to see that impact.
Michael Murphy: Thanks, Tracy. So again, we looked at the geographic distribution of Medicaid enrollees with one of the conditions of interest who are at risk of losing coverage. And here we broke out the analysis between enrollees with and without children. Starting on the left, those without children, which is a majority of this population, over two-thirds of those with one of the conditions of interest, we see a larger proportion of those with mental health conditions residing in the Midwest. But diabetes and cardiovascular disease, see more enrollees who reside in the South. And then shifting over to the right-hand side of the graph, those with children, we see a clear plurality of those at risk across all three conditions of interest residing in the South region of the US.
Tracy Barone-Almond: So overall, there will be a significant impact of HR1 on state budgets. The HR1 changes put financial stress on Medicaid expansion states without creating any changes in expansion eligibility, meaning states have only two choices, continue the Medicaid expansion to 138% of federal poverty level as required under the ACA or end their Medicaid expansion. States are not permitted to decrease the population covered based on eligibility of by income or change the benefit provided. So everybody who expands has to expand their full Medicaid program. Nor does HR1 change the federal match calculation. In this slide, the states in yellow in the first bullet not only received some of the highest federal funding percentages due to the state’s per capita GDPs, but they have also expanded Medicaid. So, this means that for these states, under HR1, their funding for the general Medicaid population and the expansion look very similar.
About 70 to 80% will be federally funded with the remaining funded by the state. Many of you may remember that whenever the ACA was originally established, the government, the federal government was to pay for at least 90%. And that would have been the floor, the least they would have paid for the expansion population. And so now that has changed. And in these states with low gross domestic product and low incomes, they will absolutely feel some pain whenever they are looking at an expansion population that is pretty much just matched at the same rate as their normal Medicaid population. We analyzed the funding losses across states and what they will experience and considered various scenarios of abilities of the states to make up those losses. Mike is going to walk us through the potential impact of these difficult decisions on patients whenever states are faced with budget crises.
Michael Murphy: Thanks, Tracy. So, as Tracy said, states are going to face difficult decisions. And so we considered a few scenarios with federal cuts impacting 10 to 20% of enrollees and states making up 25 to 50% of that shortfall. We start with those enrollees who have a mental health condition. Under our best case scenario with federal cuts impacting 10% of enrollees and states making up half of the shortfall, nearly half a million enrollees would lose coverage.
If the states are only able to make up 25%, then over 700,000 would lose their coverage. And if the federal cuts are even more impactful, then we would see over 900,000 lose coverage and up to 1.4 million lose coverage if the states are unable to come up with that additional funding. We see that the largest share of impacted enrollees reside in the South.
Michael Murphy: There we go. Yeah, so just the last point to make on this slide. As we said, depending on the levels of federal cuts or states making up the shortfall, we could see a range of nearly half a million to nearly one and a half million. And across all the scenarios, the larger share of impacted enrollees would reside in the South region of the US and the smallest number in the Northeast.
Again, under the same scenarios, those at risk of losing coverage would range from 370,000 under the best case scenario to 1.1 million under the worst case. Again, we see that the largest share of those impacted are in the South region of the US with the smallest in the Northeast.
And here we would see the largest number of patients impacted, ranging from 550,000 up to over 1.6 million under the worst case scenario. And we see the same geographic trend with the South being the most impacted and the Northeast having the smallest number of impacted enrollees.
Tracy Barone-Almond: Thanks, Mike. And so now I think it’s important for us to recognize that there is still time for us to make a difference here. What we know right now is that patients are not necessarily aware of the changes that have happened. They’re not aware they’re going to be reporting requirements, and they’re not going to really understand what those are. And it will vary from state to state what those reporting requirements are and how much notice is given, how much communication there is with patients and with their caregivers.
And so it’s going to be important to monitor that on the state level, to educate patients, to watch for notices, to pay attention to mail that comes, to email that comes, to announcements that are made. And also for those same patients and your groups to engage at the state and the federal levels to share the stories of what burdensome requirements are going to mean to those patients, the value of access protections, the importance of maintaining those access protections without any drops in coverage, especially for chronic conditions, and then also to do whatever else is necessary to minimize the impact, asking for help from providers and provider groups in the state, asking them to be active as well, along with patients and patient groups is important.
States are facing budget crises. We know that a large percentage of their budget is already spent on Medicaid. Those that are expansion states are going to have to make significant changes or at least plan to make significant changes with different requirements over the course of the next few years. And their pressure is not only on Medicaid. We recognize that there are pressures on the education system. There are pressures on the grant system. There are pressures coming from outside of HR one on FEMA and other funding that the states get. So, as you’re advocating on the state level, it’s important to understand the state processes, the different balls that they’re juggling, trying to support patients, but also support state employees to support people who need other services from the state.
