Melissa Stearns keeps the heat very low and keeps the lights off and shuts down the TV right away whenever she leaves her living room. That's part of life on a tight budget.
"I'm so frugal when it comes to lights," explained Stearns, 38, a single mom who earns $32,000 as a part-time a church youth director and lives paycheck to paycheck. Because of her income and kids, she's on MinnesotaCare, a heavily subsidized insurance program with modest out of pocket costs.
Her kids are among the roughly 1 million low-income and disabled Minnesotans enrolled in Medicaid who otherwise might not have access to affordable health care.
Stearns, though, fears that may soon come to an end. The U.S. House of Representatives is set to vote Thursday on the Republicans' controversial replacement for the Affordable Care Act. The legislation would drastically cut federal funding for Medicaid. She and others who depend on Medicaid are concerned they'll lose the health insurance critical to them and their families if the measure becomes law.
"I'm really worried about it," Stearns said as her kids played nearby. "I mean, I don't like to think of myself as not having insurance but I can deal with it. But my children shouldn't have to deal with it. My friends that have chronically ill children shouldn't have to be stressed out ... It's a really scary thought."
It's not entirely clear what would happen to her family's health coverage if the current GOP plan becomes law. But the Congressional Budget Office says federal funding for Medicaid would drop by $880 billion over a decade. Minnesota officials are warning of a chasm in state finances.
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The legislation would strip billions of dollars from Minnesota, said Minnesota Department of Human Services Commissioner Emily Piper. "By 2021, within the first 18 months of implementation, the state would have reduced funding by about $2.5 billion and that grows over time," she said.
Federal funding for people covered under the Medicaid expansion would shrink over time, she added, and the formula limiting each state's share of federal funding wouldn't keep up with medical inflation. Costs would grow faster than federal dollars. The formula also puts Minnesota at a disadvantage to other states, she said, since it's based on past spending, and Minnesota has been a leader in cutting Medicaid costs.
Combine all the cuts and Minnesota would lose $5.5 billion federal Medicaid dollars over a decade, money that would be extremely difficult for the state to replace, she said. "States all across the country are going really grapple with these really hard decisions about cutting benefits, cutting access, cutting care."
The GOP bill upends longstanding Medicaid policy. States and the feds share the financial load of paying for Medicaid coverage. There's no limit on how much money the federal government will shell out. But the GOP bill would impose a limit. The legislation would eventually do away with the expansion of Medicaid which provided coverage for single adults, and would eliminate MinnesotaCare, which covers Melissa Stearns.
The bill's backers argue that the Obamacare provision expanding Medicaid coverage was too costly.
"You know when President Obama expanded Medicaid, the federal government offered 90 percent of the cost to those states that would enroll able-bodied adults, many of them without children," Minnesota GOP U.S. House Rep. Jason Lewis said last week in a video emailed to constituents. "Our plan says in order to preserve Medicaid for the truly vulnerable — kids, [the] elderly, [the] disabled — we've got to reform this."
Piper said elderly and disabled Medicaid recipients are most vulnerable to Medicaid funding cuts. They account for 60 percent of spending even though they're only 20 percent Minnesota's Medicaid population. House Republicans recently amended their bill setting aside more money for elderly and disabled people on Medicaid. Medicaid pays for 40 percent of the cost of long-term care in the U.S.
If cuts must be made to long-term care for the elderly, Minnesotans who are not old will likely be picking up the tab, Piper warned.
"Many people in nursing homes, aging parents in nursing homes, those nursing home bills are being paid for by Medicaid," she said. "Without Medicaid paying that, it's going to be a burden that falls on families across the state to provide care and funding and resources for those aging parents."
Reducing health insurance benefits or taking them away from Medicaid recipients would likely lead to more uncompensated care at emergency rooms and hospitals, she added, costs that would be passed along to everyone else.
"They're playing with people's lives," said 63-year-old Jan Hayne, who lives just north of Stillwater and is enrolled in Medicaid.
She volunteers at a hospital and for an organization that promotes the importance of dads in kids' lives. She said she finds the debate about cutting Medicaid disturbing.
Hayne said her only income comes from Social Security, about $1,300 a month, and she's worried the state may have no choice but to pass on Medicaid cuts to people like her. "I could have more out-of-pocket costs. My co-pays could increase."
Another provision of the House bill could require Hayne to find a job. It gives states the option to impose work or job training requirements for able-bodied Medicaid recipients.
Piper noted that many people covered through Medicaid already work if they're able and tracking a recipient's work status would be an administrative burden.
But as alarmed as she is about the prospect of Minnesota losing billions of dollars in federal Medicaid money, Piper cautions the debate is far from over. "It has a long path before it passes at the federal level and then also how the state chooses to respond."