If Congress cuts Medicaid, ending homelessness gets much harder

UPDATE: Since this was posted, the Senate announced it would delay a vote until after the July 4th recess. While this delay is an important victory, it does not mean it had been defeated. Now is still the time to take action to fight these cuts!

The Senate is barreling toward a reported goal to vote on their newly released Better Care Reconciliation Act (BCRA) before July 4th, and advocates are scrambling to understand what’s in the bill. In order to give advocates the best chance to fight for a better bill, the Alliance wants to clarify what is in the current version of the bill, highlight potential changes that could come up this week, and underscore what impact proposed changes to the health care system might have on communities’ efforts to end homelessness.

First, what do we know?

A draft of the BCRA was released last week, and yesterday, June 26, the CBO released a “score” evaluating the potential impacts of the legislation on the health care system. CBO is a non-partisan agency that analyzes the economic effects of proposed legislation for Congress. Here are a few topline items from their report, or score, on the bill:

  • The headline you will have seen: 22 million more people will be uninsured under the BCRA than under current law (ACA)
  • The number that matters most for ending homelessness: 15 million people will lose Medicaid coverage
  • The BCRA cuts Medicaid spending by more than $770 billion in 10 years, and restricts the growth of the program even more steeply after that period

What happens next?

With Democrats expected to stand together against any proposed repeal efforts, and only a slim 52-48 majority for Republicans in the Senate, this means that Republicans can only afford to lose two votes in their own party. Since the report was made public, a handful of Senators have expressed displeasure with the bill. A few Senators on the right are firm in the belief that the bill doesn’t go far enough to repeal the ACA, while more moderate Senators are concerned over the cuts to Medicaid and the bill’s impacts on premiums and out of pocket costs.

The Senate has scheduled a vote on the bill for this Thursday, but in order to vote, they must first approve a “motion to proceed”.  A number of Senators have publicly stated that they are not willing to vote on this motion with the bill in its current form. Amendments might be necessary to get the bill to the Senate floor for a vote. While these amendments may include relatively small amounts of funding for specific populations, they are unlikely to make any significant impact when paired with massive cuts to Medicaid.

What does this mean for the fight against homelessness?

Access to Medicaid has been a powerful tool for local communities combating chronic homelessness. Any cuts to Medicaid, regardless of the type, or the time period over which they occur, will greatly reduce crucial resources that are used to pay for services for people with disabilities or recovering from substance abuse disorders. For people living in extreme poverty, particularly individuals and families who experience homelessness, Medicaid is essential for securing and maintaining adequate health coverage. The nearly $800 billion in cuts that are included in the final BCRA will mean that fewer people will get the healthcare they need to maintain housing stability, more people will cycle through emergency or homeless systems when they experience a health crisis, and communities across the country will be left footing the bill.

While the bill has finally been made public, the race to pass it without debate or mark-up is unprecedented. With so much at stake for our country’s most vulnerable citizens, and a framework that will be devastating for communities battling homelessness, this decision can’t be made without careful, informed consideration and public input.

What can you do about it?

Reporting still indicates that the Senate is trying to vote on the BCRA this week. That means the next few days are the most important for you to raise your voice. With only three Senators needed to reject a bill that hurts every community, your input will be crucial. The Alliance has an easy guide to calling your Senators, to make sure our voices are heard. We need as many advocates as we can get to tell the Senate they need to:

  • Vote NO on any healthcare bill that cuts or caps Medicaid, or phases out the Medicaid expansion.
  • Commit to protecting coverage for people exiting homelessness, including services for people with severe health or mental health conditions, and those recovering from substance abuse disorders.
  • Commit to holding a public hearing on a final bill, to ensure we know how it will impact the most vulnerable in our community before a vote.