And so understanding the roles and responsibilities of various agencies at different levels of government, who to call, who to ask for help, who would be supportive, who would make sense to educate so that they can then perhaps help you at the state legislature as well. These are all going to be important going forward with specifically related to HR1.
And then also aligning with other interests when possible. So, whether it’s around minority communities or whether it’s around children on Medicaid, whether it’s around employers who are hiring Medicaid enrollees or Medicaid enrollees and looking forward to continuing to have them work and yet not really sure how they can help them go through the various processes that are now going to be required of them. And then also for when the legislative sessions will mostly start up again in January, looking for patients and others who can develop meaningful testimony to support Medicaid access, the patients who are enrolled, the patients who are working and trying so hard to provide for their families while still on Medicaid, developing that meaningful testimony and telling those stories so that there’s not the perception that Medicaid enrollees aren’t working, aren’t trying, because that’s clearly not the case.
And then it’s important to recognize that federal policymakers are caught in a trap and you can hear the testimony. You can see it where many Republicans and all the Democratic legislators have recognized the significant impacts of Medicaid changes on their state population. Every state population is going to be impacted, whether it’s an expansion state or not. And we’re already seeing Republican senators saying, it’s fine, it won’t go into effect before we can repeal it. Well, it might not go into effect completely, but states still need to make those decisions.
And so they’re going to have to start making changes so that they can comply with the law, even if deep down there’s some plan that in a year or two, this will be repealed or certain aspects of HR1 will be repealed. There’s still going to have to be some changes at the state level and these will impact patients. And once you lose a patient, they sometimes take several years to get back on because they’re kind of lost to the system for a while. And so it’s important to prioritize engagement with Republican legislators in both chambers and Democrats as well to emphasize the harm of leaving this gap in time period where we know things are coming, but we’re going to fix it before it really takes effect because…states have to act now. States have to balance their budgets and the changes that they are required to make will be starting in 2026, even if many of these penalties won’t start until further down the road. And so with that, we’re happy to take questions.
Amy Hinojosa: Thank you so much, Tracy and Mike. The report is sobering to say the least. And I know we’ve got advocates on the line. If there are questions, please feel free to put them in the Q&A and we’ll be happy to get to those as many as we can. So let’s start and kind of back up a little bit. So, and we know obviously the caveat to all of this is that it’s going to vary from state to state depending on what framework they’re working from. So overall, what is going to be, in your opinion, the most significant challenge that employed Medicaid enrollees with chronic conditions are going to face under the new work requirements? And then how is that going to contribute directly to potential loss of coverage?
Tracy Barone-Almond: You know, in my opinion, what we’re going to see is process, right? And I don’t know how anybody else feels about process. I detest process. Having to save your pay stubs, having to photocopy them or turn them into a PDF and send them to the state to show that you’re working, getting something signed from your employer or from a community leader if you’re working as some type of a community aid or volunteering. These types of things take time from lives that are already very busy. And so when you’re working full-time or maybe even working more than full-time on a couple of different jobs, taking the time out to do that just to make sure that you have health insurance. I think that we can all think about what if we had to do that once a month, once a quarter? Would there be times when you forget?
And would there be times whenever you can’t read that PDF that was sent? And so rather than erring on the side of caution, maybe Medicaid is canceled for these patients, which could be devastating. You miss a month of your diabetes medication. That’s a hospitalization in many cases. So I think the process and how states implement that is a significant risk, quite honestly.
Amy Hinojosa: Right. And can we talk about that last point a little more in detail and thinking about how critical care may start to become the first line of folks actually going to the hospital? I mean, and the only thing I can compare it to really is pre-ACA when folks were not getting preventative care, they weren’t getting the regular visits and treatment that they needed. And then they were winding up in the emergency room. Is that something that you think potentially we can start seeing that we might go back to?
Tracy Barone-Almond: I think that those circumstances certainly are on the horizon. I would hate to say that it would be in 2026. I think that there are, there’s enough attention being paid, I believe, at the state level to the importance of Medicaid to this expansion population that I think that they will try to do what they have to do for the work requirements, but not tremendously impact these patients because they expanded Medicaid for a reason, right? I mean, they recognize the value. They recognized it was a good deal to them. The extension of that is though that the changes in reimbursement and other changes within HR1 do pose a risk to the rural hospital system and other provider reimbursement.
