Before I launch into the really dry stuff, I want to introduce you to Josh.

Josh is my partner, life mate, equally medically complex better half, bff, confidante or whatever it is you want to call two people who are committed to one another but not married. Josh was paralyzed in a car accident when he was 17. Because of his level of injury, he is paralyzed from the chest down and has limited arm and hand movement, which means that he needs assistance to transfer in and out of bed as well as with bathing and dressing. This, in turn, means that he requires in home health care every day, twice a day. Because this kind of long term care product is not sold by any private insurance company anywhere in the United States, he is one of Colorado’s 1.33 million Medicaid clients. His life literally, and my life figuratively, depends on Medicaid. Our family’s ability to stay together is solely dependent on Medicaid offering long term supports and services in a home setting and not a nursing home. A large portion of Colorado’s Medicaid budget is spent providing long term care for people with disabilities and the elderly. These services help people age in place and help keep people like Josh out of nursing homes.

He is one of thousands of Coloradans whose freedom and ability to live in the community (and with me, together as a family) depends on a strong Medicaid program. Some of the proposals that have been put forth by Congress would fundamentally remake, and ultimately weaken, the Medicaid program, which would put hundreds of thousands of people’s care in jeopardy including Josh. As hard as it was to watch my family sacrifice for the medical care that I needed while growing up, it is even harder to live with the idea that Josh’s ability to get out of bed every morning and live the kind of life he wants to live is dependent on the decisions that Congress and the incoming administration will make about Medicaid.   

Most people traditionally think of Medicaid, or Health First Colorado as its known in our state, as a health insurance program for people who don’t make enough money to cover the cost of their own insurance and medical care. And this is true, but it’s also so much more.

Medicaid not only covers health care for those living in poverty, but it also provide care and in home services and supports for people with disabilities and seniors.

One thing that is not well known about Medicare is that the program doesn’t cover long term care, so those seniors in need of long term care often receive it through Medicaid if they meet the proper eligibility requirements. Medicaid also provides hundreds of thousands of Coloradans with health care that they would not otherwise be able to afford. Medicaid existed before the ACA (it’s been around since 1965), but the ACA (after a court battle) allowed states to expand Medicaid and have the federal government

pick up the tab to cover most of the people who were newly eligible. These newly eligible people are often called “the expansion population.” Colorado chose to expand Medicaid, and for the first time, many adults without dependents were eligible for the program. Health First Colorado currently covers more than 1.3 million people with 466,000 of those covered by the Medicaid expansion.

While not all of Medicaid was directly affected by the ACA, many of the potential plans to repeal the ACA that are happening in Congress right now also include Medicaid. Many would like to repeal the funding for the Medicaid expansion. While that alone wouldn’t force states to end the expansion, no federal funding would make it impossible for Colorado to pay for this newly eligible population, which would likely mean that cuts to the program would have to be made.

In addition to a potential repeal of the expansion, members of Congress have also been talking about block granting Medicaid as a whole. There are few details available right now, but historically, block granting has meant that states get a set amount of money to cover a certain program. The single block grant that Colorado would get to run Medicaid under this scenario would also likely mean cuts to the program as a whole, not just the expansion portion of the program.

Block granting would be particularly devastating in a state like Colorado that has the constraints of the Tax Payers Bill of Rights (TABOR) and very limited options for raising revenue at the state level.

Because long term care, which can be expensive, is such an important and integral part of the services Medicaid provides, Colorado would likely have to make some very, very difficult decisions if Medicaid were block granted.

And it’s not only those individuals and families who are Medicaid clients that would suffer. Medicaid is a huge economic driver in Colorado and helps hospitals, providers, home health care workers and medical equipment companies (just to name a few) stay in business and provide steady sources of income for many of Colorado’s workers. A recent study by the Colorado Health Foundation found that the expansion alone added 31,074 jobs in FY 2015-2016 and is projected to add a total of 43,108 jobs by FY 2034-2035. The same analysis also found that the average household income was $643 higher in FY 2015-2016 because of the expansion. Our thriving state economy depends on a strong health system with a robust Medicaid program that provides services that are not always available in the private market.

Last week I told you that we couldn’t save the gains we‘ve made in our health care system in the last six and a half years without your help. So today I’m asking you to call Senator Gardner and Senator Bennet and tell them that you oppose attempts to block grant Medicaid and repeal the Medicaid expansion. All of our health and Colorado’s economy depends on having a robust health system, so please consider making the call today.

If you’ve made the call and still want to take action, please consider sharing your story with us! And stay tuned for my next blog where I’ll be talking about the process Congress will use to repeal and replace the ACA and potentially make changes to Medicaid.