There are not always enough safety nets at every level of care. So if you do have to get admitted and your rural hospital is closed, is it directly related, indirectly related? But I do think it’s fair that if it goes 100% into effect, HR1 and all of the impacts are felt two to three years down the road, yes, I do think you see people who are diagnosed with any one of these conditions or other conditions who show up at the ER with crazy high blood glucose levels because they haven’t had medication for weeks or months.
Amy Hinojosa: All right, so we’ve got a question in the chat and she runs a nonprofit organization that advocates for access to health care for the Illinois immigrant community. And her question is how have states like Illinois responded to federal pressures and budget constraints in maintaining health care access for immigrants? And then obviously the follow up to that is what can advocates do to help the process?
Tracy Barone-Almond: I personally don’t know exactly what Illinois has done, unfortunately, but I do think that there are those offices within state government that have been responsible for immigrant services. And I think that, you know, the governor has been pretty clear not to come after the immigrants in Illinois, not to target certain neighborhoods, not to send in federal troops. So I think that when you think about a state that has done what they can do and is willing to stand by the citizens who are living there as well as the immigrant community. I think that you can count on them to continue to be active and on the right side of the issue. That said, the budget rules all, right? And so really staying in touch with how budget changes are being discussed going into the legislative session.
Understanding who your allies are, who your natural allies are, and maybe who your allies who you haven’t worked with before, maybe the religious community, or maybe people in the education sector, because yeah, their budgets are being cut, but they want to see immigrant kids in school and they want to see immigrant kids healthy. And so I think looking for those allies that you may not have worked with before and just staying on top of everybody if you can.
Amy Hinojosa: Right, and the work requirements really are going to be at the crux of issues for individual folks. What are some of the ways that states with, for example, voluntary employment programs? How can they be better prepared to meet these new requirements mandated in HR1?
Tracy Barone-Almond: I think that looking at how your Medicaid population is employed, the more you understand about your state’s expansion population and the Medicaid population, it gives you a better idea of what to do for your citizens, what’s going to be workable. They are also going to have to figure out what’s acceptable to the federal government as verification of employment, so finding the way to meet the federal requirements without undue burden on your citizens. And then also looking at the opportunities that you have to make things better and easier. I know that the one, we noticed some significant differences in mental health in one of the analyses. And our belief is that that’s because that sector of the country, the States have taken the time to really find training and community service programs for the mental health population specifically, or that were actually easily accessed by the mental health population. So maybe they weren’t directed at them, and yet the mental health population has benefited tremendously by those, and so is more engaged than they are in other areas, and thus less at risk. So I think really just understanding your population and doing your best for them while you’re also trying to manage your budget.
Amy Hinojosa: And so truly those public-private partnerships are going to be critical moving forward to make sure that folks aren’t getting left behind. So the report focuses quite a bit on mental health, diabetes and cardiovascular diseases and really puts into stark detail how HR1 is going to impact the folks with these diseases in particular. Are there other chronic conditions that you think may also be significantly impacted by HR1? And then is there data missing? Is there information that you need that’s not available yet in order to confirm that?
Michael Murphy: Yeah, we looked at those conditions, well, one, because they are among the most common in the Medicaid population and also because they were readily identifiable in our data. Other conditions that would probably be of high interest in this population, I can think of chronic kidney disease, asthma and COPD. But the truth is these cuts are going to impact everyone from the healthy to the sick. We know that with these populations of interest, the ones we looked at in our report, we also know that a very large proportion of them are treated by prescription drugs. So like we talked about, you lose your coverage there. Drugs, you know, can be expensive, but a lot of times for these conditions, the drugs are fairly cheap, especially compared to an ER visit or a hospital stay. And so that was why the report focused on those conditions. But the fact is these cuts are going to impact everyone who is enrolled in Medicaid. Could impact anyone enrolled in Medicaid.
Amy Hinojosa: Right. So for advocacy groups, as well as policymakers, what are the most critical recommendations from the report that should be addressed immediately to sort of try to get in front of all of these potential negative impacts?
Tracy Barone-Almond: I mean, I think it’s time to educate and engage everywhere you can. You can’t skip providers. You can’t skip professional associations. You can’t skip any legislative caucus that has anything to do with the budget or healthcare. You have to make sure patients understand, which is again, so difficult to really get patients to stop and understand that, yes, you only got into Medicaid a year ago, and yes, you just did a re-verification, but now you have to do them every six months and what that entails.
I don’t think there’s an easy way around this for the next couple of years, except to educate and engage because it will take, I think, at least two years for any of this to be significantly changed and for us to all understand what’s now on the back burner, what’s never going to be implemented, and what’s still going forward. And then I think that the last thing to remember is that states can make changes as well, because as we discussed, states have implemented work requirements and reporting on their own. So if the reporting of the work records goes away from the Medicaid expansion population, that doesn’t mean your state won’t implement it again on its own. And in the past, the initial Trump administration approved those work requirements and reporting requirements, whereas the Biden administration did not. So even if the feds change things, the states could come back and punch back.
Amy Hinojosa: And, and in thinking about that, you said the really full two years before we start to feel the brunt of all of the worst impacts. Are there any estimates on how soon some folks could start feeling these changes?
Tracy Barone-Almond: I think the patient’s real feel will probably be beginning of ’27. But again, if you don’t get to the state legislators now and get them to enact something reasonable and to consider how they’re going to fund any losses that they’re going to see, you need to be spending ’26 educating them so that maybe there’s less impact on those patients in ’27.
Amy Hinojosa: Right. So HR1 also includes changes to provider taxes and other financing mechanisms. And we went through the chart of how that’s going to impact different parts of the country. So how are these changes also going to affect the health care providers, particularly rural hospitals and community health centers that rely heavily on these Medicaid reimbursements?
Tracy Barone-Almond: I think that looking at the change in reimbursement from 100% to 110%, that’s a significant change in inpatient facility and nursing facility reimbursements. That’s a significant change, pretty much regardless of the type of hospital you’re trying to operate, right? This is how rural hospitals are going to fare without a vibrant Medicaid program because there’s a significant number of enrollees who are in rural areas where this is their sole source of income and a large percentage of the patient population. Provider taxes are always one of those things where it’s always been considered a loophole, but it was a loophole that everybody recognized and knew was being used.
And what happens is the providers pay the tax, but they get a better Medicaid reimbursement from the state because they pay the tax. If you’re a Medicaid provider who is now paying less of a tax, how much are you willing to let your Medicaid reimbursement be cut before you have to say, I can’t take any more than, pick a percentage, 25% of my patient population being Medicaid or 20%. And then that starts the spiral of where do the Medicaid patients go? The Medicaid provider tax went away, Medicaid reimbursements to providers are now lower, providers are limiting their Medicaid population, and now you have people who have Medicaid, but they can’t find a provider. That’s not a solution. And so there’s a very good chance that if this continues and the provider tax limitation goes into effect, that there will be a spiral of how do you get your Medicaid patients to a provider?
Amy Hinojosa: Thank you. And we’re getting close to the end here, but I would love before we close to have Tracy, both you and Mike give us any final thoughts, any big takeaways that you just want to make sure folks on the line are keeping in mind as they move forward with their own efforts.
Michael Murphy: Sure. To me, the big takeaway is seeing that the large number of Medicaid enrollees that were going to be impacted that have these conditions, I keep coming back to the, what do you want to pay to keep these people treated and on their drugs and healthy, not just healthy, but what does that do to your ability to work and be productive? Compared to losing your coverage, getting off your medication, ending up in the hospital. And so that’s, I think that that really sort of drives home. It’s not just, there’s a budget cut and people are impacted. You can really like conceptually see how it flows from budget cut to real health impact on individuals.
Tracy Barone-Almond: I think that’s 100% true. And my thoughts actually pick up on that pretty nicely because every elected official should care what that pass-through looks like and how much you’re paying for things that could be prevented and how much is urgent care versus chronic care. And yet state legislators are closer to it, right? And so for every Josh Hawley who says, I know my Medicaid recipients are going to be hurt by this and I’m going to fix it before it hurts them.
There are people who are closer at the state level who really should care much more and never let something like this pass that would hurt their recipients. So I say focus on the states, recognize the states have a lot of control over the Medicaid program, the Medicaid enrollment, now these new processes, and how they adjust to the budget cuts. So spend your time in the States. Don’t forget about the feds, but the States are the place where you could really save your patients a lot of pain and suffering, literally.
Amy Hinojosa: Well, thank you both so much for the work you did on this report. Thank you for taking the time to have the conversation with us. And on behalf of all of our colleagues at the Health Equity Collaborative, I just wanna say thank you to Michael Murphy, Tracy Barone-Almond. Thank you to everyone who was on the webinar with us today. We will be sending out copies of the report and the recording of this session will be available. Please share this with your networks.
Advocates, we have a lot of work to do and we hope that this work is able to jumpstart the work that you’re doing and give you some of the background and information that you need to take to your federal advocacy, to your state advocacy, and really in service to helping the most patients that we can across the country. So again, thank you all for your time and we look forward to the work ahead. Have a great day.